Original articlePrognostic significance of pleural fluid data in patients with malignant effusion
Introduction
Malignant pleural effusion (MPE) indicates advanced neoplastic disease (i.e. IIIB stage in lung cancer and IV stage in breast cancer) and implies lower survival and quality of life for the patient [1], [2]. The decision to employ a palliative treatment such as pleurodesis depends on the presence of dyspnea secondary to MPE, pulmonary re-expansion after pleural fluid (PF) evacuation and expected survival. Thus, it is important to consider the influence of those prognostic factors that may predict a short-term outcome [3].
It is known that survival in MPE is directly associated with the type of tumor and the patient's functional state (measured by the Karnofsky index) [4]. However, the effect of other factors, such as the biochemistry of the PF [5], [6] or the size of the pleural effusion (PE) [7], [8], is less clear. The present study was performed to determine whether patient survival is affected by the type of pleural cavity tumor, the biochemistry of the PF or the size of the MPE, and the relative contribution of each of these potential predictors of survival.
Section snippets
Methods
The Ethics Committee of the Arnau de Vilanova University Hospital in Lleida, Spain, approved this study in accordance with the recommendations found in the Helsinki declaration. Clinical, radiological and biochemical data on patients with MPE were collected from our pleural effusion database. Patients submitted to a diagnostic thoracentesis from June 1993 to August 2006 were included in this retrospective analysis. We collected information on patient age and sex; size and localization of the PE
Patients and tumor type
A total of 1431 patients with PE were identified, of which 284 had MPE confirmed by cytological studies of PF (262 patients) or pleural biopsy (22 patients). There were 150 males and 134 women with a mean age of 67 ± 13 years. The date of death of 206 patients was obtained, while in 66 patients the follow-up was lost a median of 4 months (range 1 day to 72 months) after MPE diagnosis. Moreover, 12 patients were still alive at the end of the study with a median survival of 11 months (range 5 days
Discussion
Part of the rationale for initiating certain palliative treatments such as pleurodesis is the prediction of a good prognosis in the short term [1]. The diagnosis of MPE implies a poor survival, which was shown in our study to be 5.4 months (median). In a previous meta-analysis of 417 patients with MPE, a median survival of 4 months was observed [9]. We hypothesize that such variation in the predicted duration of survival for MPE patients depends upon the type of primary tumor. When viewed as a
Learning points
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Pleural fluid analysis has not only diagnostic but also prognostic significance in patients with malignant effusions.
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The finding of high LDH or low protein concentrations in the pleural fluid anticipates a poor survival. Pleural acidosis is also a poor prognostic factor in metastatic malignant effusions.
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