Dorry Michael, Davidson Kevin, Dash Rajesh, Jug Rachel, Clarke Jeffrey M, Nixon Andrew B, Mahmood Kamran
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University, Durham, NC, USA.
Department of Medicine, WakeMed Hospital, Raleigh, NC, USA.
Transl Lung Cancer Res. 2021 Jun;10(6):2500-2508. doi: 10.21037/tlcr-21-123.
Malignant pleural effusion (MPE) portends a poor prognosis in non-small cell lung cancer (NSCLC). However, the yield of pleural fluid cytology as well as survival of patients with MPE associated with squamous cell carcinoma versus adenocarcinoma is not well understood. We conducted this study to assess the diagnostic yield of pleural cytology and survival of patients with NSCLC related MPE.
We performed a single-center, retrospective analysis of patients with NSCLC related MPE between 2010 and 2017. Kaplan-Meier method was used to compare survival and Cox proportional hazards analysis to assess if squamous cell cytopathology was associated with mortality.
We identified 277 patients, 29 with squamous cell and 248 with adenocarcinoma MPE. Pleural fluid cytology from initial thoracentesis was diagnostic in 13.8% (4/29) patients with squamous cell and 80.2% (199/248) with adenocarcinoma (P<0.001). Cytology from second thoracentesis was diagnostic in 13.3% (2/15) patients with squamous cell carcinoma, compared to 37.5% (12/32) with adenocarcinoma (P=0.17). There was no statistically significant difference in the pleural biopsy yield from medical pleuroscopy or video-assisted thoracoscopic surgery (VATS) in the two groups. The median survival of patients with squamous cell MPE was 112 [interquartile range (IQR): 44-220] days versus 194 (IQR: 54-523) days in adenocarcinoma (Log-rank test P=0.04). Multivariate Cox proportional hazards analysis showed that squamous cell cytopathology was independent predictor of mortality (hazard ratio for death of 1.73, 95% CI: 1.1-2.6; P=0.01).
Pleural fluid cytology has a low diagnostic yield in squamous cell carcinoma MPE, and these patients have a poor survival compared to lung adenocarcinoma.
恶性胸腔积液（MPE）预示着非小细胞肺癌（NSCLC）患者预后不良。然而，与鳞状细胞癌和腺癌相关的MPE患者的胸腔积液细胞学诊断率以及生存率尚不清楚。我们开展这项研究以评估NSCLC相关MPE患者的胸腔细胞学诊断率和生存率。
我们对2010年至2017年间NSCLC相关MPE患者进行了单中心回顾性分析。采用Kaplan-Meier法比较生存率，并采用Cox比例风险分析评估鳞状细胞细胞学是否与死亡率相关。
我们共纳入277例患者，其中29例为鳞状细胞MPE，248例为腺癌MPE。初次胸腔穿刺的胸腔积液细胞学检查对13.8%（4/29）的鳞状细胞癌患者和80.2%（199/248）的腺癌患者具有诊断价值（P<0.001）。二次胸腔穿刺的细胞学检查对13.3%（2/15）的鳞状细胞癌患者具有诊断价值，而腺癌患者为37.5%（12/32）（P=0.17）。两组经内科胸腔镜或电视辅助胸腔镜手术（VATS）进行的胸膜活检诊断率无统计学差异。鳞状细胞MPE患者的中位生存期为112天[四分位数间距（IQR）：44-220天]，腺癌患者为194天（IQR：54-523天）（对数秩检验P=0.04）。多因素Cox比例风险分析显示，鳞状细胞细胞学是死亡率的独立预测因素（死亡风险比为1.73，95%CI：1.1-2.6；P=0.01）。
胸腔积液细胞学对鳞状细胞癌MPE的诊断率较低，与肺腺癌患者相比，这些患者的生存率较差。
