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Alawneh A, Farsakh FA, Smadi M, Samrah S. Validating LENT score in malignant pleural effusion. Future Sci OA 2024; 10:FSO958. [PMID: 38817378 PMCID: PMC11137780 DOI: 10.2144/fsoa-2023-0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 01/04/2024] [Indexed: 06/01/2024] Open
Abstract
Aim: LENT score was developed to predict survival in malignant pleural effusion (MPE), this study aims to validate this score. Objectives: Validate LENT Prognostic Score for MPE and explore survival in these patients. Methods: Retrospective analysis of 202 patients who had MPE and received drainage between January 2013 and June 2015. Results: Median survival was 2.98 months. Patients were classified according to LENT score as low, moderate and high-risk groups: 5 (4.2%), 61 (50.8%), and 54 (45%), respectively. Kaplan-Meier curve showed median survival for each group: 9.41, 5.36 and 0.56 months, respectively, p-values <0.001. AUC for 1, 3 and 6 months: 0.741, 0.781, 0.790, respectively, p-values <0.001. Conclusion: LENT score is valid for predicting survival in patients with MPE.
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Affiliation(s)
- Alia Alawneh
- Jordan University of Science & Technology, Faculty of Medicine, Internal Medicine Department, 3030, Ar-Ramtha, Jordan
| | - Fadi Abu Farsakh
- King Hussein Cancer Center, Palliative Medicine Department, Queen Rania St 202, Amman, Jordan
| | - Mahmoud Smadi
- Jordan University of Science & Technology, Faculty of Science, Mathematics Department, 3030, Ar-Ramtha, Jordan
| | - Shaher Samrah
- Jordan University of Science & Technology, Faculty of Medicine, Internal Medicine Department, Pulmonary & Critical Care Division, 3030, Ar-Ramtha, Jordan
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2
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Barton E, Verduri A, Carter B, Hughes J, Hewitt J, Maskell NA. The association between frailty and survival in patients with pleural disease: a retrospective cohort study. BMC Pulm Med 2024; 24:180. [PMID: 38627673 PMCID: PMC11020337 DOI: 10.1186/s12890-024-02981-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND There are currently no data on the relationship between frailty and mortality in pleural disease. Understanding the relationship between frailty and outcomes is increasingly important for clinicians to guide decisions regarding investigation and management. This study aims to explore the relationship between all-cause mortality and frailty status in patients with pleural disease. METHODS In this retrospective analysis of a prospectively collected observational cohort study, outpatients presenting to the pleural service at a tertiary centre in Bristol, UK with a radiologically confirmed, undiagnosed pleural effusion underwent comprehensive assessment and were assigned a final diagnosis at 12 months. The modified frailty index (mFI) was calculated and participants classified as frail (mFI ≥ 0.4) or not frail (mFI ≤ 0.2). RESULTS 676 participants were included from 3rd March 2008 to 29th December 2020. The median time to mortality was 490 days (IQR 161-1595). A positive association was found between 12-month mortality and frailty (aHR = 1.72, 95% CI 1.02-2.76, p = 0.025) and age ≥ 80 (aHR = 1.80, 95% CI 1.24-2.62, p = 0.002). Subgroup analyses found a stronger association between 12-month mortality and frailty in benign disease (aHR = 4.36, 95% CI 2.17-8.77, p < 0.0001) than in all pleural disease. Malignancy irrespective of frailty status was associated with an increase in all-cause mortality (aHR = 10.40, 95% CI 6.01-18.01, p < 0.0001). CONCLUSION This is the first study evaluating the relationship between frailty and outcomes in pleural disease. Our data demonstrates a strong association between frailty and 12-month mortality in this cohort. A malignant diagnosis is an independent predictor of 12-month mortality, irrespective of frailty status. Frailty was also strongly associated with 12-month mortality in patients with a benign underlying cause for their pleural disease. This has clinical relevance for pleural physicians; evaluating patients' frailty status and its impact on mortality can guide clinicians in assessing suitability for invasive investigation and management. TRIAL REGISTRATION This study is registered with the Health Research Authority (REC reference 08/H0102/11) and the NIHR Portfolio (Study ID 8960).
