Abstract
BackgroundThe approach to palliative treatment of malignant pleural effusion (MPE) should be individualized because these patients generally have poor survival. Our study aimed to develop a model to identify prognostic factors or survival time in patients diagnosed with MPE.MethodsThis is a retrospective, descriptive, observational study to identify prognostic factors related to MPE in patients with a confirmed cancer diagnosis. Cox regression analysis was used to determine significant potential prognostic factors with respect to survival time. Survival time was defined as the time from pathological diagnosis to death.ResultsOne hundred and sixty-five patients were included; 77 were men (47%) and 88 were women (53%). The median age was 60 years, and all of the patients were pathologically proven to have MPE. Non-small-cell lung cancer (36.0%), breast carcinoma (26%), and lymphoma (13.0%) were the most frequently diagnosed tumors. The median overall survival of patients from the initial diagnosis was 5 months (range: 1.0–96.0 months). Kaplan–Meier univariate analysis showed that survival was significantly related to the following prognostic factors: ECOG PS (hazard ratio [HR] 10.0, 95% confidence interval [95% CI] 5.96 to 18.50, p < 0.0001), primary cancer site (HR 1.99, 95% CI 1.23 to 3.22, p < 0.01), positive pleural cytology (HR 1.25, 95% CI 0.88 to 1.78, p = 0.04), and positive histology (HR 1.33, 95% CI 0.97 to 1.81, p = 0.04). Other potential independent diagnostic factors that were examined did not affect survival. Cox regression analysis showed that only the ECOG PS was highly predictive of survival (HR 73.58, 95% CI 23.44 to 230.95, p < 0.0001).ConclusionsECOG PS is an independent predictor of survival in patients with MPE at initial diagnosis. This prognostic factor can help physicians select patients for appropriate palliative treatment of this syndrome.
Highlights
The approach to palliative treatment of malignant pleural effusion (MPE) should be individualized because these patients generally have poor survival
MPE can be a complication of any malignancy, but in patients with lung cancer, the frequency of MPE ranges from 7% to 23% [1] MPE is characteristic of advanced malignancies, but it may appear in patients with a longer projected survival
The most common symptoms that were reported by patients were dyspnea (80%) with a modified Medical Research Council score of 2 to 4, dull chest pain (30%), and nonproductive cough (10%)
Summary
The approach to palliative treatment of malignant pleural effusion (MPE) should be individualized because these patients generally have poor survival. Our study aimed to develop a model to identify prognostic factors or survival time in patients diagnosed with MPE. A malignant pleural effusion (MPE) is often the first sign of cancer and it is a prognostic factor in patients with advanced disease. The quality of life in patients with MPE is usually compromised because of distressing symptoms, such as coughing, dyspnea, and chest pain [2,3,4]. The presence of MPE signifies an advanced stage of disease and usually indicates that death will likely result within a few months of the time pleural fluid is first detected [4,5]. Several treatments can relieve the respiratory symptoms of MPE. If the expected survival is short, less-invasive procedures are preferred for MPE [5,6,7,8]
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