非小细胞肺癌胸腔冲洗液细胞学检查及其预后价值

The prognostic value of examining pleural lavage cytology during surgery for non small cell lung cancer patients

目的评估非小细胞肺癌(NSCLC)患者术中胸腔冲洗液细胞学检查(PLC)与预后的关系,评估胸腔镜肺癌根治术是否增加胸膜腔微转移的风险。方法对220例无胸水肺叶切除的NSCLC患者(开胸组124例,胸腔镜组96例)进行了胸腔冲洗,于手术前和手术后分别收集冲洗液行细胞学检查。评估PLC阳性率与临床病理因素以及3年生存率的相关性。结果术前PLC阳性31例(14.1%),术后PLC阳性34例(15.5%),胸腔镜组与开胸组相比,术前术后PLC阳性率无统计学差异。术前与术后PLC阳性率与患者年龄、性别、分化程度以及组织类型无关,与T分期、N分期以及病理分期正相关。术前PLC阴性组3年生存率显著高于术前PLC阳性组(66.1%vs.48.4%,P=0.008);术后PLC阴性组3年生存率显著高于术后PLC阳性组(67.7%vs.41.2%,P<0.001);胸腔镜组3年生存率(62.5%)略低于开胸组(64.5%),差异无统计学意义(P=0.753)。结论 PLC检测能够有效预测NSCLC患者的预后,胸腔镜肺叶切除并不增加肺癌根治术中胸膜腔微转移的风险。

Objective To detect free carcinoma cells in the pleural cavity of lung cancer patients without pleural effusion,to evaluate the correlation between cytological findings and histopathological factors,and to assess the predictive value of pleural lavage cytology(PLC).To evaluate the risk of intrapleural dissemination of cancer cells during the VATS surgery.Methods From Jan 1,2007,to Dec 31,2007,220(124 conventional surgery cases and 96 VATS surgery cases)patients with NSCLC were enrolled in the study.Pleural lavage fluid was collected immediately after thoracotomy and just before closing the thorax.They were evaluated immediately for its cytological characteristics.All patients were followed up until Dec 31,2011.Results PLC after thoracotomy was positive in 31 patients(14.1%).The 3-year survival rate in the PLC after thoracotomy positive cases was significantly poorer than in PLC after thoracotomy negative cases(48.4% vs.66.1%,P=0.008).In contrast,there were 34 PLC(15.5%)before closure positive cases.The 3-year survival rate in the PLC before closure positive cases was significantly poorer than in the PLC before closure negative cases(41.2% vs.67.7%,P<0.001).There was no significant difference in the incidence of positive PLC between the conventional surgery group and VATS surgery group.The 3-year survival rate of the VATS surgery cases was not inferior than the conventional surgery(62.5% vs.64.5%,P=0.753).The incidence of positive results was correlated with primary tumor size(T3>T3>T1),lymph node status(N2+N1>N0),and pathological stage(Ⅲ>Ⅱ>Ⅰ).Conclusions Free carcinoma cells may be present in the pleural cavity of patients with lung cancer without accompanying pleural effusion and may be correlated with T and N factors.PLC is important for ascertaining prognosis in patients with NSCLC.VATS techniques used in NSCLC surgery were not associated with a higher risk for intrapleural dissemination of cancer cells than the conventional surgery.