Intraoperative pleural lavage cytology after lung resection as an independent prognostic factor for staging lung cancer

Shintani, Yasushi; Ohta, Mitsunori; Iwasaki, Teruo; Ikeda, Naoki; Kanou, Takashi; Tomita, Emiko; Nakagawa, Katsuhiro; Yasumitsu, Tsutomu; Ohno, Yuko

doi:10.1016/j.jtcvs.2008.09.027

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 137, Issue 4 , Pages 835-839, April 2009

Intraoperative pleural lavage cytology after lung resection as an independent prognostic factor for staging lung cancer

Yasushi Shintani, MD, PhD
- Department of Thoracic Surgery, Osaka Prefectural Hospital Organization, Osaka Prefectural Medical Center for Respiratory and Allergic Disease, Osaka, Japan
- Address for reprints: Yasushi Shintani, MD, PhD, 3-7-1 Habikino, Osaka 583-8588, Japan.
Mitsunori Ohta, MD, PhD
- Department of Thoracic Surgery, Osaka Prefectural Hospital Organization, Osaka Prefectural Medical Center for Respiratory and Allergic Disease, Osaka, Japan
Teruo Iwasaki, MD, PhD
- Department of Thoracic Surgery, Osaka Prefectural Hospital Organization, Osaka Prefectural Medical Center for Respiratory and Allergic Disease, Osaka, Japan
Naoki Ikeda, MD, PhD
- Department of Thoracic Surgery, Osaka Prefectural Hospital Organization, Osaka Prefectural Medical Center for Respiratory and Allergic Disease, Osaka, Japan
Takashi Kanou, MD
- Department of Thoracic Surgery, Osaka Prefectural Hospital Organization, Osaka Prefectural Medical Center for Respiratory and Allergic Disease, Osaka, Japan
Emiko Tomita, MD
- Department of Thoracic Surgery, Osaka Prefectural Hospital Organization, Osaka Prefectural Medical Center for Respiratory and Allergic Disease, Osaka, Japan
Katsuhiro Nakagawa, MD, PhD
- Department of Thoracic Surgery, Osaka Prefectural Hospital Organization, Osaka Prefectural Medical Center for Respiratory and Allergic Disease, Osaka, Japan
Tsutomu Yasumitsu, MD, PhD
- Department of Thoracic Surgery, Osaka Prefectural Hospital Organization, Osaka Prefectural Medical Center for Respiratory and Allergic Disease, Osaka, Japan
Yuko Ohno, PhD
- Department of Mathematical Health Science, Osaka University Graduate School of Medicine, Osaka, Japan

Received 25 April 2008; received in revised form 12 August 2008; accepted 12 September 2008. published online 12 January 2009.

Objective

Although malignant pleural effusion or dissemination is regarded as T4 per TNM classification of lung cancer, the prognostic significance in staging of pleural lavage cytologic examination remains undetermined. The purpose of this study was to clarify the utility of pleural lavage cytologic staging as a prognostic factor in patients with non–small cell lung cancer.

Methods

In 1271 patients with lung cancer who underwent curative resection, intraoperative pleural lavage cytologic examination was performed at thoracotomy (first cytologic examination), immediately after pulmonary resection and mediastinal lymph node dissection (second cytologic examination), and after last washing of pleural cavity (third cytologic examination). Positive first cytologic result represented cytologic positive result before lung resection; positive second and third cytologic results were regarded as cytologic positive results after lung resection.

Results

Eighty-nine patients (7.0%) had positive findings of pleural lavage cytologic examination before or after lung resection. Five-year survivals were 44.1% for patients with positive results before lung resection and 23.4% for patients with positive results after lung resection, both significantly worse than that for patients with negative results. Multivariate analyses revealed that positive lavage result after lung resection was an independent prognostic factor. We found significantly greater pleural recurrence among patients with positive pleural lavage cytologic results after lung resection than among those with negative results.

Conclusions

In addition to TNM classification, results of pleural lavage cytologic examination after lung resection should be considered when staging non–small cell lung cancer. Adjuvant systemic therapy may improve outcome for patients with positive results.

Abbreviations and Acronyms: CI, confidence interval, NSCLC, non–small cell lung cancer, PLC, pleural lavage cytologic examination

CTSNet classification: 10