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Affiliation(s)
- Eleanor Barton
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
| | - A Verduri
- Respiratory Unit, Department of Surgical and Medical Sciences, University of Modena and Reggio Emilia, Policlinico Modena, Italy
| | - B Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- Department of Population Medicine, Cardiff University, Cardiff, UK
| | - J Hughes
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - J Hewitt
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - N A Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
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Wei M, Zhang Y, Zhao L, Zhao Z. Development and validation of a radiomics nomogram for diagnosis of malignant pleural effusion. Discov Oncol 2023; 14:213. [PMID: 37999794 PMCID: PMC10673775 DOI: 10.1007/s12672-023-00835-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/21/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE We aimed to develop a radiomics nomogram based on computed tomography (CT) scan features and high-throughput radiomics features for diagnosis of malignant pleural effusion (MPE). METHODS In this study, 507 eligible patients with PE (207 malignant and 300 benign) were collected retrospectively. Patients were divided into training (n = 355) and validation cohorts (n = 152). Radiomics features were extracted from initial unenhanced CT images. CT scan features of PE were also collected. We used the variance threshold algorithm and least absolute shrinkage and selection operator (LASSO) to select optimal features to build a radiomics model for predicting the nature of PE. Univariate and multivariable logistic regression analyzes were used to identify significant independent factors associated with MPE, which were then included in the radiomics nomogram. RESULTS A total of four CT features were retained as significant independent factors, including massive PE, obstructive atelectasis or pneumonia, pleural thickening > 10 mm, and pulmonary nodules and/or masses. The radiomics nomogram constructed from 13 radiomics parameters and four CT features showed good predictive efficacy in training cohort [area under the curve (AUC) = 0.926, 95% CI 0.894, 0.951] and validation cohort (AUC = 0.916, 95% CI 0.860, 0.955). The calibration curve and decision curve analysis showed that the nomogram helped differentiate MPE from benign pleural effusion (BPE) in clinical practice. CONCLUSION This study presents a nomogram model incorporating CT scan features and radiomics features to help physicians differentiate MPE from BPE.
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Affiliation(s)
- Mingzhu Wei
- Department of Radiology, Shaoxing People's Hospital, Shaoxing, Zhejiang, People's Republic of China.
- Department of Radiology, Shaoxing People's Hospital, No. 568, Zhongxing North Road, Yuecheng District, Shaoxing, 312000, Zhejiang, People's Republic of China.
| | - Yaping Zhang
- Department of Radiology, Shaoxing People's Hospital, Shaoxing, Zhejiang, People's Republic of China
| | - Li Zhao
- Department of Radiology, Shaoxing People's Hospital, Shaoxing, Zhejiang, People's Republic of China
| | - Zhenhua Zhao
- Department of Radiology, Shaoxing People's Hospital, Shaoxing, Zhejiang, People's Republic of China
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Li T, Tian P, Huang Q, Zeng H, Wei Q, Li Y. Development and validation of the CAIL prognostic score in non-small cell lung cancer patients with malignant pleural effusion. THE CLINICAL RESPIRATORY JOURNAL 2023; 17:1158-1168. [PMID: 37723659 PMCID: PMC10632079 DOI: 10.1111/crj.13700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 08/30/2023] [Accepted: 09/03/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Patients with malignant pleural effusion (MPE) typically have poor prognoses, and predicting survival is challenging. The present study aimed to identify prognostic factors of overall survival (OS) in non-small cell lung cancer (NSCLC) patients with MPE in the time of immunotherapy and targeted therapy. METHODS Data of 344 consecutive NSCLC patients with MPE on clinical, radiological, and molecular characteristics and treatment options were collected. The risk factors in the training cohort were assessed using univariate and multivariate proportional hazards analyses. A clinical prognostic score was established and validated. RESULTS According to the results of the multivariable survival analysis, the Eastern Cooperative Oncology Group (ECOG) performance score (PS), antiangiogenic therapy, immunotherapy, and lactic dehydrogenase (LDH) in pleural fluid (CAIL) prognostic score was developed (n = 275) and subsequently validated (n = 69). Patients who underwent risk stratification into low-, moderate-, and high-risk groups had median OS of 46.1, 23.1, and 9.6 months, respectively (P < 0.0001). The area under the curve (AUC) analysis showed the CAIL score to be superior at predicting survival compared with the LENT score at 6 (0.84 vs. 0.77, P < 0.01), 12 (0.87 vs. 0.82, P < 0.01), and 36 months (0.80 vs. 0.77, P < 0.01). CONCLUSIONS For NSCLC patients with MPE, the validated CAIL prognostic score integrates clinical characteristics and therapeutic modalities to predict survival.
