OA21.05 Wet M1a Non-Small Cell Lung Cancer: Is It Possible to Predict Recurrence of Pleural Effusion?

Abstract

Pleural and oncological treatment options for malignant pleural effusion (MPE) are increasing and hence, more accurate prognosis at presentation may help to identify patients with the higher risk of pleural recurrence, in order to individualize more intensive treatment strategies. The aim of this study was to identify predictors of malignant pleural effusion recurrence in patients with M1a non-small cell lung cancer (NSCLC). All patients with NSCLC and MPE submitted to pleural palliative procedures including simple pleural drainage, videothoracoscopic pleural drainage, pleurodesis and indwelling pleural catheter were enrolled in a prospective study between 2014 and 2015, and divided into two groups. Group I included patients who had pleural recurrence, and Group II with no pleural recurrence after the palliative procedures. Prognostic factors for pleural recurrence were identified by univariate analysis, using Fisher's exact test for the analysis of categorical variables and Student’s t test for quantitative variables. Subsequently the significant variables were entered into a multivariate logistic regression analysis (with p< 0.05 considered significant). The cutoff points for any significant continuous variables were determined by receiver operating characteristics (ROC) analysis. A total of 82 patients were included in the analysis. Median follow-up time for surviving patients was 81 days (range 1 to 1070 days). There were 15 patients (18.3%) in Group I and 67 patients (81.7%) in Group II. Univariate analysis of factors affecting postoperative recurrence were: adenosine deaminase concentration in pleural fluid < 16 mg/dl (p=0.04), albumin concentration in pleural fluid < 2.4 mg/dl (p= 0.03), administration of second-line palliative chemotherapy (p= 0.018) and type of procedure (simple pleural drainage vs. videothoracoscopic pleural drainage, pleurodesis and indwelling pleural catheter) (p= 0.023). At the multivariate analysis, only the type of procedure (simple pleural drainage)(p= 0.031) was identified as independent predictor of recurrence. In our cohort of NSCLC patients with MPE submitted to pleural palliative procedures, simple pleural drainage was the only significantly factor associated with recurrence of MPE. The identification of this factor may assist the choice of the optimal palliative technique, at the first episode of MPE in NSCLC patients. Definitive procedure as pleurodesis is recommended, the indwelling pleural catheter or videothoracoscopic drainage are options for patients whom lung are trapped.