Prognostic Factors in Patients Presenting with Pleural Effusion Revealing Malignancy

Abstract

Background: The survival of patients with malignant pleural effusion is considered generally poor. Most of the studies reporting results of prognostic factors are retrospective, using pleural thoracentesis for diagnosis. The objectives of our study were to reveal possible prognostic factors in patients initially presenting with undiagnosed pleural effusion proven to be malignant by diagnostic thoracoscopy. Methods: Ninety consecutive patients, 48 of whom were male (53%), with a median age of 69 years (range 37-93) and a performance status (PS) of 0/1 (63%) and with initially undiagnosed pleural effusion that was proven to be malignant by thoracoscopy were evaluated. Survival time was defined as the time from thoracoscopic diagnosis to death or the last follow-up. A regression analysis was used to determine significant clinical and biological prognostic factors. Results: Lung carcinoma (44.4%), breast carcinoma (24.4%), and mesothelioma (12.2%) were the most frequent tumors diagnosed. The median overall survival was 11 months (range 0.5-55). The survival of the patients was related to the following factors: histology of the primary tumor (p = 0.008), PS (p < 0.001), white blood cells (p = 0.018), and the blood neutrophil-to-lymphocyte (N/L) ratio (p = 0.002). Multiple regression showed PS, histology, and the N/L ratio. Conclusion: The factors affecting survival in our patients were PS, primary tumor histology, and the N/L ratio. These factors may help physicians select patients for treatment and/or interventional procedures.

Should We Really Compare Indwelling Pleural Catheters to Any Pleurodesis?

“…Any neoplasm may lead to this manifestation: in primary tumors of the pleura (mesothelioma), it occurs in up to 95% of the cases, whereas in metastatic neoplasms in males lung carcinomas account for 40% and in females breast carcinomas account for 30% [1,2]. Although the survival of patients with MPE is globally reported to be poor, we have to differentiate between patients with MPE as an initial manifestation of the disease, who are naïve to any treatment, and patients with MPE occurring during disease progression, who are relapsing and/or resisting to treatment [3]. …”

Prognostic Factors in Patients with Malignant Pleural Effusion

“…We read with interest the study by Anevlavis et al [1] in which they shortlisted 3 prognostic factors that determine survival in malignant pleural effusion. Certain points need discussion for better interpretation.…”

Authors' Reply

“…We consider the mechanisms concerned to have been sufficiently explained and discussed in our published paper [1] as well as in the international literature [3,4,5,6]. In addition, patients presenting with significant comorbidities that can affect short-term survival and therefore the outcome of thoracoscopy, such as hypoventilation or unstable cardiac disease, are not suitable for any interventional procedure [7].…”

“…In addition, patients presenting with significant comorbidities that can affect short-term survival and therefore the outcome of thoracoscopy, such as hypoventilation or unstable cardiac disease, are not suitable for any interventional procedure [7]. Regarding the subgroup analysis in lung cancer patients, as you probably noticed in our table 1 [1], there were 34 patients with non-small cell lung cancer and 6 with small cell lung cancer. To perform subgroup analyses by combining histological subtypes with performance status and all assessed parameters would have resulted in groups with very few patients, with the result that no reliable interpretations could have been made and no useful conclusions could have been drawn.…”

“…Indeed, as you mentioned in your letter, we designed our study to include only patients in whom pleural effusion was the presenting syndrome, and we therefore excluded all patients with an already known carcinoma who secondarily developed pleural effusion [1]. It is a fallacy that all patients with malignant pleural effusion are likely to have poor survival.…”