Nakagawa Tatsuo, Okumura Norihito, Kokado Yujiro, Miyoshi Kentaroh, Matsuoka Tomoaki, Kameyama Kotaro
Department of Thoracic Surgery, Kurashiki Central Hospital, Okayama, Japan.
Ann Thorac Surg. 2007 Jan;83(1):204-8. doi: 10.1016/j.athoracsur.2006.07.035.
Intraoperative pleural lavage cytology for patients with lung cancer has been reported to be useful in detecting subclinical pleural dissemination. However, this procedure is not necessary for the staging of lung cancer in the current TNM staging system.
Clinical records of 1025 patients with non-small cell lung cancer who underwent surgery were retrospectively reviewed and evaluated for the clinical relevance of intraoperative pleural lavage cytology.
Specimens of 37 patients (3.6%) were positive for pleural lavage cytology (PLC). Patients were categorized into three groups: positive PLC group, 27 patients with positive PLC without malignant pleural effusion or pleural dissemination; pleural dissemination (PD) group, 21 patients with malignant pleural effusion or PD; negative PLC group, 977 patients with negative PLC or negative PLC without PD. The positive PLC group had a significantly higher ratio of adenocarcinomas than the negative PLC group (p = 0.014). There was a significant difference in distribution of pleural factors between the positive and negative PLC groups (p < 0.001). Survival in the positive PLC group was significantly worse than in the negative PLC group (p = 0.007), especially in pathologic stage I (p = 0.001), but significantly better than in the PD group (p = 0.038). PLC status was found to be a significant independent prognostic factor in the multivariate analysis (p = 0.016).
The present study demonstrates the clinical relevance of intraoperative PLC in early stage non-small cell lung cancer. The result of intraoperative PLC should be involved in the staging system of lung cancer.
据报道，肺癌患者术中胸膜冲洗细胞学检查有助于检测亚临床胸膜播散。然而，在当前的TNM分期系统中，该检查对于肺癌分期并非必需。
回顾性分析1025例行手术治疗的非小细胞肺癌患者的临床记录，评估术中胸膜冲洗细胞学检查的临床相关性。
37例患者（3.6%）的胸膜冲洗细胞学检查（PLC）结果为阳性。患者分为三组：PLC阳性组，27例PLC阳性但无恶性胸腔积液或胸膜播散的患者；胸膜播散（PD）组，21例有恶性胸腔积液或PD的患者；PLC阴性组，977例PLC阴性或PLC阴性且无PD的患者。PLC阳性组腺癌的比例显著高于PLC阴性组（p = 0.014）。PLC阳性组和阴性组的胸膜因素分布存在显著差异（p < 0.001）。PLC阳性组的生存率显著低于PLC阴性组（p = 0.007），尤其是在病理I期（p = 0.001），但显著高于PD组（p = 0.038）。在多因素分析中，PLC状态是一个显著的独立预后因素（p = 0.016）。
本研究证明了术中PLC在早期非小细胞肺癌中的临床相关性。术中PLC结果应纳入肺癌分期系统。
