Breathlessness Predicts Survival in Patients With Malignant Pleural Effusions

Mishra, Eleanor; Muruganandan, Sanjeevan; Clark, Allan; Bhatnagar, Rahul; Maskell, Nick A; Lee, Y. C. Gary; Rahman, Najib M.

doi:10.1016/j.chest.2021.02.052

Cited by 18 publications

(11 citation statements)

References 28 publications

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“…13 Our recent meta-analysis 7 of five randomized controlled trials demonstrated, in individuals with MPE, increasing breathlessness is independently associated with worsening survival. 7 The same relationship has been observed in other respiratory and cardiovascular diseases, such as interstitial lung disease (ILD) 14 and chronic obstructive pulmonary disease (COPD). 15 The mechanism of this association is unclear.…”

Section: Pleural Effusion Survival and Breathlessnessmentioning

confidence: 62%

“…Median survival in patients with MPE is about 6 months. 7 A previous prospective cohort study of patients under the care of a specialist pleural service with cardiac, renal, and hepatic disease showed a 1-year mortality rates of 50, 46, and 25%, respectively. 13 Our recent meta-analysis 7 of five randomized controlled trials demonstrated, in individuals with MPE, increasing breathlessness is independently associated with worsening survival.…”

Section: Pleural Effusion Survival and Breathlessnessmentioning

confidence: 98%

“…5 Unfortunately, not all patients have symptom benefit from pleural drainage. 6,7 As a result, some are exposed to the risk of complications of the procedure, 8 further reducing their quality of life, without symptom benefit. An accurate method to identify patients without pleural infection who will benefit from pleural fluid drainage would reduce unnecessary interventions.…”

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confidence: 99%

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Breathlessness with Pleural Effusion: What Do We Know?

Muruganandan

Mishra

Singh

2023

Semin Respir Crit Care Med

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Breathlessness is the most common symptom in individuals with pleural effusion and is often disabling. The pathophysiology of breathlessness associated with pleural effusion is complex. The severity of breathlessness correlates weakly with the size of the effusion. Improvements in ventilatory capacity following pleural drainage are small and correlate poorly with the volume of fluid drained and improvements in breathlessness. Impaired hemidiaphragm function and a compensatory increase in respiratory drive to maintain ventilation appear to be an important mechanism of breathlessness associated with pleural effusion. Thoracocentesis reduces diaphragm distortion and improves its movement; these changes appear to reduce respiratory drive and associated breathlessness by improving the neuromechanical efficiency of the diaphragm.

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Section: Pleural Effusion Survival and Breathlessnessmentioning

confidence: 62%

Section: Pleural Effusion Survival and Breathlessnessmentioning

confidence: 98%

mentioning

confidence: 99%

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Breathlessness with Pleural Effusion: What Do We Know?

Muruganandan

Mishra

Singh

2023

Semin Respir Crit Care Med

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“…Malignant pleural effusion (MPE) refers to the accumulation of pleural fluid caused by thoracic malignancies and still lacks standard managements currently 2 . Patients have a median survival of only 4−7 months from the time of diagnosis and usually suffer from severe respiratory distress due to the presence and recurrence of MPE 3–5 . Removing fluid and preventing its accumulation is presently the main strategy for the management of MPE 6,7 .…”

Section: Introductionmentioning

confidence: 99%

Single‐cell transcriptomics reveal metastatic CLDN4+ cancer cells underlying the recurrence of malignant pleural effusion in patients with advanced non‐small‐cell lung cancer

Zhang,

Wang,

Wen

et al. 2024

Clinical & Translational Med

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BackgroundRecurrent malignant pleural effusion (MPE) resulting from non‐small‐cell lung cancer (NSCLC) is easily refractory to conventional therapeutics and lacks predictive markers. The cellular or genetic signatures of recurrent MPE still remain largely uncertain.Methods16 NSCLC patients with pleural effusions were recruited, followed by corresponding treatments based on primary tumours. Non‐recurrent or recurrent MPE was determined after 3–6 weeks of treatments. The status of MPE was verified by computer tomography (CT) and cytopathology, and the baseline pleural fluids were collected for single‐cell RNA sequencing (scRNA‐seq). Samples were then integrated and profiled. Cellular communications and trajectories were inferred by bioinformatic algorithms. Comparative analysis was conducted and the results were further validated by quantitative polymerase chain reaction (qPCR) in a larger MPE cohort from the authors' centre (n = 64).ResultsThe scRNA‐seq revealed that 33 590 cells were annotated as 7 major cell types and further characterized into 14 cell clusters precisely. The cell cluster C1, classified as Epithelial Cell Adhesion Molecule (EpCAM)+ metastatic cancer cell and correlated with activation of tight junction and adherence junction, was significantly enriched in the recurrent MPE group, in which Claudin‐4 (CLDN4) was identified. The subset cell cluster C3 of C1, which was enriched in recurrent MPE and demonstrated a phenotype of ameboidal‐type cell migration, also showed a markedly higher expression of CLDN4. Meanwhile, the expression of CLDN4 was positively correlated with E74 Like ETS Transcription Factor 3 (ELF3), EpCAM and Tumour Associated Calcium Signal Transducer 2 (TACSTD2), independent of driver‐gene status. CLDN4 was also found to be associated with the expression of Hypoxia Inducible Factor 1 Subunit Alpha (HIF1A) and Vascular Endothelial Growth Factor A (VEGFA), and the cell cluster C1 was the major mediator in cellular communication of VEGFA signalling. In the extensive MPE cohort, a notably increased expression of CLDN4 in cells from pleural effusion among patients diagnosed with recurrent MPE was observed, compared with the non‐recurrent group, which was also associated with a trend towards worse overall survival (OS).ConclusionsCLDN4 could be considered as a predictive marker of recurrent MPE among patients with advanced NSCLC. Further validation for its clinical value in cohorts with larger sample size and in‐depth mechanism studies on its biological function are warranted.Trial registrationNot applicable.

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“…As the result showed, patients with atelectasis had worse outcomes of COVID-19, which may be attributed to causes of atelectasis, such as malignant pleural effusion and bronchial obstruction, leading to further lung deterioration. 9 Atelectasis can also induce local tissue inflammation and immune response disorders, increasing the vulnerability to infection. 10 In conclusion, we found that ILD and atelectasis are correlated with an elevated likelihood of adverse outcomes in cancer patients receiving ICIs.…”

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confidence: 99%

Association of lung diseases with coronavirus disease 2019 in cancer patients receiving immune checkpoint inhibitors: A multicenter study during national Omicron outbreak in China

Li,

Wang,

Zhang

et al. 2023

Clinical & Translational Med

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Breathlessness Predicts Survival in Patients With Malignant Pleural Effusions

Cited by 18 publications

References 28 publications

Breathlessness with Pleural Effusion: What Do We Know?

Breathlessness with Pleural Effusion: What Do We Know?

Single‐cell transcriptomics reveal metastatic CLDN4+ cancer cells underlying the recurrence of malignant pleural effusion in patients with advanced non‐small‐cell lung cancer

Association of lung diseases with coronavirus disease 2019 in cancer patients receiving immune checkpoint inhibitors: A multicenter study during national Omicron outbreak in China

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