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首页> 外文期刊>The Journal of Thoracic and Cardiovascular Surgery >Intraoperative pleural lavage cytology is an independent prognostic indicator for staging non-small cell lung cancer.
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Intraoperative pleural lavage cytology is an independent prognostic indicator for staging non-small cell lung cancer.

机译：术中胸腔灌洗细胞学检查是诊断非小细胞肺癌的独立预后指标。

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OBJECTIVES: For patients undergoing lung resection for cancer, macroscopic evidence of metastasis is clearly associated with adverse prognosis. However, less is known about the significance of tumor cells detected by using tests such as pleural lavage cytology. To ascertain the frequency and quantify the effect of this finding on survival, we performed a prospective study of intraoperative pleural lavage cytology. METHODS: Pleural lavage cytology consisted of cytologic analysis of 100 mL of saline irrigated over the lung surface immediately after thoracotomy. Patients were excluded if they had an existing effusion, extreme adhesions, or lateral chest wall invasion or if resection was not performed. Survival was calculated by means of Kaplan-Meier analysis and compared by using log-rank tests. Cox regression was used to ascertain independent predictors of prognosis. RESULTS: From 1995 through 2003, we performed pleural lavage cytology on 292 patients undergoing thoracotomy for lung cancer. The mean age was 64 (SD, 10) years, and 196 (67%) patients were men. Of 292 samples, 13 (4.5%) showed evidence of malignant cells. The median time to follow-up was 15 months (interquartile range, 1-40 months), with a median survival of 49 months for patients with negative pleural lavage cytology results and 13 months for patients with positive pleural lavage cytology results (P =.002). Univariate prognostic predictors were positive pleural lavage cytology status (P =.03), stage (P =.03), adenocarcinoma (P =.06), and parietal pleural involvement (P =.01). In the final multivariate model only positive pleural lavage cytology status (P =.006) and stage (P =.03) remained significant. CONCLUSIONS: Intraoperative pleural lavage cytology is a simple addition to intrathoracic staging and an independent predictor of prognosis. Positive results potentially affect survival by upstaging patients to stage IIIB or greater.
机译：目的：对于接受肺癌肺切除术的患者，转移的宏观证据显然与不良预后相关。然而，对于通过使用诸如胸腔灌洗细胞学检查等检测方法检测到的肿瘤细胞重要性的了解还很少。为了确定频率并量化此发现对生存的影响，我们对术中胸腔灌洗液细胞学进行了前瞻性研究。方法：胸腔灌洗液细胞学包括对开胸后立即在肺表面灌溉的100 mL盐水进行细胞学分析。如果患者有积液，极度粘连或胸壁外侧浸润或未进行切除，则将其排除在外。通过Kaplan-Meier分析计算存活率，并通过对数秩检验进行比较。使用Cox回归来确定预后的独立预测因子。结果：从1995年到2003年，我们对292例接受肺癌开胸手术的患者进行了胸膜灌洗细胞学检查。平均年龄为64（SD，10）岁，196名（67％）患者为男性。在292个样本中，有13个（4.5％）显示出恶性细胞的证据。随访中位时间为15个月（四分位间距为1-40个月），胸膜灌洗细胞学结果阴性的患者中位生存期为49个月，胸膜灌洗细胞学结果为阳性的患者中位生存期为13个月（P =。 002）。单因素预后指标为阳性的胸腔灌洗细胞学状态（P = .03），分期（P = .03），腺癌（P = .06）和顶叶胸膜受累（P = .01）。在最终的多元模型中，只有阳性的胸腔灌洗细胞学状态（P = .006）和分期（P = .03）仍然很重要。结论：术中胸膜灌洗细胞学检查是胸腔内分期的简单补充，并且是预后的独立预测指标。积极的结果可能会使患者升级到IIIB或更高阶段，从而可能影响生存。

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