Non-small-cell lung cancer prognosis using carcinoembryonic antigen levels in pleural lavage fluid.
OBJECTIVE
The study aimed to evaluate the prognostic significance of carcinoembryonic antigen levels in pleural lavage fluid (p-CEA) in patients with completely resected non-small-cell lung cancer (NSCLC).


METHODS
We examined 72 patients who underwent curative surgical resections. Pleural lavage fluid was collected at thoracotomy before lung resection. Pleural lavage cytology and p-CEA were determined. The relationships between p-CEA and clinicopathological factors were analysed.


RESULTS
Four patients (5.6%) had positive pleural lavage cytologies. The median p-CEA was 65.2 ng/g protein (range, 0-7331.7). p-CEA was significantly correlated with pleural invasion and CEA levels in serum (s-CEA). Receiver operating characteristic curve analysis identified an optimal cut-off of 38 ng/g protein for p-CEA for predicting recurrence [area under the curve (AUC) = 0.669; sensitivity = 91.7%; specificity = 43.7%; 95% confidence interval (CI) = 0.541-0.796; P = 0.020], whereas this could not be identified for s-CEA (AUC = 0.535; 95% CI = 0.392-0.678; P = 0.629). With a mean follow-up period of 57.5 months, 5-year disease-free survival (DFS) rates were 86.5% for p-CEA ≤ 38 ng/g protein and 47.7% for p-CEA >38 ng/g protein (P = 0.0013). Even for patients with Stage I lung cancer, 5-year DFS rates were 88.2 and 53.8%, respectively (P = 0.017). Multivariate Cox analysis revealed that p-CEA was a significant independent factor for DFS and overall survival.


CONCLUSIONS
Intraoperative p-CEA may be a more powerful prognostic determinant than s-CEA for patients with NSCLC.
Department of Surgical Oncology,  Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima,  Japan.
Yasuhiro
Y
Tsutani
Yoshinori
Y
Yamashita
Keizo
K
Misumi
Takuhiro
T
Ikeda
Yoshihiro
Y
Miyata
Morihito
M
Okada
D000368:Aged; D000369:Aged, 80 and over; D002272:Carcinoembryonic Antigen / Q000378:metabolism*; D002289:Carcinoma, Non-Small-Cell Lung / Q000378:metabolism / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care; D008175:Lung Neoplasms / Q000378:metabolism / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000378:metabolism; D035422:Pleural Cavity / Q000378:metabolism*; D011013:Pneumonectomy; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D007507:Therapeutic Irrigation; D013908:Thoracotomy
D002272:Carcinoembryonic Antigen