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Ann Thorac Surg 2006;82:2338-2339
© 2006 The Society of Thoracic Surgeons

Correspondence

Should Pleural Fluid Cytology Be Incorporated in the TNM Staging System for Operable Nonsmall Cell Lung Cancer?

C.S. Pramesh, MS, FRCS, Rajesh C. Mistry, MS, Jaiprakash Agarwal, MD, Ramesh Bishnoi, MS

Division of Thoracic Surgery, Department of Surgical Oncology and Radiotherapy, Tata Memorial Hospital, India, Mumbai, 400012 India

(Email: cspramesh{at}vsnl.net).

To the Editor:

We commend Enatsu and colleagues [1] on their large study demonstrating the prognostic importance of preoperative and postoperative pleural lavage cytology (PLC) in operable nonsmall cell lung cancers (NSCLCs). Prospective evaluations of almost 1,200 patients for 10 years at a single institution are a massive exercise, and the authors deserve to be congratulated on their perseverance. Although there have been previous studies [2, 3] with similar conclusions, the sheer numbers give this study irrefutable strength. The authors conclusively demonstrate that both preoperative and postoperative PLC are independent prognostic factors in operable NSCLC. The magnitude of the difference in 5-year survival (27% vs 71% in positive and negative preoperative PLC and 10% vs 73% in positive and negative postoperative PLC) clearly shows the impact that PLC has as a prognostic indicator. We wish the article had included survival data in the authors’ own institution of patients with other T4 NSCLC to compare with patients with a positive preoperative or postoperative PLC. If they were in fact similar, the results of this study would be a powerful argument for the routine performance of PLC and the incorporation of positive results as T4 disease in the present TNM staging system. We also urge the initiation of a prospective global database with a minimum dataset to be shared between large-volume centers performing lung resectional surgery for NSCLCs. This would build up a large database with multiple prognostic indicators so that an individual patient who had details included in this minimum dataset would have an accurate assessment of his disease. The use of artificial neural networks (ANNs) would then give each individual patient a reasonable estimate of the risk of recurrence or death due to disease. The use of ANNs for highly accurate prediction of prognosis has already been demonstrated in other cancers [4]. The treating oncologist and the patient would then be able to take educated decisions on whether to consider adjuvant treatment rather than a blunderbuss attitude of adjuvant treatment for all (or none). With rapid advances in computer software and ANNs, the era of customized treatment protocols for individual patients is not really too far.


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 References
 

  1. Enatsu S, Yoshida J, Yokose T, et al. Pleural lavage cytology before and after lung resection in non-small cell lung cancer patients Ann Thorac Surg 2006;81:298-304.[Abstract/Free Full Text]
  2. Kondo H, Asamura H, Suemasu K, et al. Prognostic significance of pleural lavage cytology immediately after thoracotomy in patients with lung cancer J Thorac Cardiovasc Surg 1993;106:1092-1097.[Abstract]
  3. Okada M, Sakamoto T, Nishio W, Uchino K, Tsuboshima K, Tsubota N. Pleural lavage cytology in non-small cell lung cancer: lessons from 1000 consecutive resections J Thorac Cardiovasc Surg 2003;126:1911-1915.[Abstract/Free Full Text]
  4. Sato F, Shimada Y, Selaru FM, et al. Prediction of survival in patients with esophageal carcinoma using artificial neural networks Cancer 2005;103:1596-1605.[Medline]

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Sotarou Enatsu, Junji Yoshida, Mitsuyo Nishimura, Yutaka Nishiwaki, Kanji Nagai, Tomoyuki Yokose, and Takayuki Shirakusa
Ann. Thorac. Surg. 2006 82: 2339-2340. [Extract] [Full Text] [PDF]



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S. Enatsu, J. Yoshida, M. Nishimura, Y. Nishiwaki, K. Nagai, T. Yokose, and T. Shirakusa
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Ann. Thorac. Surg., December 1, 2006; 82(6): 2339 - 2340.
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