title: Prognostic Value of Pleural Lavage Cytology in Patients with Lung Cancer Resection: An Updated Meta-Analysis.
abstract: OBJECTIVE
  Pleural lavage cytology (PLC) is considered as a possible tool for assessing prognosis of lung cancer patients. We aimed to comprehensively review the prognosis value of PLC in patients undergoing surgical resection.
  
  
  METHODS
  We searched 4 electronic databases for relevant studies comparing positive PLC and negative PLC. The primary outcomes included survival rate and recurrence rate at maximum follow-up.
  
  
  RESULTS
  The meta-analysis included 28 studies, with a total of 20,714 patients. For the overall survival rate of all stages, the results demonstrated that positive pre-resection, post-resection and pooled PLC were associated with unfavorable survival: hazard ratio (HR) 2.89 (95% confidence interval [CI] 2.48-3.37), 2.70 (1.90-3.83), and 2.89 (2.52-3.31), respectively. For the stage I survival rate, the combined results also suggested that positive pre-resection, post-resection and pooled PLC were associated with unfavorable survival: HR 3.29 (95% CI 2.55-4.25), 4.85 (2.31-10.20), and 3.16 (2.53-3.94), respectively. Furthermore, a meta-analysis of 14 studies included 14,279 patients showed that positive pre-resection, post-resection and pooled PLC were associated with an increased risk of overall recurrence: risk ratio (RR) 2.45 (95% CI 1.91-3.15), 2.37 (1.11-5.09), and 2.37 (95% CI 2.00-2.80), respectively. Positive PLC was also associated with a high pleural recurrence (RR 4.77; 95% CI 3.13-7.26) or distant recurrence (RR 2.33; 95% CI 1.65-3.29).
  
  
  CONCLUSIONS
  Both positive pre- resection and post-resection PLC are associated with not only higher tumor recurrence but also unfavorable survival outcomes in patients with lung cancer resection. This technique can therefore act as a strong prognostic factor for tumor recurrence and adverse survival rates.
authors.affiliation: Department of Respiratory Diseases, the People's Hospital of Shenzhen Guangming New District, Shenzhen, China.
authors.forename: Chun-Mei
authors.initials: CM
authors.lastname: Wang
authors.affiliation: Department of Respiratory Diseases, the Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China.
authors.forename: Zhou-Gui
authors.identifier: http://orcid.org/0000-0001-5174-5262
authors.initials: ZG
authors.lastname: Ling
authors.affiliation: Institute of Respiratory Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
authors.forename: Yan-Bin
authors.initials: YB
authors.lastname: Wu
authors.affiliation: Institute of Respiratory Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
authors.forename: Shuang-Qi
authors.initials: SQ
authors.lastname: Cai
authors.affiliation: Department of Respiratory Diseases, the Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China.
authors.forename: Zhen-Ming
authors.initials: ZM
authors.lastname: Tang
authors.affiliation: Institute of Respiratory Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
authors.forename: Cong
authors.initials: C
authors.lastname: Wu
authors.affiliation: Institute of Respiratory Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
authors.forename: Yi-Qiang
authors.initials: YQ
authors.lastname: Chen
mesh_terms: D003581:Cytodiagnosis; D016208:Databases, Factual; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016017:Odds Ratio; D016066:Pleural Effusion, Malignant / Q000473:pathology*; D011013:Pneumonectomy; D011379:Prognosis; D016016:Proportional Hazards Models; D017594:Publication Bias