Sienel Wulf, Seen-Hibler Rita, Mutschler Wolf, Pantel Klaus, Passlick Bernward
Department of Surgery, Chirurgische Klinik und Poliklinik-Innenstadt, University of Munich, 80336 Munich, Germany.
Eur J Cardiothorac Surg. 2003 Apr;23(4):451-6. doi: 10.1016/s1010-7940(02)00865-5.
This prospective study was performed to examine whether tumour cells are detectable in the tumour draining vein of patients with non-small cell lung cancer. Furthermore, the impact of these cells on the clinical course was analysed.
Sixty-two consecutive patients with completely resected primary non-small cell lung cancer (pT1-4 pN0-2 M0) were admitted to the study. Pulmonary venous blood was drawn at the time of surgery for primary non-small cell lung cancer. The tumour draining vein was punctured subsequent to thoracotomy prior to manipulation of the tumour. The blood samples were examined for occult tumour cells by immunocytochemical staining of cytospins using the pancytokeratin antibody A45-B/B3 (murine immunoglobulin G1; Micromet, Munich, Germany).
Disseminated cancer cells in pulmonary venous blood were observed in 11 of 62 patients (18%) and did not correlate with standard clinico-pathological parameters. In patients without involvement of mediastinal lymph nodes (pN0-pN1), detection of occult tumour cells was an independent prognostic parameter for unfavourable outcome: log rank analysis showed a significant association of occult tumour cells in pulmonary venous blood with shortened cancer-related survival (P=0.019) and multivariate regression analysis demonstrated an independently significant (P=0.004) prognostic impact.
The present study shows that disseminated cancer cells in the pulmonary venous blood are detectable in about 20% of the patients with operable non-small cell lung cancer and that they are associated with a poor clinical outcome. Therefore, the detection of such cells might be useful for the identification of patients who benefit from adjuvant therapy. Furthermore, in order to avoid an additional systemic spread of tumour cells intraoperatively, the pulmonary veins should be ligated first during lung cancer surgery.
本前瞻性研究旨在检测非小细胞肺癌患者的肿瘤引流静脉中是否可检测到肿瘤细胞。此外，还分析了这些细胞对临床病程的影响。
连续纳入62例原发性非小细胞肺癌完全切除患者（pT1-4 pN0-2 M0）。在原发性非小细胞肺癌手术时采集肺静脉血。开胸后在处理肿瘤之前穿刺肿瘤引流静脉。使用全细胞角蛋白抗体A45-B/B3（鼠免疫球蛋白G1；德国慕尼黑Micromet公司）对血样本的细胞涂片进行免疫细胞化学染色，以检测隐匿性肿瘤细胞。
62例患者中有11例（18%）在肺静脉血中观察到播散癌细胞，且与标准临床病理参数无关。在无纵隔淋巴结受累（pN0-pN1）的患者中，隐匿性肿瘤细胞的检测是不良预后的独立预测参数：对数秩分析显示肺静脉血中的隐匿性肿瘤细胞与缩短的癌症相关生存期显著相关（P = 0.019），多因素回归分析显示具有独立显著的（P = 0.004）预后影响。
本研究表明，约20%可手术的非小细胞肺癌患者肺静脉血中可检测到播散癌细胞，且与不良临床结局相关。因此，检测此类细胞可能有助于识别可从辅助治疗中获益的患者。此外，为避免术中肿瘤细胞的额外全身播散，肺癌手术中应首先结扎肺静脉。
