Clinical significance of pleural lavage cytology for non-small cell lung cancer: is surgical resection valid for patients with positive pleural lavage cytology?

Abstract

The purpose of the present study was to retrospectively analyze the clinicopathological characteristics and clarify the validity of surgical resection for patients with positive pleural lavage cytology (PLC). Between 1993 and 2006, 563 patients who underwent complete surgical resection for primary non-small cell lung cancer and who were examined with regard to PLC were retrospectively analyzed. Forty-two patients (7.2%) showed positive PLC. The 5-year survival rates were 65.0% and 33.5% for patients with negative and positive PLC, respectively. The 5-year survival rates for patients with positive PLC were 57.1%, 50.8%, 40.0%, and 0% for pathological stage I, II, IIIA, and IIIB, respectively. Multivariate analysis revealed that preoperative carcinoembryonic antigen (CEA) level, PLC, vascular invasion, lymphatic permeation, and pathological stage were independent prognostic factors. The 5-year survival rate for the patients with a high CEA level and positive PLC was 0%. Intrathoracic recurrence was observed more frequently in patients with positive PLC. PLC was an independent prognostic factor. While positive PLC alone may not be a contraindication for surgical resection, patients who are complicated with a high CEA level preoperatively should receive special attention since no long-term survivors were observed.

Positive pre-resection pleural lavage cytology is associated with increased risk of lung cancer recurrence in patients undergoing surgical resection: a meta-analysis of 4450 patients

“…The OR was of statistical significance at 10.01 (95% CI 5.09 to 19.69). Similarly, PLC was positive for 5–10% of the total participants also in two studies (108 patients, 5.94%): OR was of statistical significance at 2.62 (95% CI 1.31 to 5.24) 10 11. Finally, two studies (60 patients, 13.0%)29 32 reported 10–20% of the total participants had positive PLC with similar results.…”

“…Of the seven studies reporting overall recurrence, three followed up more than 350 patients 3 10 11. The OR of these three studies (149 patients (5.58%) had positive pre-resection PLC) was of statistical significance at 4.40 (95% CI 1.52 to 12.73).…”

Blood Vessel Invasion as a Strong Independent Prognostic Indicator in Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis

“…In multivariate analyses, there were 27 studies that identified BVI as a significant prognostic factor for OS [8]–[10], [16], [20], [23], [26], [27], [31]–[47], [58], [59] and 10 that identified blood vessel as a non-significant prognostic factor [18], [21], [28], [30], [48], [49], [52], [53], [56], [70]. Evaluability was not associated with positivity in the systematic review.…”

“…Usually, HRs and 95% confidence intervals (CIs) were directly obtained from published literatures using univariate [8]–[11], [13]–[15], [18], [19] or multivariate survival analyses. In some studies, BVI was determined to be an independent prognostic indicator using multivariate analysis; HRs and 95% CIs were generally reported [9], [10], [16], [18], [20], [21], [23], [26]–[29], [31], [33]–[36], [38], [40]–[45], [47]–[49], [52], [56]–[59], [60]. Some studies reported the HR but did provide sufficient information on survival by BVI status; we thus estimated the HR and CIs according to the methods of Parmar et al [61].…”

Pleural lavage cytology as an independent prognostic factor in non-small-cell lung cancer patients with stage I disease and adenocarcinoma

“…Additionally, several other studies have suggested that PLC findings obtained during surgery are important prognostic indicators (4)(5)(6)(7)(8)(9)(10)(11)(12)(13). However, the contribution of PLC to TNM staging has not yet been established.…”