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Affiliation(s)
- Tianyuan Li
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Precision Medicine Key Laboratory of Sichuan ProvinceWest China Hospital, Sichuan UniversityChengduSichuanChina
| | - Panwen Tian
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Precision Medicine Key Laboratory of Sichuan ProvinceWest China Hospital, Sichuan UniversityChengduSichuanChina
| | - Qin Huang
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Precision Medicine Key Laboratory of Sichuan ProvinceWest China Hospital, Sichuan UniversityChengduSichuanChina
| | - Hao Zeng
- Lung Cancer Center, West China HospitalSichuan UniversityChengduSichuanChina
| | - Qi Wei
- Lung Cancer Center, West China HospitalSichuan UniversityChengduSichuanChina
| | - Yalun Li
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Precision Medicine Key Laboratory of Sichuan ProvinceWest China Hospital, Sichuan UniversityChengduSichuanChina
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5
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Wang Y, Zhou T, Zhao S, Li N, Sun S, Li M. A Novel Clinical Prognostic Model for Breast Cancer Patients with Malignant Pleural Effusion: Avoiding Chemotherapy in Low-Risk Groups? Cancer Manag Res 2023; 15:409-422. [PMID: 37197007 PMCID: PMC10184893 DOI: 10.2147/cmar.s409918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/04/2023] [Indexed: 05/19/2023] Open
Abstract
Purpose Malignant pleural effusion (MPE) is a severe complication in patients with advanced cancer that is associated with a poor prognosis. Breast cancer is the second leading cause of MPE after lung cancer. We therefore aim to describe clinical characteristics of the patients with MPE combined with breast cancer and construct a machine learning-based model for predicting the prognosis of such patients. Methods This study is a retrospective and observational study. Least absolute shrinkage and selection operator (LASSO) and univariate Cox regression analyses were applied to identify eight key clinical variables, and a nomogram model was established. Model performance was evaluated by receiver operating characteristic (ROC) curve, calibration curve, and decision curve analyses. Results 196 patients with both MPE and breast cancer (143 in the training group and 53 in the ex-ternal validation group) were analyzed in this study. The median overall survival in two cohorts was 16.20 months and 11.37 months. Based on the ROC curves for 3-, 6-, and 12-month survival, the areas under the curves were 0.824, 0.824, and 0.818 in the training set and 0.777, 0.790, and 0.715 in the validation set, respectively. In the follow-up analysis, both systemic and intrapleural chemotherapy significantly increased survival in the high-risk group compared to the low-risk group. Conclusion Collectively, MPE confers a poor prognosis in breast cancer patients. We have developed a first-ever survival prediction model for breast cancer patients with newly diagnosed MPE and validated the model using an independent cohort.
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Affiliation(s)
- Yichen Wang
- Department of Oncology, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, People’s Republic of China
| | - Tao Zhou
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, People’s Republic of China
| | - Shanshan Zhao
- Department of Oncology, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, People’s Republic of China
| | - Ning Li
- Department of Foreign Language, Dalian Medical University, Dalian, 116050, People’s Republic of China
| | - Siwen Sun
- Department of Oncology, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, People’s Republic of China
| | - Man Li
- Department of Oncology, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, People’s Republic of China
- Correspondence: Man Li; Siwen Sun, Department of Oncology, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, People’s Republic of China, Tel +86-17709873580; +86-17709891126, Email ;
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6
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Liu Q, Mei J, Chen C. LNP-CDN: a novel nanomaterial for inflaming immune-cold malignant pleural effusion. Sci Bull (Beijing) 2022; 67:1837-1839. [PMID: 36546294 DOI: 10.1016/j.scib.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Qianglin Liu
- School of Medical and Life Sciences/Reproductive & Women-children Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Jie Mei
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety & CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing 100190, China; School of Nanoscience and Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Chunying Chen
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety & CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing 100190, China; School of Nanoscience and Technology, University of Chinese Academy of Sciences, Beijing 100049, China; The GBA National Institute for Nanotechnology Innovation, Guangzhou 510700, China.
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7
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Jacobs B, Sheikh G, Youness HA, Keddissi JI, Abdo T. Diagnosis and Management of Malignant Pleural Effusion: A Decade in Review. Diagnostics (Basel) 2022; 12:1016. [PMID: 35454064 PMCID: PMC9030780 DOI: 10.3390/diagnostics12041016] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/12/2022] [Accepted: 04/12/2022] [Indexed: 02/04/2023] Open
Abstract
Malignant pleural effusion (MPE) is a common complication of thoracic and extrathoracic malignancies and is associated with high mortality. Treatment is mainly palliative, with symptomatic management achieved via effusion drainage and pleurodesis. Pleurodesis may be hastened by administering a sclerosing agent through a thoracostomy tube, thoracoscopy, or an indwelling pleural catheter (IPC). Over the last decade, several randomized controlled studies shaped the current management of MPE in favor of an outpatient-based approach with a notable increase in IPC usage. Patient preferences remain essential in choosing optimal therapy, especially when the lung is expandable. In this article, we reviewed the last 10 to 15 years of MPE literature with a particular focus on the diagnosis and evolving management.
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Affiliation(s)
| | | | | | | | - Tony Abdo
- Section of Pulmonary, Critical Care and Sleep Medicine, The University of Oklahoma Health Sciences Center and The Oklahoma City VA Health Care System, Oklahoma City, OK 73104, USA; (B.J.); (G.S.); (H.A.Y.); (J.I.K.)
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8
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Karpathiou G, Péoc’h M, Sundaralingam A, Rahman N, Froudarakis ME. Inflammation of the Pleural Cavity: A Review on Pathogenesis, Diagnosis and Implications in Tumor Pathophysiology. Cancers (Basel) 2022; 14:1415. [PMID: 35326567 PMCID: PMC8946533 DOI: 10.3390/cancers14061415] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 12/12/2022] Open
Abstract
Pleural effusions are a common respiratory condition with many etiologies. Nonmalignant etiologies explain most pleural effusions and despite being nonmalignant, they can be associated with poor survival; thus, it is important to understand their pathophysiology. Furthermore, diagnosing a benign pleural pathology always harbors the uncertainty of a false-negative diagnosis for physicians and pathologists, especially for the group of non-specific pleuritis. This review aims to present the role of the inflammation in the development of benign pleural effusions, with a special interest in their pathophysiology and their association with malignancy.
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Affiliation(s)
- Georgia Karpathiou
- Pathology Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France;
| | - Michel Péoc’h
- Pathology Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France;
| | - Anand Sundaralingam
- Oxford Centre for Respiratory Medicine, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LE, UK; (A.S.); (N.R.)
| | - Najib Rahman
- Oxford Centre for Respiratory Medicine, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LE, UK; (A.S.); (N.R.)
| | - Marios E. Froudarakis
- Pneumonology and Thoracic Oncology Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France;
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9
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Zhang S, Zhang Y, Feng W, Shi Z, Shi H, Zhang Y. Prediction modeling using routine clinical parameters to stratify survival in malignant pleural mesothelioma patients complicated with malignant pleural effusion. Thorac Cancer 2021; 12:3304-3309. [PMID: 34704370 PMCID: PMC8671893 DOI: 10.1111/1759-7714.14202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/07/2021] [Accepted: 10/10/2021] [Indexed: 11/28/2022] Open
Abstract
Background Malignant pleural effusion (MPE) is common in malignant pleural mesothelioma (MPM). The survival of patients with MPM and MPE is heterogeneous. The LENT and BRIMS scores using routine clinical parameters were developed to predict the survival of patients with unselected MPE and MPM, respectively. This study aimed to stratify the survival of selected MPM patients with MPE. Methods Data were collected from subjects diagnosed with MPM and MPE. The LENT and BRIMS scores were applied using a combination of clinical variables to stratify subjects and compare survival characteristics. Results In total, 101 patients with MPM complicated by MPE were included in the study. The median follow‐up time was 71 months (interquartile range: 24–121 months). Overall median survival was 24 (interquartile range: 12–52 months). Based on the LENT score, the low‐, moderate‐, and high‐risk groups accounted for 65.3% (66 cases), 34.7% (35 cases), and 0%, respectively. The cumulative survival rates of the two groups were statistically significant (p = 0.031). The area under the curve (AUC) of the LENT score was 0.662. Based on the BRIMS score, the first, second, third, and fourth risk groups accounted for 1.0% (1 case), 42.9% (35 cases), 28.7% (29 cases), and 19.4% (36 cases), respectively. Survival was significantly higher in patients in the risk groups 1 and 2 than in patients in the risk groups 3 and 4 (p = 0.037). The AUC of the BRIMS score was 0.605. Conclusions Using routinely available clinical variables, both LENT and BRIMS scores could stratify selected MPM and MPE patients into risk groups with statistically different survival.
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Affiliation(s)
- Shu Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, China
| | - Yuan Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, China
| | - Wei Feng
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Zhongyue Shi
- Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Huanzhong Shi
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, China
| | - Yuhui Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, China
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Désage AL, Karpathiou G, Peoc’h M, Froudarakis ME. The Immune Microenvironment of Malignant Pleural Mesothelioma: A Literature Review. Cancers (Basel) 2021; 13:3205. [PMID: 34206956 PMCID: PMC8269097 DOI: 10.3390/cancers13133205] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 12/13/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is a rare and aggressive tumour with a poor prognosis, associated with asbestos exposure. Nowadays, treatment is based on chemotherapy with a median overall survival of less than two years. This review highlights the main characteristics of the immune microenvironment in MPM with special emphasis on recent biological advances. The MPM microenvironment is highly infiltrated by tumour-associated macrophages, mainly M2-macrophages. In line with infiltration by M2-macrophages, which contribute to immune suppression, other effectors of innate immune response are deficient in MPM, such as dendritic cells or natural killer cells. On the other hand, tumour infiltrating lymphocytes (TILs) are also found in MPM, but CD4+ and CD8+ TILs might have decreased cytotoxic effects through T-regulators and high expression of immune checkpoints. Taken together, the immune microenvironment is particularly heterogeneous and can be considered as mainly immunotolerant or immunosuppressive. Therefore, identifying molecular vulnerabilities is particularly relevant to the improvement of patient outcomes and the assessment of promising treatment approaches.
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Affiliation(s)
- Anne-Laure Désage
- Department of Pulmonology and Thoracic Oncology, North Hospital, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France;
| | - Georgia Karpathiou
- Pathology, North Hospital, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; (G.K.); (M.P.)
| | - Michel Peoc’h
- Pathology, North Hospital, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; (G.K.); (M.P.)
| | - Marios E. Froudarakis
- Department of Pulmonology and Thoracic Oncology, North Hospital, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France;
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Takeuchi E, Okano Y, Machida H, Atagi K, Kondou Y, Kadota N, Hatakeyama N, Naruse K, Shinohara T. Eosinophilic pleural effusion due to lung cancer has a better prognosis than non-eosinophilic malignant pleural effusion. Cancer Immunol Immunother 2021; 71:365-372. [PMID: 34170380 PMCID: PMC8783892 DOI: 10.1007/s00262-021-02994-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/19/2021] [Indexed: 11/26/2022]
Abstract
Objective Tumor-related eosinophilia may have extended survival benefits for some cancer patients. However, there has been no report on the prognosis difference between eosinophilic pleural effusion (EPE) and non-EPE in lung cancer patients. Our study aimed to investigate the prognosis difference between EPE and non-EPE due to lung cancer. Patients and methods We retrospectively reviewed patients diagnosed with lung cancer who presented with malignant pleural effusion (MPE) between May 2007 and September 2020 at the National Hospital Organization Kochi Hospital. EPE is defined as pleural fluid with a nucleated cell count containing 10% or more eosinophils. Results A total of 152 patients were included: 89 were male (59%). The median age was 74.4 years (range 37–101), and all patients were pathologically shown to have MPE. Most patients (140; 92%) had an Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) of 0/1. Twenty patients had EPE. The median overall survival (OS) of all 152 lung cancer patients with MPE was 298 days. The median OS of the patients with EPE was 766 days, and the median OS of the patients with non-EPE was 252 days. Kaplan–Meier univariate analysis showed that lung cancer patients with EPE had a significantly better prognosis than patients with non-EPE (P < 0.05). Cox proportional regression analysis showed that EPE, ECOG PS, sex, and the neutrophil-to-lymphocyte ratio in the serum (sNLR) may be independent prognostic factors affecting survival in patients with MPE. Conclusion Lung cancer patients with EPE have a better prognosis than those with non-EPE.
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Affiliation(s)
- Eiji Takeuchi
- Department of Clinical Investigation, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi-city, Kochi 780-8507 Japan
| | - Yoshio Okano
- Department of Respiratory Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi-city, Kochi 780-8507 Japan
| | - Hisanori Machida
- Department of Respiratory Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi-city, Kochi 780-8507 Japan
| | - Katsuhiro Atagi
- Department of Respiratory Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi-city, Kochi 780-8507 Japan
| | - Yoshihiro Kondou
- Department of Respiratory Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi-city, Kochi 780-8507 Japan
| | - Naoki Kadota
- Department of Respiratory Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi-city, Kochi 780-8507 Japan
| | - Nobuo Hatakeyama
- Department of Respiratory Medicine, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi-city, Kochi 780-8507 Japan
| | - Keishi Naruse
- Department of Pathology, National Hospital Organization Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi-city, Kochi 780-8507 Japan
| | - Tsutomu Shinohara
- Department of Community Medicine for Respirology, Graduate School of Biomedical Sciences, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503 Japan
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Simsek FS, Yuksel D, Yaylali O, Aslan HS, Kılıçarslan E, Bir F, Arslan M, Can FE, Ugurlu E. Can PET/CT be used more effectively in pleural effusion evaluation? Jpn J Radiol 2021; 39:1186-1194. [PMID: 34165683 DOI: 10.1007/s11604-021-01155-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/10/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Sometimes, characterization of pleural effusion (PE) can be challenging especially in patients whom invasive procedures/recurrent invasive procedures cannot be performed. The main purpose of the study is to answer this question, Can 18F-FDG-PET/CT contribute to reduction in the number of invasive procedures or patients undergoing to invasive procedures? Results may increase the effectiveness of patient management by facilitating clinical decision-making, especially in patients who cannot undergo invasive/recurrent invasive procedures. METHODS Sixty-seven patients' 18F-FDG-PET/CT, pleural fluid cytologies (PFCs) and, if any, pleural biopsies were re-assessed. If patient's PFC/biopsy was malignant, effusion was considered as malignant. If two consecutive PFCs were negative in patients without biopsy, effusion was considered as benign. Characterization was based on consensus with baseline/follow-up 18F-FDG-PET/CT and clinical parameters in patients with one negative PFC (n = 6). RESULTS None of the 18F-FDG-PET/CT parameters could characterize PE alone. However, if PE maximum standardized uptake value (SUVmax) > 1.3 or PE SUVmax/mean standardized uptake value of mediastinal blood pool (MBP SUVmean) > 1.2 was combined with at least one of the following, specificity and positive predictive value (PPV) were 100%, accuracy was around 90%. Diffuse-nodular/nodular pleural thickness, post-obstructive atelectasis, nodule/mass with SUVmax > 2.5 in lung, multiple pulmonary nodules. All 29 patients who had SUVmax > 1.3 together with at least one of the mentioned four parameters diagnosed malignant pleural effusion (MPE). However, sensitivity and negative predictive value (NPV) were still insufficient. CONCLUSION Patients who have contraindications for invasive diagnostic methods, and meet the aforementioned criteria may be considered as MPE primarily. On the other hand, if PE SUVmax < 1.3 or PE SUVmax/MBP SUVmean < 1.2 with the negativity of the all four parameters mentioned above, it is difficult to say that this can be considered as benign pleural effusion (BPE) according to our results.
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Affiliation(s)
- Fikri Selcuk Simsek
- Nuclear Medicine Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey.
| | - Dogangun Yuksel
- Nuclear Medicine Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Olga Yaylali
- Nuclear Medicine Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Halil Serdar Aslan
- Radiology Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Emel Kılıçarslan
- Pathology Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Ferda Bir
- Pathology Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Muhammet Arslan
- Radiology Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Fatma Ezgi Can
- Biostatistics Department, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Erhan Ugurlu
- Pulmonology Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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Molina S, Martinez-Zayas G, Sainz PV, Leung CH, Li L, Grosu HB, Adachi R, Ost DE. Breast and Lung Effusion Survival Score Models: Improving Survival Prediction in Patients With Malignant Pleural Effusion and Metastasis. Chest 2021; 160:1075-1094. [PMID: 33852918 DOI: 10.1016/j.chest.2021.03.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Evidence-based guidelines recommend management strategies for malignant pleural effusions (MPEs) based on life expectancy. Existent risk-prediction rules do not provide precise individualized survival estimates. RESEARCH QUESTION Can a newly developed continuous risk-prediction survival model for patients with MPE and known metastatic disease provide precise survival estimates? STUDY DESIGN AND METHODS Single-center retrospective cohort study of patients with proven malignancy, pleural effusion, and known metastatic disease undergoing thoracentesis from 2014 through 2017. The outcome was time from thoracentesis to death. Risk factors were identified using Cox proportional hazards models. Effect-measure modification (EMM) was tested using the Mantel-Cox test and was addressed by using disease-specific models (DSMs) or interaction terms. Three DSMs and a combined model using interactions were generated. Discrimination was evaluated using Harrell's C-statistic. Calibration was assessed by observed-minus-predicted probability graphs at specific time points. Models were validated using patients treated from 2010 through 2013. Using LENT (pleural fluid lactate dehydrogenase, Eastern Cooperative Oncology Group performance score, neutrophil-to-lymphocyte ratio and tumor type) variables, we generated both discrete (LENT-D) and continuous (LENT-C) models, assessing discrete vs continuous predictors' performances. RESULTS The development and validation cohort included 562 and 727 patients, respectively. The Mantel-Cox test demonstrated interactions between cancer type and neutrophil to lymphocyte ratio (P < .0001), pleural fluid lactate dehydrogenase (P = .029), and bilateral effusion (P = .002). DSMs for lung, breast, and hematologic malignancies showed C-statistics of 0.72, 0.72, and 0.62, respectively; the combined model's C-statistics was 0.67. LENT-D (C-statistic, 0.60) and LENT-C (C-statistic, 0.65) models underperformed. INTERPRETATION EMM is present between cancer type and other predictors; thus, DSMs outperformed the models that failed to account for this. Discrete risk-prediction models lacked enough precision to be useful for individual-level predictions.
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Affiliation(s)
- Sofia Molina
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gabriela Martinez-Zayas
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Paula V Sainz
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; School of Medicine and Health Sciences, Tecnologico de Monterrey, Monterrey, Mexico
| | - Cheuk H Leung
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Liang Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Horiana B Grosu
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Roberto Adachi
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David E Ost
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Chollet B, Guinde J, Laroumagne S, Dutau H, Astoul P. Does the LENT score risk-stratify patients with malignant pleural mesothelioma? An observational study. Thorac Cancer 2021; 12:1752-1756. [PMID: 33949775 PMCID: PMC8169304 DOI: 10.1111/1759-7714.13987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/16/2021] [Accepted: 04/16/2021] [Indexed: 01/19/2023] Open
Abstract
Background Malignant pleural mesothelioma (MPM) is a rare, highly aggressive and deadly disease with a poor patient life expectancy. A few years ago, the main challenge was the histological diagnosis of this disease; at present, the search for the best therapeutic strategy is now a priority. However, an optimal therapeutic strategy is not yet clear, despite growing efforts in the treatment armamentarium and research, and at the era of tailored and individualized treatment, tools to predict patient survival are needed for therapeutic decision‐making. Among them, the LENT scoring system was developed to predict prognosis in patients with malignant pleural effusion. The aim of this study was to assess the performance of the LENT score in predicting prognosis in patients with MPM. Methods A retrospective observational study was conducted by analyzing the prospective collected databases of patients undergoing medical thoracoscopy in a single center with a final diagnosis of MPM confirmed by the MESOPATH National Reference Center. Results A total of 41 patients with MPM were studied. All patients underwent platinum‐based chemotherapy combined with pemetrexed ± bevacizumab. No high‐risk category patients were found using the LENT scoring system in this cohort. The median (range) LENT score at the time of medical thoracoscopy was 0 (0–3) and the median survival was 15.5 (2–54) months for the entire cohort. The median survival of low‐risk and moderate‐risk category patients was 21.4 months (2–54, 32 patients) and 6.7 months (2–19, nine patients), respectively. A total of 27 patients with MPM of epithelial subgroup had a median LENT score of 1 (0–2) with a 26 (2–54) months median survival. The median LENT score and median survival of nonepithelial mesothelioma patients (biphasic MPM subgroup, eight patients; sarcomatoid MPM subgroup, six patients) were 0 (0–3) and 11 (2–52) months, respectively. Conclusions Applied to a homogenous cohort of MPM patients, the LENT score underestimated prognosis and was not useful per se for the management of this disease, as evidenced in the epithelial mesothelioma subgroup of patients in our study.
