Okada Morihito, Sakamoto Toshihiko, Nishio Wataru, Uchino Kazuya, Tsuboshima Kenji, Tsubota Noriaki
Department of Thoracic Surgery, Hyogo Medical Center for Adults, Akashi City, Hyogo, Japan.
J Thorac Cardiovasc Surg. 2003 Dec;126(6):1911-5. doi: 10.1016/s0022-5223(03)00715-3.
Intraoperative pleural lavage cytology for lung cancer has not been widely accepted. The prognostic significance of this procedure has yet to be intensively analyzed because the reports published thus far have involved small patient populations. We therefore performed a large prospective trial of pleural lavage cytology to elucidate its importance.
Cytologic status of pleural lavage fluid before any manipulation of the lung was examined in 1000 consecutive patients with non-small cell lung cancer but no pleural effusion who underwent tumor resection.
Forty-five (4.5%) of 1000 patients had positive cytologic findings. Positive cytologic findings were observed more frequently in patients with adenocarcinoma, advanced stage, higher involvement of lymph nodes, pleural involvement of the tumor, lymphatic permeation, vascular invasion, high level of serum carcinoembryonic antigen, and male sex. The survival rate for 5 years was 28% in patients with positive findings and 67% in patients with negative findings (P <.0001). Among 587 patients with stage I disease, 13 (2.2%) had positive findings, and their 5-year survival was 43%, which was significantly poor compared with that of patients with negative findings (81%, P =.0009). Multivariable analysis demonstrated that pleural lavage cytology was an independent prognostic determinant (P =.0290). Regarding the recurrence pattern in patients with positive findings, distant metastases (19/45 [42.2%]) were observed more frequently rather than local recurrences (19/45 [22.2%]).
Cytologic status of pleural lavage fluid immediately after thoracotomy, an independent significant prognostic factor, constitutes valuable information to detect patients at a high risk of recurrence. Therefore cytology should be performed at the time of curative resection for non-small cell lung cancer.
肺癌术中胸膜腔灌洗细胞学检查尚未被广泛接受。由于迄今为止发表的报告所涉及的患者群体较小，该检查的预后意义尚未得到深入分析。因此，我们进行了一项关于胸膜腔灌洗细胞学检查的大型前瞻性试验，以阐明其重要性。
对1000例连续的非小细胞肺癌且无胸腔积液并接受肿瘤切除术的患者，在对肺进行任何操作之前检查胸膜腔灌洗液的细胞学状况。
1000例患者中有45例（4.5%）细胞学检查结果为阳性。腺癌、晚期、淋巴结受累程度较高、肿瘤侵犯胸膜、淋巴渗透、血管侵犯、血清癌胚抗原水平高及男性患者的细胞学检查阳性结果更为常见。检查结果阳性的患者5年生存率为28%，检查结果阴性的患者为67%（P<0.0001）。在587例I期疾病患者中，13例（2.2%）检查结果为阳性，其5年生存率为43%，与检查结果阴性的患者（81%，P=0.0009）相比显著较差。多变量分析表明，胸膜腔灌洗细胞学检查是一个独立的预后决定因素（P=0.0290）。关于检查结果阳性患者的复发模式，远处转移（19/45[42.2%]）比局部复发（19/45[22.2%]）更常见。
开胸术后即刻胸膜腔灌洗液的细胞学状况是一个独立的重要预后因素，为检测复发高危患者提供了有价值的信息。因此，在非小细胞肺癌根治性切除时应进行细胞学检查。
