RESUMO
BACKGROUND: In patients undergoing lung resection for non-small cell lung cancer (NSCLC), the primary TNM (tumor-regional lymph node-distant metastasis) staging system is the best prognostic factor. However, it is necessary to investigate other factors that could more accurately predict a patient's prognosis. In this study we evaluated the significance of positive intraoperative pre-resectional lavage in patients with NSCLC. METHODS: We enrolled 84 patients (79 men, 5 women) aged between 36 and 81 years (mean age, 64.8 years) undergoing a major lung resection for NSCLC, with no preoperative evidence of pleural effusions. Intraoperatively, the patients were given a pre-resectional pleural lavage with physiologic saline solution. The fluid was aspirated and sent to cytology. RESULTS: Pre-resectional pleural lavage was positive in 19 patients (22.6%). The lavage was positive in 7.3% in patients with early stage I disease (3/41) and 37.2% in patients with stage II/III disease. In the group of 16 patients with chest wall neoplastic involvement (T3), 9 had a positive lavage (56.2%; p = 0.05). No significant correlation was found between positive lavage and nodal status, visceral pleural involvement, or histologic findings. Patients with malignant cells in the pre-resectional lavage had a significantly shorter survival than patients with a negative lavage (p = 0.025). CONCLUSIONS: A positive cytology finding of intraoperative pre-resectional pleural lavage could be an important prognostic factor in patients undergoing major lung resection for NSCLC. Patients with a positive lavage should be upstaged. However, larger series are needed to define accurately the role of this technique in early stage lung cancer.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/patologia , Cuidados Intraoperatórios/métodos , Neoplasias Pulmonares/patologia , Cavidade Pleural/citologia , Derrame Pleural Maligno/diagnóstico , Irrigação Terapêutica , Adenocarcinoma/patologia , Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/secundário , Carcinoma de Células Escamosas/cirurgia , Feminino , Seguimentos , Humanos , Tábuas de Vida , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Derrame Pleural Maligno/patologia , Pneumonectomia , Valor Preditivo dos Testes , Prognóstico , Análise de SobrevidaRESUMO
In the present study, by comparing the responses in wild-type (WT) mice and mice lacking [knockout (KO)] the 5-lipoxygenase (5-LO), we investigated the role played by 5-LO in the development of acute inflammation. When compared with carragenan-treated 5-LOWT mice, 5-LOKO mice, which had received carrageenan, exhibited a reduced degree of pleural exudation, polymorphonuclear cell migration. Lung myeloperoxidase activity, an index of neutrophil infiltration, was significantly reduced in 5-LOKO mice in comparison with 5-LOWT. Lung-tissue sections from carrageenan-treated 5-LOWT mice showed positive staining for intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), P-selectin, and E-selectin, which were mainly localized around vessels. The intensity and degree of ICAM-1, VCAM-1, P-selectin, and E-selectin were markedly reduced in tissue section from carrageenan-5-LOKO mice, which also improved the histological status of the inflamed lungs. Taken together, our results clearly demonstrate that 5-LO modulates neutrophil infiltration in the acute lung inflammation.