Can serum inflammatory parameters estimate outcome of pleurodesis in mesothelioma?

Our plain-English summary of Can serum inflammatory parameters estimate outcome of pleurodesis in mesothelioma?, by M. Bilgin, L. Hasdiraz, M. Ozkaya, et al (ANZ Journal of Surgery, 2007).

The study

• Authors: M. Bilgin, L. Hasdiraz, M. Ozkaya, F. Oguzkaya
• Journal: ANZ Journal of Surgery
• Published: 2007;77(4):253-5
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: As pleurodesis causes systemic inflammation and is associated with considerable cost and morbidity during long-term follow up, the identification of patients who will experience an unsuccessful pleurodesis would be desirable. This study was aimed to investigate whether systemic inflammatory reaction induced by insuflation of talc into the pleura can predict the outcome of pleurodesis.

Methods: A total of 58 consecutive patients (26 men, 32 women) with malignant pleural mesothelioma underwent video-assisted thoracoscopy under general anaesthesia with monopulmonary ventilation between the years 2003 and 2006. Four grammes of asbestos-free and sterile talc were insuflated into the pleural space under direct vision. To assess the success of pleurodesis, chest radiographs were obtained at the 8th and 30th postoperative days. Venous blood samples were drawn both on admission and at the 24th hour after pleurodesis for the analysis of white blood cells, erythrocyte sedimentation rate and C-reactive protein.

Results: The mean age (standard deviation) of patients was 59.0 +/- 12.0 years. Pleurodesis was achieved (no effusion on chest radiograph) in 43 of 58 patients (74.1%)(group I), whereas it was unsuccessful in the remaining 15 patients (25.9%)(group II). There was a significant difference between two groups for basal and postpleurodesis levels of measured inflammatory parameters, C-reactive protein and erythrocyte sedimentation rate (for each, P < 0.05). However, the difference was not significant for white blood cells between the groups.

Conclusion: Serum levels of inflammatory parameters (C-reactive protein and erythrocyte sedimentation rate) may be used to predict the success of pleurodesis in patients with malign mesothelioma who underwent thoracoscopic talc poudrage.

In plain English

This study, from a thoracic surgery department at Erciyes University in Kayseri, Turkey, followed 58 consecutive patients (26 men, 32 women) with biopsy-confirmed malignant pleural mesothelioma. Between 2003 and 2006, each had talc pleurodesis: 4 g of asbestos-free talc was sprayed into the chest cavity during video-assisted thoracoscopy to stop fluid building up again. Blood levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cells were measured on admission and 24 hours after the procedure. Pleurodesis succeeded in 43 of 58 patients (74.1%). ESR and CRP rose significantly after the procedure only in the successful group. White blood cells rose in both groups. When the two groups were compared directly, the ESR and CRP differences were not statistically significant, and the authors found no cut-off value that predicted success. The authors called the study weakly powered, with only 15 patients in the unsuccessful group. They still believed CRP and ESR may be used as an early indicator of success, and said larger studies were needed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: prospective study of consecutive surgical patients (no comparison treatment group); patients were split by whether pleurodesis succeeded
• Who was studied: 58 consecutive patients (26 men, 32 women; mean age 59.0 years, standard deviation 12.0) with biopsy-confirmed malignant pleural mesothelioma, treated at the Department of Thoracic Surgery, Erciyes University Medical Faculty, Kayseri, Turkey, between 2003 and 2006
• Exposure: Asbestos exposure was not studied. The intervention was talc pleurodesis: 4 g of asbestos-free talc sprayed into the pleural space during video-assisted thoracoscopy. Blood ESR, CRP and white blood cells were measured at baseline and 24 hours after.
• Main results:
  • Pleurodesis succeeded (no effusion on chest radiograph) in 43 of 58 patients (74.1%, group I) and failed in 15 patients (25.9%, group II)
  • ESR and CRP rose significantly from baseline to 24 hours only in the successful group (P = 0.001 for each in the table). In the unsuccessful group the rises were not significant (P = 0.106 for ESR, P = 0.098 for CRP).
  • Mean ESR at 24 hours was 51.69 mm/h (SD 32.18) in the successful group and 58.33 mm/h (SD 34.67) in the unsuccessful group
  • White blood cell counts rose after pleurodesis in both the successful and unsuccessful groups
  • Direct comparisons between the successful and unsuccessful groups were not statistically significant for ESR or CRP (table P values 0.153 to 0.571)
  • Receiver operating characteristic analysis found no cut-off value for ESR or CRP that predicted successful pleurodesis
• The authors' conclusion: The authors still believed that serum CRP and ESR may be used as a novel early indicator of pleurodesis success in patients with malignant pleural mesothelioma. They said larger studies were needed before a definitive conclusion.
• Limitations the authors state:
  • The study was weakly powered because of the limited number of patients
  • The unsuccessful group was too small (15 patients, against 43 in the successful group) to show a significant difference for ESR and CRP
  • Larger series would be needed for a definitive conclusion

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Talc and vermiculite.

Medical terms in this study, explained in our Lexicon: Pleurodesis, Mesothelioma, Inflammation, Talc, Pleura, Pleural Mesothelioma, Thoracoscopy, Chest X-Ray.

Related studies

• Outcome and prognostic factors of pleural mesothelioma after surgical diagnosis and/or pleurodesis — M. Baud, S. Strano, et al. (2013)
• Pleurodesis outcome in malignant pleural mesothelioma — E.T. Fysh, S.K. Tan, et al. (2013)
• Clinically important associations of pleurodesis success in malignant pleural effusion: Analysis of the TIME1 data set — R.M. Mercer, J. Macready, et al. (2020)
• A randomized controlled trial of the efficacy of cosmetic talc compared with iodopovidone for chemical pleurodesis — R. Agarwal, A.S. Paul, et al. (2011)
• Tumor type influences the effectiveness of pleurodesis in malignant effusions — S. Bielsa, P. Hernández, et al. (2011)
• Success rate of medical thoracoscopy and talc pleurodesis in malignant pleurisy: A single-centre experience — J. Leemans, C. Dooms, et al. (2018)

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