Hillerdal G, Dernevik L, Almgren S O, Kling P A, Gustafsson G
Department of Pulmonary Medicine, Karolinska Hospital, Stockholm, Sweden.
Lung Cancer. 1998 Jul;21(1):47-52. doi: 10.1016/s0169-5002(98)00043-9.
Despite seemingly radical surgery many patients operated on for bronchial carcinoma will die from their disease. Some patients might benefit from postoperative treatment and a prognostic factor that could identify those with an increased risk for tumor relapse would be of great clinical importance. One possible such factor is the occurrence of malignant cells in pleural lavage performed at operation. To test this hypothesis 224 consecutive patients who had been operated on due to verified or strongly suspected bronchial carcinoma, preoperatively staged as stage I or II, were investigated. After opening the thorax and before manipulation or palpation of the lungs, 300 ml of physiological saline solution was installed into the pleura. After excluding patients who were not radically operated, there remained 138 patients with histologically confirmed lung cancer (carcinoids excluded) and 12.3% showed tumour cells in the washings. Two of 18 patients with metastatic lung disease ( 11%) and one of ten patients with carcinoid tumor also showed malignant cells in the lavage. The patients with lung cancer have been followed for 3 years or until death. After three years 60.2% of those without malignant cells in the pleural lavage were still alive, while this figure was 41.2% in the other group. The difference was not statistically significant. Other factors, such as spread to local lymph nodes, size of tumor, etc. were related to the occurrence of malignant cells in the pleura, and these factors were also better prognostic ones. We conclude that the clinical use of pleural lavage cytology is limited.
尽管手术看似激进，但许多接受支气管癌手术的患者仍会死于该疾病。一些患者可能会从术后治疗中获益，而一个能够识别肿瘤复发风险增加患者的预后因素具有重要的临床意义。一个可能的此类因素是手术时进行的胸膜腔灌洗中出现恶性细胞。为了验证这一假设，我们对224例因经证实或高度怀疑患有支气管癌而接受手术、术前分期为I期或II期的连续患者进行了研究。打开胸腔后，在对肺进行操作或触诊之前，向胸膜腔内注入300毫升生理盐水。排除未进行根治性手术的患者后，剩下138例经组织学确诊为肺癌（不包括类癌）的患者，其中12.3%的患者灌洗液中出现肿瘤细胞。18例转移性肺癌患者中有2例（11%）以及10例类癌肿瘤患者中有1例的灌洗液中也出现了恶性细胞。肺癌患者已随访3年或直至死亡。三年后，胸膜腔灌洗中无恶性细胞的患者中有60.2%仍然存活，而另一组的这一比例为41.2%。差异无统计学意义。其他因素，如局部淋巴结转移、肿瘤大小等，与胸膜中恶性细胞的出现有关，并且这些因素也是更好的预后指标。我们得出结论，胸膜腔灌洗细胞学的临床应用有限。
