Nakao Masayuki, Hoshi Rira, Ishikawa Yuichi, Matsuura Yosuke, Uehara Hirofumi, Mun Mingyon, Nakagawa Ken, Okumura Sakae
Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
Department of Cytology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan.
Interact Cardiovasc Thorac Surg. 2015 Jun;20(6):777-82. doi: 10.1093/icvts/ivv047. Epub 2015 Mar 11.
Positive pleural lavage cytology (PLC) is considered as a precursor condition of pleural dissemination (PD) or malignant pleural effusion (PE), and one of the poor prognostic factors in surgically resected non-small-cell lung cancer (NSCLC) patients. Although PD and PE are classified as M1a, PLC does not contribute to the tumour, node and metastasis (TNM) classification of the Union Internationale Contre le Cancer. This study aimed to evaluate the prognostic effect of positive PLC status in surgically resected NSCLC patients compared with PD and/or PE. We also aimed to consider the contribution of positive PLC status to the TNM classification.
We reviewed 1572 consecutive patients with completely resected NSCLC, and analysed the relationship between PLC status, other clinicopathological factors and prognosis. The survival rates of 45 patients with PD and/or PE were also investigated.
Positive preresection PLC (pre-PLC) status was observed in 56 patients. Pre-PLC status was significantly associated with other clinicopathological factors. Positive pre-PLC patients exhibited a worse 5-year overall survival (50.6%) compared with negative pre-PLC patients (78.0%), but better survival than PD and/or PE patients (21.0%). Prognosis of positive pre-PLC patients was equal to that of pT3, negative pre-PLC patients; survival equality was observed when patients were stratified according to pN0, pN1 and pN2.
Positive pre-PLC had the significant prognostic effect in surgically resected NSCLC patients. However, it is not a contraindication for surgical resection, unlike PD and/or PE. Our data suggest that positive pre-PLC should be classified as pT3 in next TNM classification.
阳性胸腔灌洗细胞学检查（PLC）被认为是胸膜播散（PD）或恶性胸腔积液（PE）的前驱状态，也是手术切除的非小细胞肺癌（NSCLC）患者预后不良的因素之一。尽管PD和PE被归类为M1a，但PLC并不影响国际抗癌联盟的肿瘤、淋巴结和转移（TNM）分类。本研究旨在评估手术切除的NSCLC患者中阳性PLC状态与PD和/或PE相比的预后影响。我们还旨在考虑阳性PLC状态对TNM分类的贡献。
我们回顾了1572例连续的完全切除的NSCLC患者，并分析了PLC状态、其他临床病理因素与预后之间的关系。还调查了45例PD和/或PE患者的生存率。
56例患者术前PLC（pre-PLC）状态为阳性。Pre-PLC状态与其他临床病理因素显著相关。与pre-PLC阴性患者（78.0%）相比，pre-PLC阳性患者的5年总生存率较差（50.6%），但比PD和/或PE患者（21.0%）的生存率要好。Pre-PLC阳性患者的预后与pT3、pre-PLC阴性患者相同；根据pN0、pN1和pN2分层时，生存率相同。
术前PLC阳性对手术切除的NSCLC患者有显著的预后影响。然而，与PD和/或PE不同，它不是手术切除的禁忌症。我们的数据表明，在下次TNM分类中，术前PLC阳性应归类为pT3。
