Prognosis of Cancer with Synchronous or Metachronous Malignant Pleural Effusion

Our plain-English summary of Prognosis of Cancer with Synchronous or Metachronous Malignant Pleural Effusion, by J.M. Porcel, C. Solé, A. Salud, et al (Lung, 2017).

The study

• Authors: J.M. Porcel, C. Solé, A. Salud, S. Bielsa
• Journal: Lung
• Published: 2017;195(6):775-779
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: Malignant pleural effusions (MPE) may either coincide with or follow the diagnosis of a primary tumor. Whether this circumstance influences prognosis has not been well substantiated.

Methods: Retrospective review of all consecutive patients who were cared for at a Spanish university hospital during an 11-year period and received a diagnosis of MPE.

Results: Of 401 patients, the MPE was the first evidence of cancer in 265 (66%), and it followed a previously diagnosed neoplasm in 136 (34%). Lung cancer predominated in the former group (131, 50%), and breast cancer in the latter (55, 40%). MPE that were the presenting manifestation of hematological and ovarian tumors had a statistically significant survival advantage as compared to those which developed in patients from a previously known cancer (respective absolute differences of 41 and 20 months; p < 0.005).

Conclusions: In hematological and ovarian malignancies, the synchronous or metachronous diagnosis of MPE may have prognostic implications.

In plain English

This retrospective review looked at patients diagnosed with malignant pleural effusion (fluid around the lungs caused by cancer) at Arnau de Vilanova University Hospital in Lleida, Spain, from January 2006 to January 2017. Of 644 patients diagnosed, the 401 whose diagnosis was confirmed from pleural fluid or tissue were studied. In 265 (66%) the effusion was found at the same time as the cancer (group A). In 136 (34%) it appeared after a cancer was already known (group B). Most effusions from lung cancer (84%) and from mesothelioma (12 of 13 patients) were in group A. The one group B mesothelioma was peritoneal and later involved the pleura. Most breast cancer effusions (87%) appeared later, a median of 70 months after the cancer was found. Overall median survival was 4 months. Median survival was longer in group A than in group B for hematological cancers (44 vs 3 months) and ovarian cancer (22 vs 2 months). This difference held after adjusting for performance status. The study did not examine asbestos exposure. The authors concluded that the overall prognosis was poor in both groups.

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 consecutive patients at a single hospital
• Who was studied: 401 patients (195 men, 206 women, median age 70) with malignant pleural effusion confirmed by pleural cytology or histology, out of 644 diagnosed at Arnau de Vilanova University Hospital, Lleida, Spain, January 2006 to January 2017. Group A (effusion found together with the cancer) was 265 (66%). Group B (effusion found after a known cancer) was 136 (34%).
• Exposure: Asbestos exposure was not studied. The comparison was based on timing: synchronous effusion (found together with the primary tumor) versus metachronous effusion (primary tumor diagnosed before the effusion). Tumor types included lung, breast, hematological, gastrointestinal, ovarian, unknown origin and mesothelioma.
• Main results:
  • The effusion and the primary tumor were diagnosed at the same time (group A) in most patients with lung cancer (84%), unknown primary (94%) and mesothelioma (92%, 12 of 13).
  • The single group B mesothelioma was a peritoneal mesothelioma that later involved the pleura.
  • 87% of breast cancer patients developed the effusion a median of 70 (29–135) months after the cancer was found.
  • Overall median survival of all 401 patients was 4 (3.2–4.8) months. Patients with breast cancer, hematological malignancies and mesothelioma had longer survival (11, 9 and 9 months).
  • Survival was longer in group A than in group B for hematological cancers (44 vs 3 months, p = 0.004) and ovarian cancers (22 vs 2 months, p = 0.001).
  • After adjusting for performance status (ECOG-PS), a later-appearing (metachronous) effusion had hazard ratios of 2.83 (95% CI 1.21–6.61) in hematological tumors and 3.76 (95% CI 1.36–10.37) in ovarian tumors.
  • The mesothelioma comparison between groups A and B was considered uninterpretable because group B had only one patient.
  • The need for palliative pleural interventions was similar in group A and group B (57% vs 66%, p = 0.108).
• The authors' conclusion: The authors concluded that an effusion appearing as the first sign of hematological or ovarian cancer carried a survival advantage over one appearing later in the disease. They also concluded that malignant pleural effusion had a poor overall prognosis either way.
• Limitations the authors state:
  • Retrospective design, and relatively small numbers of patients with some specific primary tumor types.
  • Probable malignant effusions with negative cytology were not investigated.
  • Single-center study; the authors said the results must be confirmed by others.
  • Only 8 breast cancer patients were in group A, too few for meaningful comparison of breast cancer subtypes.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma, Ovarian cancer.

Medical terms in this study, explained in our Lexicon: Prognosis, Pleural Effusion, Neoplasm, Lung Cancer.

Related studies

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• Soluble AXL is ubiquitously present in malignant serous effusions — K. Flem Karlsen, E. McFadden, et al. (2019)
• Diagnosis and origin determination of malignant pleural effusions through the use of the breast cancer marker human mammaglobin — S. Roncella, P. Ferro, et al. (2010)
• PINCH-2 expression in cancers involving serosal effusions using quantitative PCR — Y. Yuan, H.P. Dong, et al. (2011)
• Video-assisted management of malignant pleural effusion in breast carcinoma — R. Gasparri, F. Leo, et al. (2006)
• EZH2, a unique marker of malignancy in effusion cytology — H. Jiang, R. Gupta, et al. (2014)

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