Survival in patients with malignant pleural effusion undergoing talc pleurodesis

Our plain-English summary of Survival in patients with malignant pleural effusion undergoing talc pleurodesis, by M. Hassan, R.M. Mercer, N.A. Maskell, et al (Lung Cancer, 2019).

The study

• Authors: M. Hassan, R.M. Mercer, N.A. Maskell, R. Asciak, D.J. McCracken, E.O. Bedawi, H. Shaarawy, A. El-Ganady, I. Psallidas, R.F. Miller, N.M. Rahman
• Journal: Lung Cancer
• Published: 2019;137:14-18
• Cited by: 32 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objectives: Recent observations indicate a potential survival benefit in patients with malignant pleural effusion (MPE) who achieve successful pleurodesis in comparison to patients who experience effusion recurrence post pleurodesis. This study aimed to explore this observation using two datasets of patients with MPE undergoing talc pleurodesis.

Materials And Methods: Dataset 1 comprised patients who underwent talc pleurodesis at Oxford Pleural Unit for MPE. Dataset 2 comprised patients enrolled in the TIME1 clinical trial. Pleurodesis success was defined as absence of need for further therapeutic procedures for MPE in the three months following pleurodesis. Data on various clinical, laboratory and radiological parameters were collected and survival was compared according to pleurodesis outcome (success vs. failure) after adjusting for the aforementioned parameters.

Results: Dataset 1 comprised 60 patients with mean age 74.1±10.3 years. The most common primary malignancies were mesothelioma, breast and lung cancer. 29 patients (48.3%) achieved pleurodesis. The adjusted odds ratio (aOR) for poor survival with pleurodesis failure was 2.85 (95% CI 1.08-7.50, =p 0.034). Dataset 2 comprised 259 patients from the TIME1 trial. The mean age was 70.8±10.3 and the most common primary malignancies were mesothelioma, lung and breast cancer. Pleurodesis was successful in 205 patients (79%). aOR for poor survival was 1.62 (95% CI 1.09-2.39, p = 0.015).

Conclusion: Achieving pleurodesis seems to impart a survival benefit in patients with MPE. Further studies are required to explore factors that may contribute to this phenomenon and to address the difference in survival between pleurodesis and indwelling pleural catheter interventions.

Copyright © 2019 Elsevier B.V. All rights reserved.

In plain English

This study looked back at two groups of patients with malignant pleural effusion (cancer-caused fluid around the lung) treated with talc pleurodesis, a procedure meant to stop the fluid returning. One group was 60 patients treated at the Oxford Pleural Unit in 2016 and 2017; the other was 259 patients from the TIME1 trial. Mesothelioma was the most common cancer in both groups. Pleurodesis succeeded in 29 of 60 Oxford and 205 of 259 trial patients. Oxford median survival was 16 months (95% CI 8.06 to 23.93) after success and 5 months (95% CI 2.57 to 7.48) after failure. Trial figures were 11 months (95% CI 10.81 to 11.18) and 6.4 months (95% CI 4.87 to 7.93) respectively. After adjusting for other factors, failure was linked to poorer survival: adjusted odds ratio 2.85 (95% CI 1.08 to 7.50; 45 Oxford patients) and 1.62 (95% CI 1.09 to 2.39; 222 trial patients). The authors concluded there is an association between successful pleurodesis and survival. They called the results by no means definitive and had no data on patients' general fitness (performance status).

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: Post-hoc analysis of two independent, non-overlapping datasets: a clinical cohort from one hospital unit and patients from a randomised controlled trial (TIME1)
• Who was studied: Dataset 1: 60 patients (of 69) with malignant pleural effusion who had talc pleurodesis at the Oxford Pleural Unit, UK, in 2016 and 2017, with mean age 74.1 years. Dataset 2: 259 patients from the TIME1 trial, with mean age 70.8 years. The trial recruited 320 patients in the UK, US and Canada between 2007 and 2013, and 285 of them were in the trial's final analysis. Only patients who survived at least one month and whose pleurodesis outcome was known were included. Mesothelioma was the most common primary cancer in both datasets: 22 of 60 (36.6%) in Dataset 1 and 104 of 259 (40%) in Dataset 2.
• Exposure: Talc pleurodesis, given either as thoracoscopic talc poudrage or as talc slurry through a chest drain. Survival was compared by pleurodesis outcome, success versus failure, where failure meant needing further procedures for the effusion within three months. The article does not study asbestos exposure.
• Main results:
  • Dataset 1: pleurodesis succeeded in 29 of 60 patients (48.3%).
  • Dataset 1: median survival was 16 months (95% CI 8.06 to 23.93) for patients with successful pleurodesis and 5 months (95% CI 2.57 to 7.48) for those whose pleurodesis failed (p = 0.007).
  • Dataset 1: after adjustment for other factors (45 patients in the model), the adjusted odds ratio for poor survival with pleurodesis failure was 2.85 (95% CI 1.08 to 7.50, p = 0.034).
  • Dataset 2 (TIME1): pleurodesis succeeded in 205 of 259 patients (79%).
  • Dataset 2: median survival was 11 months (95% CI 10.81 to 11.18) after successful pleurodesis and 6.4 months (95% CI 4.87 to 7.93) after failed pleurodesis (p = 0.001).
  • Dataset 2: the adjusted odds ratio for poor survival with pleurodesis failure was 1.62 (95% CI 1.09 to 2.39, p = 0.015) in a model of 222 patients. A second model that also adjusted for pleural fluid LDH, based on only 157 patients, gave 1.86.
• The authors' conclusion: The authors concluded that the study supports an association between achieving successful pleurodesis and survival in patients with malignant pleural effusion. They said further studies are needed to explore why, and that talc pleurodesis and indwelling pleural catheters should be compared in prospective studies.
• Limitations the authors state:
  • No data on patients' performance status were available in either dataset.
  • Other possible confounders could not be accounted for because data were lacking: extent of metastatic disease, time from cancer diagnosis to pleurodesis, and degree of response to anti-cancer treatment.
  • The authors described the results of this post-hoc analysis as not definitive.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Talc Pleurodesis, Pleurodesis, Clinical Trial, Mesothelioma, Lung Cancer, Odds Ratio, Indwelling Pleural Catheter.

Related studies

• Clinically important associations of pleurodesis success in malignant pleural effusion: Analysis of the TIME1 data set — R.M. Mercer, J. Macready, et al. (2020)
• Indwelling pleural catheter versus talc pleurodesis for malignant pleural effusion: a meta-analysis — M. Yeung, E.W. Loh, et al. (2020)
• 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)
• Prognostic factors in malignant pleural mesothelioma: role of talc pleurodesis — B.S. Al-Alao, H. Parissis, et al. (2012)
• CT appearances of talc pleurodesis — S. Narayanaswamy, S. Kamath, et al. (2007)

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