Prognostic impact of pleural effusion in patients with malignancy: A systematic review and meta‐analysis

Abstract

The exact role of pleural effusion in the prognosis of cancer patients remains unclear. We aimed to systematically review the prognostic value of pleural effusion in patients with cancer. We performed a systematic review and meta-analysis with a systematic literature search. All cohort studies with available overall survival (OS) and progression-free survival (PFS) results for patients with cancer with or without pleural effusion were included. The Mantel-Haenszel method was used to calculate the pooled hazard ratios (HRs) and 95% confidence intervals (CIs).Heterogeneity and publication bias were examined. Subgroup analysis and sensitivity analysis were performed. A total of 47 studies with 146,117 patients were included in the analysis. For OS, pleural effusion was a prognostic factor associated with a poor prognosis for patients with cancer (HR, 1.58, 95% CI, 1.43-1.75; I 2 94.8%). In the subgroup analysis, pleural effusion was a prognostic factor associated with poor survival for patients with lung cancer (HR, 1.44, 95% CI, 1.35-1.54; I 2 60.8%), hematological cancer (HR, 2.79, 95% CI, 1.63-4.77; I 2 29.4%) and other types of cancer (HR, 2.08, 95% CI, 1.43-3.01; I 2 55.1%). For PFS, pleural effusion was a prognostic factor associated with a poor prognosis for patients with cancer (HR, 1.61, 95% CI, 1.28-2.03; I 2 42.9%). We also observed that massive pleural effusion was a prognostic factor associated with a poorer prognosis compared to minimal pleural effusion. Pleural effusion had prognostic value in both OS and PFS of patients with cancer, except for patients with malignant pleural mesothelioma, regardless of whether the malignant effusion was confirmed histologically or cytologically. However, future evidence of other pleural effusion characteristics is still needed.

Survival analysis and prognosis of patients with breast cancer with pleural metastasis

“…Although we observed significant differences in M-OS among the four molecular subtypes of BC (Supplemental Figures 3A, B), multivariate Cox results revealed that it was not an independent prognostic factor for patients with only PM. Similarly, Yang Y et al suggested that the prognosis of patients with cancer with MPE was independent of histology (41). This may be caused by the particularities of the studied patients or by data bias.…”

“…In our results, the incidence of MPE in patients with PM (81.0% in group A and 76.7% in group C) was high. On the one hand, MPE is consider an unfavorable complication that restricts life quality ( 41 ) and related to poor prognosis ( 42 ). Consistently, our study reported that in BC, MPE was an independent risk factor for patients with PM.…”

“…Similarly, Yang Y et al. suggested that the prognosis of patients with cancer with MPE was independent of histology ( 41 ). This may be caused by the particularities of the studied patients or by data bias.…”

Impact of multidisciplinary team on the pattern of care for brain metastasis from breast cancer

“…However, a part of these therapies was less available before they were included by national healthcare since 2019. Yang reported that 40.5% of HER2-positive patients with BM did not receive anti-HER2 therapy between 2003 and 2015 ( 19 ). In a previous study from our center, Ou et al.…”

Correlative analysis from a phase I clinical trial of intrapleural administration of oncolytic vaccinia virus (Olvi-vec) in patients with malignant pleural mesothelioma

“…With an estimated annual incidence of at least 150,000 patients in the United States, malignant pleural effusions (MPEs) occur in 15% of all patients with cancer during the course of their disease ( 1 ). In addition to causing symptoms that limit quality of life, such as shortness of breath that requires interventions ( 2 ), the presence of MPE represents advanced cancer and contributes to poor prognosis ( 3 ). Palliative interventions have been the mainstay for symptomatic relief and prevention of MPE recurrence that can interrupt cancer therapy in patients with MPE ( 2 , 4 ).…”