Prognostic value of CD4+ lymphocytes in pleural cavity of patients with non-small cell lung cancer
K Takahashi, S Saito, Y Kamamura, M Katakawa, Y Monden
Second Department of
Surgery, School of Medicine, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima 770, Japan
Correspondence to: Dr K Takahashi tkeiji{at}clin.med.tokushima-u.ac.jp
Received 1 November 2000; Returned to authors 24 January 2001; Revised version received 28 February 2001; Accepted for publication 25 April 2001
BACKGROUND
For
patients with non-small cell lung cancer the TNM staging system and
other conventional prognostic factors fail to predict accurately the
outcome of treatment and survival. This study attempts to determine the
prognostic value for survival of the proportions of CD4+ lymphocytes in
the pleural cavity (PLY) of patients with resectable non-small cell
lung cancer.
METHODSLymphocytes in
the pleural cavity separated from 51 patients with non-small cell lung
cancer were examined by flow cytometry to measure the proportions of
CD4+ PLY. Univariate and multivariate analyses were performed to assess
the association between the proportion of CD4+ PLY and survival.
RESULTSThe 5 year
survival rate of patients with percentage CD4+ PLY of 
30% was 84%
whereas that of patients with %CD4+ PLY >30% was 26.9%. The
difference in survival between the %CD4+ PLY 30% and %CD4+ PLY
>30% groups was significant (p<0.0001). The %CD4+ PLY in those who
survived for 5 years was significantly lower than that in the patients
who died within 5 years (p<0.0001). The difference in survival between
patients with stage IA and IB lung cancer with %CD4+ PLY 30% and
those with %CD4+ PLY >30% was also significant (p =0.015).
Multivariate analysis showed that the proportion of CD4+ PLY (hazard
ratio=6.9, 95% CI 0.045 to 0.47) and nodal status (hazard ratio=22.7,
95% CI 0.006 to 1.806) are significant and independent prognostic
factors for the survival of patients with lung cancer.
CONCLUSIONSThe
proportion of CD4+ PLY may help to select patients who are likely to
have a poorer prognosis after surgery and therefore may be suitable for
consideration of adjuvant treatments. These results need confirmation
in a larger prospective study.
Keywords: lung cancer; prognosis; CD4
© 2001 by Thorax
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