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Purpose <p>Pleural lavage cytology (PLC) is a recognized prognostic marker in non-small cell lung cancer (NSCLC); however, the impact of serial intraoperative changes remains unclear.</p> Methods <p>We retrospectively analyzed 439 patients who underwent curative NSCLC resection. PLC was performed at three intraoperative points: after thoracotomy (pre-PLC), after lung resection, and after lavage at chest closure (post-PLC). Associations between recurrence-free survival (RFS) and pleural dissemination were evaluated by a Kaplan–Meier analysis and Fine and Gray competing risks regression.</p> Results <p>Forty-one patients had at least one positive PLC result. RFS was the lowest in pre-PLC( +)/post-PLC( +) (<i>n</i> = 10), intermediate in pre-PLC(–)/post-PLC( +) (<i>n</i> = 11), and best in post-PLC( −) (<i>n</i> = 20). Importantly, post-PLC( −) patients included 13 patients with pre-PLC positivity, yet their RFS matched that of consistently negative cases (<i>n</i> = 398). The cumulative incidence of pleural dissemination exhibited a similar pattern. In a multivariate analysis, post-PLC positivity, but not pre-PLC positivity, independently predicted poor RFS (hazard ratio, 3.06; <i>p</i> &lt; 0.001).</p> Conclusion <p>Post-PLC, but not pre-PLC, provides decisive prognostic information for recurrence and pleural dissemination, likely reflecting residual lavage-resistant tumor clusters. Importantly, combining pre- and post-PLC results refines risk stratification and identifies the poorest-outcome subgroup that may benefit from adjuvant therapy.</p>

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Serial changes in pleural lavage cytology during lung cancer surgery predict recurrence and pleural dissemination

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月17日

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  • Go Kamimura,
  • Masaya Aoki,
  • Satomi Imamura,
  • Shoichiro Morizono,
  • Yuto Nonaka,
  • Takuya Tokunaga,
  • Aya Harada-Takeda,
  • Koki Maeda,
  • Toshiyuki Nagata,
  • Kazuhiro Ueda

摘要

Purpose

Pleural lavage cytology (PLC) is a recognized prognostic marker in non-small cell lung cancer (NSCLC); however, the impact of serial intraoperative changes remains unclear.

Methods

We retrospectively analyzed 439 patients who underwent curative NSCLC resection. PLC was performed at three intraoperative points: after thoracotomy (pre-PLC), after lung resection, and after lavage at chest closure (post-PLC). Associations between recurrence-free survival (RFS) and pleural dissemination were evaluated by a Kaplan–Meier analysis and Fine and Gray competing risks regression.

Results

Forty-one patients had at least one positive PLC result. RFS was the lowest in pre-PLC( +)/post-PLC( +) (n = 10), intermediate in pre-PLC(–)/post-PLC( +) (n = 11), and best in post-PLC( −) (n = 20). Importantly, post-PLC( −) patients included 13 patients with pre-PLC positivity, yet their RFS matched that of consistently negative cases (n = 398). The cumulative incidence of pleural dissemination exhibited a similar pattern. In a multivariate analysis, post-PLC positivity, but not pre-PLC positivity, independently predicted poor RFS (hazard ratio, 3.06; p < 0.001).

Conclusion

Post-PLC, but not pre-PLC, provides decisive prognostic information for recurrence and pleural dissemination, likely reflecting residual lavage-resistant tumor clusters. Importantly, combining pre- and post-PLC results refines risk stratification and identifies the poorest-outcome subgroup that may benefit from adjuvant therapy.