Prognostic factors in patients presenting with pleural effusion revealing malignancy

Our plain-English summary of Prognostic factors in patients presenting with pleural effusion revealing malignancy, by S. Anevlavis, G. Kouliatsis, I. Sotiriou, et al (Respiration; International Review of Thoracic Diseases, 2014).

The study

• Authors: S. Anevlavis, G. Kouliatsis, I. Sotiriou, M.I. Koukourakis, K. Archontogeorgis, G. Karpathiou, A. Giatromanolaki, M.E. Froudarakis
• Journal: Respiration; International Review of Thoracic Diseases
• Published: 2014;87(4):311-6
• Cited by: 56 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: The survival of patients with malignant pleural effusion is considered generally poor. Most of the studies reporting results of prognostic factors are retrospective, using pleural thoracentesis for diagnosis. The objectives of our study were to reveal possible prognostic factors in patients initially presenting with undiagnosed pleural effusion proven to be malignant by diagnostic thoracoscopy.

Methods: Ninety consecutive patients, 48 of whom were male (53%), with a median age of 69 years (range 37-93) and a performance status (PS) of 0/1 (63%) and with initially undiagnosed pleural effusion that was proven to be malignant by thoracoscopy were evaluated. Survival time was defined as the time from thoracoscopic diagnosis to death or the last follow-up. A regression analysis was used to determine significant clinical and biological prognostic factors.

Results: Lung carcinoma (44.4%), breast carcinoma (24.4%), and mesothelioma (12.2%) were the most frequent tumors diagnosed. The median overall survival was 11 months (range 0.5-55). The survival of the patients was related to the following factors: histology of the primary tumor (p = 0.008), PS (p < 0.001), white blood cells (p = 0.018), and the blood neutrophil-to-lymphocyte (N/L) ratio (p = 0.002). Multiple regression showed PS, histology, and the N/L ratio.

Conclusion: The factors affecting survival in our patients were PS, primary tumor histology, and the N/L ratio. These factors may help physicians select patients for treatment and/or interventional procedures.

© 2014 S. Karger AG, Basel.

In plain English

This prospective study from Alexandroupolis, Greece, followed 90 patients whose first sign of cancer was fluid around the lung (a pleural effusion), shown to be malignant by thoracoscopy between March 2006 and December 2011. The study did not look at asbestos exposure. The talc used to seal the pleural space in some patients was described as asbestos-free. Lung cancer, breast cancer and mesothelioma (11 patients) were the most common tumours. Overall median survival was 11 months. Survival was significantly related to performance status, a score of how well patients manage daily life. Median survival was 24 months at score 0, compared with 1.5 months at score 3. Survival also varied by tumour type, from 26 months for lymphoma to 8 months for mesothelioma and 6 months for small cell lung cancer. Higher white blood cell counts and a higher blood neutrophil-to-lymphocyte ratio were linked to shorter survival. Pleural fluid pH, glucose, proteins and LDH showed no significant relation to survival. The authors concluded that tumour type, performance status and the neutrophil-to-lymphocyte ratio predicted survival.

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 patients undergoing diagnostic thoracoscopy, with survival analysis (Kaplan-Meier, univariate regression, Cox proportional hazards model)
• Who was studied: 90 treatment-naive patients (48 male, median age 69, range 37 to 93) with pleural effusion proven malignant by thoracoscopy, out of 147 consecutive patients who had diagnostic thoracoscopy at the University Hospital of Alexandroupolis, Greece, from March 2006 to December 2011. Diagnoses included non-small cell lung cancer (34), small cell lung cancer (6), breast cancer (22) and mesothelioma (11).
• Exposure: No asbestos exposure was studied. The study examined clinical and blood or pleural fluid factors in relation to survival. Talc used for pleurodesis (in 38 patients) was described as sterile asbestos-free talc.
• Main results:
  • Overall median survival of all 90 patients was 11 months (range 0.5 to 55).
  • Survival was significantly related to ECOG performance status (p less than 0.001). Median survival was 24 months at score 0, and 9, 5 and 1.5 months at scores 1, 2 and 3.
  • Survival differed by primary tumour (p = 0.008). Median survival was 26 months for lymphoma, 18 months for ovarian cancer, 15 months for breast cancer, 9.5 months for NSCLC, 8 months for mesothelioma (range 2 to 55) and 6 months for SCLC.
  • Patients with white blood cell counts below 13,000/mm3 (p = 0.001) and those with neutrophil-to-lymphocyte ratios below 3 (p = 0.002) had significantly better survival.
  • Gender, age over 70, type of intervention (diagnostic thoracoscopy vs talc poudrage, p = 0.14) and side of thoracoscopy did not significantly affect survival. There was a trend toward better survival after talc pleurodesis (median 14 vs 8.5 months).
  • No statistically significant relation was found between survival and pleural fluid pH, glucose, proteins or LDH, including when patients were grouped by tumour type (mesotheliomas: p = 0.64).
  • In the Cox model, ECOG performance status, primary tumour histology and the neutrophil-to-lymphocyte ratio were independent factors affecting survival (p = 0.020, p = 0.022 and p = 0.03).
• The authors' conclusion: The authors concluded that histology of the primary tumour, ECOG performance status and the blood neutrophil-to-lymphocyte ratio were predictors of survival in patients whose malignancy first showed as pleural effusion. They suggested these factors may help physicians select patients for treatment and/or interventional procedures.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Thoracentesis, Thoracoscopy, Performance Status, Carcinoma, Mesothelioma, Median Overall Survival, Histology.

Related studies

• Prognostic factors for survival after surgical palliation of malignant pleural effusion — J.E. Pilling, M.E. Dusmet, et al. (2010)
• Positive pleural cytology is an indicator for visceral pleural invasion in metastatic pleural effusions — M.E. Froudarakis, J. Plojoux, et al. (2018)
• Survivin is a negative prognostic factor in malignant pleural effusion — E. Arellano-Orden, B. Romero-Romero, et al. (2018)
• 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 clinical, radiographic and laboratory evaluation of prognostic factors in 363 patients with malignant pleural mesothelioma — A.C. Tanrikulu, A. Abakay, et al. (2010)
• EZH2, a unique marker of malignancy in effusion cytology — H. Jiang, R. Gupta, et al. (2014)

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