Predictors of mortality within three months in the patients with malignant pleural effusion

Our plain-English summary of Predictors of mortality within three months in the patients with malignant pleural effusion, by M.O. Ozyurtkan, A.E. Balci, M. Cakmak (European Journal of Internal Medicine, 2010).

The study

• Authors: M.O. Ozyurtkan, A.E. Balci, M. Cakmak
• Journal: European Journal of Internal Medicine
• Published: 2010;21(1):30-4
• Cited by: 30 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Malignant pleural effusion (MPE) has a limited life expectancy (3-12 months). We investigated the predictors of the early mortality (EM) within three months.

Methods: The patients were retrospectively grouped according to the death within three months (Group I) and survival more than three months (Group II). Demographical, clinical, and biochemical parameters in the fluid were analysed to determine their effects on the EM. The 30-day response rate of talc pleurodesis was investigated.

Results: The study included 85 patients (Group I/Group II=40/45). The patients in Group I died within a median of 28 days. Twenty-six patients in Group II died in a median of 205, but 19 were still alive (median 200 days). The median survival was longer in renal cell, colorectal, breast, liver, ovarian and oropharynx carcinoma, and mesothelioma. Sixty-two patients (63%) underwent talc pleurodesis, which prevented the fluid reaccumulation (p=0.04). The significant factors of the EM in the univariate analysis were the presence of high-risk tumors (lung, stomach, soft tissue, bladder, esophagus, prostate, cervix, and lymphoma), the low Karnofsky performance score (KPS) (p<0.0001), the low pH value of the fluid (p=0.05), and the low concentration of glucose (p=0.01), total protein (p<0.0001), and albumin (p<0.0001) in the fluid. According to the multivariate analysis high-risk tumors (p=0.03), a lower KPS (p<0.001), and glucose value (p=0.04) were the predictors of the EM.

Conclusion: Talc pleurodesis prevents the fluid reaccumulation. High-risk tumors, a poor performance status, and lower pleural fluid glucose concentration are predictors of the EM within three months in the patients with a MPE.

Copyright 2009 Elsevier B.V. All rights reserved.

In plain English

This retrospective study at Firat University in Elazığ, Turkey, reviewed 85 patients with malignant pleural effusion (fluid around the lung caused by cancer) referred from September 2005 to May 2009. The article does not discuss asbestos. Forty patients died within three months of diagnosis (after a median of 28 days), and 45 lived longer. Mesothelioma and lung cancer were the most common tumors, with 20 patients each. The 20 mesothelioma patients had a median survival of 180 days. In the multivariate analysis, three factors predicted death within three months: a low Karnofsky performance score (a measure of daily functioning), lower pleural fluid glucose, and a 'high-risk' tumor type, meaning one whose median survival was below the overall study median of 105 days. Talc pleurodesis was performed in 62 patients (73%). At 30 days, among patients who had not died within a month, those given talc had better responses (less fluid returning) than the eight treated by drainage alone. The authors concluded that early death was common with poor performance status, a high-risk tumor and low pleural fluid glucose. They noted the series was relatively small.

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: retrospective review of patient files (single-institution clinical series)
• Who was studied: 85 patients (48 male, 37 female; mean age 59, range 28 to 80) with malignant pleural effusion referred to a thoracic surgery department in Elazığ, Turkey, September 2005 to May 2009. 40 died within three months (Group I) and 45 survived longer (Group II).
• Exposure: No asbestos or fiber exposure was studied. The study examined demographic, clinical and pleural fluid factors as predictors of early death. It also compared treatment with talc pleurodesis (5 grams of talc given through the chest tube) against drainage alone.
• Main results:
  • Group I patients died a median of 28 days (range 5 to 90) after diagnosis. In Group II, 26 patients died at a median of 205 days, and 19 were still alive at the end of the study.
  • Mesothelioma and lung cancer were the most common primary tumors (20 patients each, 23.5%). Mesothelioma (median survival 180 days) was among the tumor types with a longer median survival than the overall median of 105 days.
  • High-risk tumors were defined as tumor types with a median survival below the median of the whole sample. 26 patients (65%) in Group I had a high-risk tumor (lung, stomach, soft tissue, bladder, esophagus, prostate, cervix, lymphoma), compared with nine patients (20%) in Group II.
  • Mean Karnofsky performance score was 44 (plus or minus 16) in Group I versus 69 (plus or minus 12) in Group II. A score of 50 or less was the best threshold for predicting early death.
  • In the multivariate analysis, three factors predicted death within three months: low performance score (p less than 0.0001), lower pleural fluid glucose (p=0.04) and a high-risk tumor (p=0.03). In the univariate analysis, lower fluid pH, total protein and albumin were also significant, but fluid LDH was not associated with early death.
  • Talc pleurodesis was performed in 62 patients (73%), with complications in three (5%). The 30-day responses were assessed after excluding 22 patients who died within a month. Talc patients had 42 complete, 8 partial and 5 no responses, versus 3, 4 and 1 for drainage only (p=0.04). Patients not given talc had been judged unsuitable for it.
• The authors' conclusion: The authors concluded that talc pleurodesis is effective in preventing fluid reaccumulation. They also concluded that death within three months of diagnosis is common in patients with a poor performance status, a high-risk tumor, and low pleural fluid glucose.
• Limitations the authors state:
  • The authors note that the series had a relatively small number of patients (in the context of comparing survival by tumor type).

Topics

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Life Expectancy, Talc Pleurodesis, Median Survival, Carcinoma, Mesothelioma, Multivariate Analysis, Performance Status.

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