OBJECTIVES: Pleural lavage cytology is the microscopic study of cells obtained from saline instilled into and retrieved from the chest during surgery for non-small-cell lung cancer. The aims of this study were to collate multi-institutional individual patient data for meta-analysis to determine independence as a prognostic marker and to characterize the impact of positive results on stage-adjusted survival. METHODS: We identified 31 publications from 22 centers/research groups that performed pleural lavage cytology during surgery for non-small-cell lung cancer and invited submission of individual patient data. Actuarial survival was calculated using Kaplan-Meier methods, and comparisons were performed using the log-rank test. Cox proportional hazards regression was used to ascertain the covariates associated with survival. RESULTS: By January 1, 2008, submissions were received internationally from 11 centers with individual data from 8763 patients. In total, 511 (5.8%) patients had a positive pleural lavage cytology result, and this was shown to be an independent predictor of adverse survival associated with a hazard ratio of 1.465 (1.290-1.665; P < .001) compared with a reference hazard ratio of 1 for a negative result. On statistical modeling, the best adjustment for patients with a positive pleural lavage cytology result was a single increase in the T category assigned to the case, up to a maximum of T4. Correction for differences in survival were obtained in stages IB (P = .315) and IIB (P = .453), with a degree of correction in stage IIIA (P = .07). CONCLUSIONS: Pleural lavage cytology should be considered in all patients with non-small-cell lung cancer suitable for resection. A positive result is an independent predictor of adverse survival, and the impact on survival suggests that it may be appropriate to upstage patients by 1 T category. Copyright 2010 The American Association for Thoracic Surgery. All rights reserved.
OBJECTIVES:Pleural lavage cytology is the microscopic study of cells obtained from saline instilled into and retrieved from the chest during surgery for non-small-cell lung cancer. The aims of this study were to collate multi-institutional individual patient data for meta-analysis to determine independence as a prognostic marker and to characterize the impact of positive results on stage-adjusted survival. METHODS: We identified 31 publications from 22 centers/research groups that performed pleural lavage cytology during surgery for non-small-cell lung cancer and invited submission of individual patient data. Actuarial survival was calculated using Kaplan-Meier methods, and comparisons were performed using the log-rank test. Cox proportional hazards regression was used to ascertain the covariates associated with survival. RESULTS: By January 1, 2008, submissions were received internationally from 11 centers with individual data from 8763 patients. In total, 511 (5.8%) patients had a positive pleural lavage cytology result, and this was shown to be an independent predictor of adverse survival associated with a hazard ratio of 1.465 (1.290-1.665; P < .001) compared with a reference hazard ratio of 1 for a negative result. On statistical modeling, the best adjustment for patients with a positive pleural lavage cytology result was a single increase in the T category assigned to the case, up to a maximum of T4. Correction for differences in survival were obtained in stages IB (P = .315) and IIB (P = .453), with a degree of correction in stage IIIA (P = .07). CONCLUSIONS:Pleural lavage cytology should be considered in all patients with non-small-cell lung cancer suitable for resection. A positive result is an independent predictor of adverse survival, and the impact on survival suggests that it may be appropriate to upstage patients by 1 T category. Copyright 2010 The American Association for Thoracic Surgery. All rights reserved.
Authors: Alice M Boylan; Xiaofei F Wang; Richard Ko; Patricia M Watson; Lin Gu; David Harpole; Raphael Bueno; Rosemary Kelly; Leslie Kohman; Robert Kratzke Journal: J Thorac Cardiovasc Surg Date: 2012-09-29 Impact factor: 5.209
Authors: Gal Shafirstein; Athar Battoo; Kassem Harris; Heinz Baumann; Sandra O Gollnick; Joerg Lindenmann; Chukwumere E Nwogu Journal: Ann Am Thorac Soc Date: 2016-02