title: The Impact of Pleural Lavage Cytology Both Before and After Lung Resection on Recurrence of Non-Small Cell Lung Cancer.
abstract: BACKGROUND
  Pleural lavage cytology (PLC) involves cytologic examination during surgery for non-small cell lung cancer (NSCLC). The timing regarding the performance of PLC is potentially important; however, a consensus remains to be established. We sought to retrospectively analyze the impact of PLC both before (pre-PLC) and after (post-PLC) lung resection on recurrence in NSCLC.
  
  
  METHODS
  From July 1994 to December 2011, 700 consecutive patients with surgically resected NSCLC were selected. Both pre-PLC and post-PLC status was tested using univariate and multivariate Cox regression analyses of recurrence-free survival (RFS).
  
  
  RESULTS
  By analyzing RFS, post-PLC status but not pre-PLC status together with pathologic N factor and pathologic stage, was identified as an independent factor for poor prognosis (p = 0.0040). A statistically significant association was observed between positive post-PLC status and pleural invasion, pathologic T factor, pathologic N factor, pathologic stage, and postoperative recurrence (p = 0.0004, p = 0.0033, p = 0.0001, p < 0.0001, and p < 0.0001, respectively). The RFS was similarly worse for patients with positive post-PLC status regardless of pre-PLC status. Conversely, the RFS was similarly better for patients with negative post-PLC status regardless of pre-PLC status.
  
  
  CONCLUSIONS
  Positive post-PLC status was found to be a predictive factor for postoperative recurrence in patients with surgically resected NSCLC. Moreover, post-PLC status might be an additional factor not only for identifying a patient group with a high risk of postoperative recurrence, but also to avoid unnecessary treatment of patients with low risk of postoperative recurrence.
authors.affiliation: Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Chuo-ku, Fukuoka, Japan. Electronic address: fshoji@surg2.med.kyushu-u.ac.jp.
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Shoji
authors.affiliation: Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Chuo-ku, Fukuoka, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Yamazaki
authors.affiliation: Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Chuo-ku, Fukuoka, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Kouso
authors.affiliation: Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Chuo-ku, Fukuoka, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Mori
authors.affiliation: Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Chuo-ku, Fukuoka, Japan.
authors.forename: Sadanori
authors.initials: S
authors.lastname: Takeo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology*; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015331:Cohort Studies; D003581:Cytodiagnosis / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology; D016066:Pleural Effusion, Malignant / Q000473:pathology; D011013:Pneumonectomy / Q000379:methods / Q000401:mortality; D011182:Postoperative Care / Q000379:methods; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis