P2.04-040 Pleural Effusion Characteristics and Relationship with Outcomes in Cancer Patients: Topic: Esophageal Cancer and Other Malignancies

Abstract

Pleural effusion is a common occurrence in cancer patients, with an estimated annual incidence of 150,000 in the United States. It generally represents advanced malignant disease with median survival of 3-12 months. It can lead to debilitating symptoms such as dyspnea and pain, adversely affecting the quality of life. We performed a retrospective analysis of a dataset of 62 cancer patients with pleural effusion after first thoracentesis procedure. The recorded data included: age, gender, type of cancer, number of thoracentesis, pleural fluid volume characteristics and volume. We studied 62 patients, with ages between 20-77 years, median 57 years; 64% were females and 36% were males. The number of patients deceased by the end of follow up was 43 (69.4%), alive at the end of follow up was 8 (12.9%), lost to follow up 11 (17.7%). Median overall survival was 3 months. The cancer type was divided into breast, 32.3%, non-small cell lung, 25.8% and 41.9% other cancers. Thirty-three (53.2%) patients had malignant pleural effusion with a median of 3 months of survival. Twenty-nine (46.8%) patients had non-malignant effusion with a similar median survival of 3 months. We analyzed the correlation of the radiologically estimated effusion volume, thoracentesis volume and presence of blood and malignant cells with outcomes (overall survival, OS). There is a negative correlation between the radiologically estimated effusion volume and OS (Pearson rank correlation of -0.43). This negative correlation is maintained in subgroup analysis (breast -0.56; lung -0.33). The thoracentesis volume was also negatively correlated with OS (Pearson rank correlation of -0.45), finding also maintained in subgroup analysis (breast -0.39, lung -0.66). We found no statistically significant difference in OS between malignant effusions (average OS 6.1 months, median 3 months) and non-malignant effusions (average OS 4.9 months, median 3 months). There was no statistically significant difference in survival between bloody effusions (average survival 3.5 months, median survival 1.25 months) and non-bloody effusions (average survival 6.2 months, median 3.5 months). We found an inverse correlation between the radiologically estimated pleural fluid volumes and OS as well as between thoracentesis volume and OS among cancer patients. This correlation is maintained in subset analysis of the two most common types of cancer in our sample, breast and NSCLC. Survival was not influenced by the presence of malignant cells or blood in the pleural fluid. A prospective study to better characterize the prognostic value of first thoracentesis may be warranted.