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  • Title: The impact on survival of positive intraoperative pleural lavage cytology in patients with non-small-cell lung cancer.
    Author: Aokage K, Yoshida J, Ishii G, Enatsu S, Hishida T, Nishimura M, Nishiwaki Y, Nagai K.
    Journal: J Thorac Cardiovasc Surg; 2010 May; 139(5):1246-52, 1252.e1. PubMed ID: 19765741.
    Abstract:
    OBJECTIVE: The aim of this study was to analyze intraoperative pleural lavage cytology results in patients with non-small-cell lung cancer and quantify the impact on survival and recurrence. METHODS: From August 1992 through November 2006, pleural lavage cytology results before and after lung resection were both available in 2178 patients with non-small-cell lung cancer. We assessed the pre-pleural lavage cytology impact on survival, comparing with 9 factors available before lung resection by multivariate analyses. We also compared the impact with that of pleural dissemination or malignant pleural effusion. For post-pleural lavage cytology, we analyzed its survival impact in relation with 15 clinicopathologic factors, including those available after resection, by multivariate analyses. RESULTS: Pre-pleural lavage cytology proved to be a strong independent prognostic factor, but the 5-year survival rate was 37% in 65 patients without dissemination but with a positive pre-pleural lavage cytology, which was significantly higher than 12% in 86 patients with dissemination. When factors available after resection were combined, post-pleural lavage cytology showed a stronger survival impact than pre-pleural lavage cytology. Post-pleural lavage cytology was also a strong predictor of recurrence. The positive post-pleural lavage cytology group had a marginally, but not significantly, better survival compared with the malignant pleural effusion group. Almost all patients with positive post-pleural lavage cytology relapsed within 5 years. CONCLUSIONS: Pre-pleural lavage cytology is of less use in clinical practice. Post-pleural lavage cytology was a very strong independent prognostic factor, and almost all patients with positive post-pleural lavage cytology relapsed within 5 years. We propose that positive post-pleural lavage cytology disease should be classified to pathologic T4 and managed similarly to dissemination.
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