Lung adenocarcinoma with malignant serous effusions: A comprehensive clinicopathologic, molecular, and outcome analysis.
Summary
This retrospective study analyzed 120 cases of lung adenocarcinoma (LUAD) with malignant serous effusions (MSE) to characterize their clinicopathologic, molecular, and prognostic features. Pleural effusions were most common, but pericardial involvement was associated with the shortest overall survival. Molecular profiling revealed TP53 mutations and actionable alterations in genes such as EGFR, KRAS, BRAF, ALK, and ROS1. NKX2-1 (TTF-1) negativity and the absence of actionable alterations were independent adverse prognostic factors, with dual NKX2-1/CD274 (PD-L1) negativity defining the poorest prognosis subgroup. Immunotherapy-based regimens and tyrosine kinase inhibitors showed varying survival benefits.
Analysis
This study is crucial because it provides a comprehensive and integrated characterization of lung adenocarcinomas with malignant serous effusions, a disease presentation often associated with a poor prognosis. By identifying key prognostic markers such as NKX2-1 negativity, absence of actionable alterations, and CD274 negativity, it enables better risk stratification and personalization of therapeutic strategies. The demonstration of differential efficacy for immunotherapies and tyrosine kinase inhibitors based on molecular and immunophenotypic profiles is directly translatable into clinical practice to optimize the management of these patients.