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[开胸手术时伴有胸腔积液的肺癌研究——相对少量胸腔积液的细胞学评估及切除后的预后]

[A study of lung cancer with presence of pleural effusion at the time of thoracotomy--cytologic evaluation of a relatively small amount of pleural effusion and prognosis after removal].

作者信息

Usuda K, Saito Y, Ota S, Sato M, Takahashi S, Kanma K, Sagawa M, Nagamoto N, Fujimura S, Nakada T

机构信息

Department of Surgery, Tohoku University, Sendai, Japan.

出版信息

Nihon Kyobu Geka Gakkai Zasshi. 1990 Jan;38(1):30-6.

PMID:2329302
Abstract

The cytologic evaluation of a relatively small amount of pleural effusion in lung cancer at the time of thoracotomy has not been previously considered, and prognosis after removal has not been clarified. In order to clarify these points, 99 cases of removed lung cancer with presence of pleural effusion at the time of thoracotomy were examined following cytology. Our study was conducted with regard to the amount and nature of pleural effusion, pleural effusion cytology, tumor development and its relation to prognosis. On the basis of this study a formula was developed relating the occurrence rate of cytologically positive pleural effusion with the development of tumor employing multivariate analysis, specifically the multiple regression analysis. 21% of these cases showed cytologically positive pleural effusion, indicating an absence of its correlation to the amount of pleural effusion; the conducting of cytology regardless of the amount of pleural effusion was found to be significant in determining the precise stage. The occurrence rate of cytologically positive squamous cell carcinoma was significantly few compared with those in other cell types. Regarding the pleural effusion of a relatively small amount, the prognosis after removal showed a relatively high three-year survival rate of 32% for those cases with negative pleural metastasis despite the positive showing of pleural effusion cytology, indicating the viability of surgery. From the occurrence rate of cytologically positive pleural effusion (Y) and the degree of pleural metastasis (X1)/the degree of pleural invasion (X2)/the degree of lymph nodes metastasis (X3), the following formula was obtained employing multiple regression analysis: Y = 0.344X1 + 0.050X2 + 0.034X3 + 0.075 (proportion 0.840).(ABSTRACT TRUNCATED AT 250 WORDS)

摘要

开胸手术时对肺癌患者相对少量胸腔积液进行细胞学评估此前未被考虑过,且切除后的预后也未明确。为阐明这些问题,对99例开胸手术时有胸腔积液的肺癌切除病例进行了细胞学检查。我们的研究涉及胸腔积液的量和性质、胸腔积液细胞学、肿瘤发展及其与预后的关系。基于这项研究,运用多变量分析,特别是多元回归分析,得出了一个将细胞学阳性胸腔积液发生率与肿瘤发展相关联的公式。这些病例中有21%显示细胞学阳性胸腔积液,表明其与胸腔积液量无关;发现无论胸腔积液量多少进行细胞学检查对于确定准确分期都很重要。与其他细胞类型相比,细胞学阳性鳞状细胞癌的发生率显著较低。对于相对少量的胸腔积液,尽管胸腔积液细胞学检查呈阳性,但胸腔转移阴性的病例切除后的预后显示三年生存率相对较高,为32%,表明手术的可行性。根据细胞学阳性胸腔积液发生率(Y)和胸膜转移程度(X1)/胸膜侵犯程度(X2)/淋巴结转移程度(X3),运用多元回归分析得出以下公式:Y = 0.344X1 + 0.050X2 + 0.034X3 + 0.075(比例0.840)。(摘要截短至250字)

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