Lim Eric, Ali Ayyaz, Theodorou Panagiotis, Nicholson Andrew G, Ladas George, Goldstraw Peter
Department of Thoracic Surgery, Royal Brompton Hospital, London, UK.
J Thorac Cardiovasc Surg. 2004 Apr;127(4):1113-8. doi: 10.1016/j.jtcvs.2003.10.025.
For patients undergoing lung resection for cancer, macroscopic evidence of metastasis is clearly associated with adverse prognosis. However, less is known about the significance of tumor cells detected by using tests such as pleural lavage cytology. To ascertain the frequency and quantify the effect of this finding on survival, we performed a prospective study of intraoperative pleural lavage cytology.
Pleural lavage cytology consisted of cytologic analysis of 100 mL of saline irrigated over the lung surface immediately after thoracotomy. Patients were excluded if they had an existing effusion, extreme adhesions, or lateral chest wall invasion or if resection was not performed. Survival was calculated by means of Kaplan-Meier analysis and compared by using log-rank tests. Cox regression was used to ascertain independent predictors of prognosis.
From 1995 through 2003, we performed pleural lavage cytology on 292 patients undergoing thoracotomy for lung cancer. The mean age was 64 (SD, 10) years, and 196 (67%) patients were men. Of 292 samples, 13 (4.5%) showed evidence of malignant cells. The median time to follow-up was 15 months (interquartile range, 1-40 months), with a median survival of 49 months for patients with negative pleural lavage cytology results and 13 months for patients with positive pleural lavage cytology results (P =.002). Univariate prognostic predictors were positive pleural lavage cytology status (P =.03), stage (P =.03), adenocarcinoma (P =.06), and parietal pleural involvement (P =.01). In the final multivariate model only positive pleural lavage cytology status (P =.006) and stage (P =.03) remained significant.
Intraoperative pleural lavage cytology is a simple addition to intrathoracic staging and an independent predictor of prognosis. Positive results potentially affect survival by upstaging patients to stage IIIB or greater.
对于因癌症接受肺切除术的患者，转移的宏观证据显然与不良预后相关。然而，对于通过诸如胸腔冲洗细胞学等检测方法检测到的肿瘤细胞的意义，人们了解较少。为了确定这一发现的频率并量化其对生存的影响，我们对术中胸腔冲洗细胞学进行了一项前瞻性研究。
胸腔冲洗细胞学包括在开胸术后立即对 100 mL 生理盐水冲洗肺表面进行细胞学分析。如果患者存在现有胸腔积液、严重粘连、胸壁外侧侵犯，或者未进行切除术，则将其排除。通过 Kaplan-Meier 分析计算生存率，并使用对数秩检验进行比较。采用 Cox 回归确定预后的独立预测因素。
从 1995 年到 2003 年，我们对 292 例因肺癌接受开胸手术的患者进行了胸腔冲洗细胞学检查。平均年龄为 64（标准差，10）岁，196（67%）例患者为男性。在 292 份样本中，13（4.5%）份显示有恶性细胞证据。随访的中位时间为 15 个月（四分位间距，1 - 40 个月），胸腔冲洗细胞学检查结果为阴性的患者中位生存期为 49 个月，结果为阳性的患者中位生存期为 13 个月（P = 0.002）。单因素预后预测因素为胸腔冲洗细胞学检查结果阳性（P = 0.03）、分期（P =
