Author of

• 12701

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  P3.12 - Poster Session 3 - NSCLC Early Stage (ID 206)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Medical Oncology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12708

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    P3.12-007 - A clinical relevance of intraoperative pleural lavage cytology in non-small lung cancer (ID 1853)

    09:30 - 09:30  |  Author(s): Y. Sakaguchi
    • Abstract

    Background
    Intraoperative pleural lavage cytology (PLC) has been reported to be useful in detecting subclinical pleural dissemination. However, the result of this examination is not reflected on the current TNM staging system.

    Methods
    A total of 1038 patients with non-small cell lung cancer who underwent surgery were retrospectively reviewed and evaluated for the clinical relevance of intraoperative PLC. PLC was performed by washing the pleural cavity with 200ml of saline solution and 20ml of lavage was obtained for cytological examination immediately after thoracotomy (pre-resection PLC) and just before closing the pleural cavity (post-resection PLC).

    Results
    Thirty five (3.4%) patients were positive for PLC. Among them, 27 (2.6%) patients were positive for pre-resection PLC and 17 (1.6%) patients were positive for post-resection PLC. The pleural invasion score was pl0 in 4 (14.8%) patients, pl1 in 10 (37.0%) patients, pl2 in 9 (33.3%) patients and pl3 in 4 (14.8%) patients in positive pre-resection PLC group and pl0 in 4(24%), pl1 in 7(41%), pl2 in 5(29%) and pl3 in 1(6%) in positive post-resection PLC group. On the other hand, in the negative PLC group, pl0 in 695 (69.3%) patients, pl1 in 206 (20.5%) patients, pl2 in 47(4.7%) patients and pl3 in 55 (5.5%) patients. The distribution rate of pl0 was significantly higher in the negative PLC group than in the positive group both of pre- and post-resection PLC (p<0.001). The 5-year survival rate was 61.7% for the positive PLC group and 79.2% for the negative PLC group (p<0.01). In regard to the survival stratified according to the pleural invasion, the 5-year survival rates was 81.2% for the negative PLC with pl0 or pl1 group (pl0-1 group) and 61.2% for the negative PLC with pl2 or pl3 group (pl2-3 group)(p<0.01). The survival of the positive PLC group was a significantly worse than that of the pl0-1 group (p<0.01) whereas there was no significant difference in survival between the positive PLC and the pl2-3 group (p=0.4732). A multivariate prognostic analysis adjusted by age, sex, tumor size and pathologic nodal status confirmed the superiority of the pl0-1 group over the pl2-3 and the positive PLC group (HR 0.547,p<0.01 and HR 0.426,p<0.01, respectively) and the similarity between the pl2-3 and the positive PLC group in survival (HR 0.776, p=0.4082). A total of 267 patients had recurrent diseases. Regarding the initial site of recurrence, pleural dissemination occurred in four of 21 (19%) patients in the positive PLC group, 19 of 197 (9.6%) patients in the pl0-1 group and 10 of 49 (20.4%) patients in the pl2-3 group.

    Conclusion
    The present study demonstrates the clinical relevance of intraoperative PLC in non-small cell lung cancer. Positive intraoperative PLC is of predictive value for adverse survival and has a similar impact on survival with the pleural invasion score of more than pl2.