Abstract
Purpose
Information regarding the treatment of pleural lavage cytology (PLC)-positive patients is still limited. This study evaluated the efficacy of intrapleural chemotherapy (IPC) in PLC-positive patients.
Methods
Three hundred eighty-six of the 567 lung cancer patients who underwent surgery had undergone PLC after thoracotomy, following by a complete resection were evaluated. IPC was performed after surgery, and cisplatin or adriamycin was injected intrapleurally through the thoracic tube.
Results
The pathological diagnosis showed that 17 patients (4.4 %) were positive for (or suspected to have) malignancy in their PLC. The univariate and multivariate analysis showed that only pleural invasion was a significant predictor of a PLC-positive status. The 5-year overall survival in PLC-positive patients was 38 % and that in PLC-negative patients was 84 %. Both the univariate (p < 0.01) and multivariate (p = 0.045) analyses showed that the status of PLC was significantly associated with the overall survival. Eight of the 17 PLC-positive patients underwent IPC. The 2-year OS rate in the patients treated with IPC was 88 % and that of those without IPC was 44 (p = 0.04).
Conclusion
IPC improved the postoperative survival in PLC-positive NSCLC patients, and a further prospective evaluation regarding this therapy is warranted.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Maruyama R, Hirai F, Ondo K, Kometani T, Hamatake M, Seto T, et al. Concurrent chemoradiotherapy using cisplatin plus S-1, an oral fluoropyrimidine, followed by surgery for selected patients with stage III non-small cell lung cancer: a single-center feasibility study. Surg Today. 2011;41(11):1492–7.
Kondo H, Asamura H, Suemasu K, Goya T, Tsuchiya R, Naruke T, et al. Prognostic significance of pleural lavage cytology immediately after thoracotomy in patients with lung cancer. J Thorac Cardiovasc Surg. 1993;106:1092–7.
Lim E, Ali A, Theodorou P, Nicholson AG, Ladas G, Goldstraw P. Intraoperative pleural lavage cytology is an independent prognostic indicator for staging non-small cell lung cancer. J Thorac Cardiovasc Surg. 2004;127:1113–8.
Riquet M, Badoual C, Le Pimpec Barthes F, Lhote FM, Souilamas R, Hubsch JP, et al. Visceral pleura invasion and pleural lavage tumor cytology by lung cancer: a prospective appraisal. Ann Thorac Surg. 2003;75:353–5.
Nakagawa T, Okumura N, Kokado Y, Miyoshi K, Matsuoka T, Kameyama K. Clinical relevance of intraoperative pleural lavage cytology in non-small cell lung cancer. Ann Thorac Surg. 2007;83:204–8.
Aokage K, Yoshida J, Ishii G, Enatsu S, Hishida T, Nishimura M, et al. The impact on survival of positive intraoperative pleural lavage cytology in patients with non-small-cell lung cancer. J Thorac Cardiovasc Surg. 2010;139:1246–52.
Lim E, Clough R, Goldstraw P, Edmonds L, Aokage K, Yoshida J, et al. Impact of positive pleural lavage cytology on survival in patients having lung resection for non-small-cell lung cancer: An international individual patient data meta-analysis. J Thorac Cardiovasc Surg. 2010;139:1441–6.
Hanagiri T, Takenaka M, Oka S, Baba T, Shigematsu Y, Nagata Y, et al. Pleural lavage cytology immediately after thoracotomy in patients with completely resected non-small cell lung cancer. Int Surg. 2011;96:171–5.
Higashiyama M, Oda K, Okami J, Maeda J, Kodama K, Takenaka A, et al. Prognostic value of intraoperative pleural lavage cytology for lung cancer without carcinomatous pleuritis: importance in patients with early stage disease during long-term follow-up. Eur J Cardiothorac Surg. 2009;35:337–42.
Shintani Y, Ohta M, Iwasaki T, Ikeda N, Kanou T, Tomita E, et al. Intraoperative pleural lavage cytology after lung resection as an independent prognostic factor for staging lung cancer. J Thorac Cardiovasc Surg. 2009;137:835–9.
Kawachi R, Nakazato Y, Masui K, Takei H, Koshi-ishi Y, Goya T. Clinical significance of pleural lavage cytology for non-small cell lung cancer: is surgical resection valid for patients with positive pleural lavage cytology? Interact Cardiovasc Thorac Surg. 2009;9:265–8.
Yoshida K, Sugiura T, Takifuji N, Kawahara M, Matsui K, Kudoh S, et al. Randomized phase II trial of three intrapleural therapy regimens for the management of malignant pleural effusion in previously untreated non-small cell lung cancer: JCOG 9515. Lung Cancer. 2007;58:362–8.
Seto T, Ushijima S, Yamamoto H, Ito K, Araki J, Inoue Y, et al. Intrapleural hypotonic cisplatin treatment for malignant pleural effusion in 80 patients with non-small-cell lung cancer: a multi-institutional phase II trial. Br J Cancer. 2006;95:717–21.
Muraoka M, Oka T, Akamine S, Tagawa T, Morinaga M, Inoue M, et al. Modified intrapleural cisplatin treatment for lung cancer with positive pleural lavage cytology or malignant effusion. J Surg Oncol. 2006;93:323–9.
Checkley W, West KP Jr, Wise RA, Baldwin MR, Wu L, LeClerq SC, et al. Maternal vitamin A supplementation and lung function in offspring. N Engl J Med. 2010;362:1784–94.
Nakamura K, Takanashi S, Ishida M, Yuasa K, Takase H, Kudoh M, et al. Experimental and Clinical Treatment with Cisplatin (CDDP) into the Pleural Cavity for Carcinomatous Pleurisy. JJLC. 1990;30:527–36.
Enatsu S, Yoshida J, Yokose T, Nishimura M, Nishiwaki Y, Shirakusa T, et al. Pleural lavage cytology before and after lung resection in non-small cell lung cancer patients. Ann Thorac Surg. 2006;81:298–304.
Conflict of interest
All authors have no conflict of interest. Tetsuro Baba is currently receiving a postdoctoral fellowship from the Uehara Memorial Foundation.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Baba, T., Uramoto, H., Kuwata, T. et al. Intrapleural chemotherapy improves the survival of non-small cell lung cancer patients with positive pleural lavage cytology. Surg Today 43, 648–653 (2013). https://doi.org/10.1007/s00595-012-0281-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00595-012-0281-y