Objective To analyze the clinical features and survival of lung cancer with pleural effusions. Methods A total of 982 consecutive patients with a newly diagnosed lung cancer from January 2008 to December 2014 were retrospectively reviewed. To analyze the clinical features and survival differences, the total patients were divided into the following two groups: with (n=204) or without (n=778) pleural effusions. Results Lung cancer comprised 682 (69.5%) males and 300 (30.5%) females, with an average age of 59.74 years (19–93 years). There were 487(49.6%) squamous carcinoma, 254 (25.9%) adenocarcinoma and 166 (16.9%) small cell lung cancer; 113 (11.5%) lung cancer at early stage (Ⅰ–Ⅱ), 247 (25.2%) cases at stage Ⅲ and 567 (57.7%) at stage Ⅳ. The median survival time of all patients was 12 months. Patients with pleural effusions had a worse prognosis compared to patients without (median survival time: 11 vs.12 months, P=0.003), the median survival time could be reduced by 1 month in males (P=0.004), 3 months in elder patients over 60 years (P<0.001), 4 to 8 months in carcinoma and small cell lung cancer (P≤0.001), and 2 to 3 months in advanced lung cancer (stage Ⅲ and Ⅳ) (P<0.05). Any or combined treatment of surgery, radiotherapy, chemotherapy and targeted therapy was associated with an improved overall survival of about 2 months (P=0.009), and targeted therapy could even improve the median survival time by 1 to 8 months (P=0.002). Conclusions About 20.8% of the patients developed pleural effusion at the same time during the course of lung cancer. Pleural effusion is a poor prognostic factor of lung cancer.