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Affiliation(s)
- Bertrand Chollet
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Marseille, France
| | - Julien Guinde
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Marseille, France
| | - Sophie Laroumagne
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Marseille, France
| | - Hervé Dutau
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Marseille, France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Marseille, France.,Aix-Marseille University, Marseille, France
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15
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Popowicz N, Cheah HM, Gregory C, Miranda A, Dick IM, Lee YCG, Creaney J. Neutrophil-to-lymphocyte ratio in malignant pleural fluid: Prognostic significance. PLoS One 2021; 16:e0250628. [PMID: 33901252 PMCID: PMC8075197 DOI: 10.1371/journal.pone.0250628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/10/2021] [Indexed: 01/04/2023] Open
Abstract
Predicting survival of patients with malignant pleural effusions (MPEs) is notoriously difficult. A robust prognostic marker can guide clinical decision making. The neutrophil-to-lymphocyte ratio (NLR) in blood has been shown to predict survival in many cancers. Pleural fluid bathes the malignant pleural tissues, thus the NLR of the pleural fluid may reflect more closely the local tumour environment. The objective of this study was to explore the prognostic significance of pleural effusion NLR for MPE. We analysed matched effusion and blood from 117 patients with malignant and 24 with benign pleural effusions. Those who had received recent chemotherapy or had a pleurodesis were excluded. Neutrophil and lymphocyte counts in effusions were performed by manual review of cytospin cell preparations by trained observers. Clinical data were extracted from a state-wide hospital database. We found significantly fewer neutrophils (expressed as percentage of total leukocyte count) in pleural fluid than in corresponding blood (9% vs 73%; p<0.001). The NLR was an order of magnitude lower in pleural fluid than in corresponding blood: median [IQR] = 0.20 [0.04-1.18] vs 4.9 [3.0-8.3], p<0.001. Correlation between blood and pleural fluid NLR in MPE patients was moderate (rs = 0.321, p<0.001). In univariate analysis, NLR (>0.745)) in malignant pleural fluid was predictive of poorer survival (HR = 1.698 [1.0054-2.736]; p = 0.030), and remained significant after adjustment for age, sex, presence of a chest drain, cancer type, concurrent infection and subsequent treatment with chemotherapy (HR = 1.786 [1.089-2.928]; p = 0.022). Patients with pleural fluid NLR > 0.745 had a significantly shorter median survival of 130 (95% CI 0-282) days compared to 312 (95% CI 195-428) days for pleural NLR < 0.745, p = 0.026. The NLR in blood was also predictive of poorer survival in MPE patients (HR = 1.959 [1.019-3.096]; p<0.001). The proportion of neutrophils in pleural fluid was predictive of prognosis more strongly than lymphocytes. This study provides evidence that NLR in malignant effusions can predict survival, and therefore may provide prognostic information for this cohort. This prognostic association in the fluid is driven by the presence of neutrophils.
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Affiliation(s)
- Natalia Popowicz
- Pharmacy Department, Sir Charles Gairdner Hospital, Perth, Australia
- Institute for Respiratory Health, University of Western Australia, Perth, Australia
| | - Hui Min Cheah
- Institute for Respiratory Health, University of Western Australia, Perth, Australia
| | - Cynthia Gregory
- National Centre for Asbestos Related Disease, Health and Medical Science, University of Western Australia, Perth, Australia
| | - Alina Miranda
- National Centre for Asbestos Related Disease, Health and Medical Science, University of Western Australia, Perth, Australia
| | - Ian M. Dick
- National Centre for Asbestos Related Disease, Health and Medical Science, University of Western Australia, Perth, Australia
| | - Y. C. Gary Lee
- Institute for Respiratory Health, University of Western Australia, Perth, Australia
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Jenette Creaney
- Institute for Respiratory Health, University of Western Australia, Perth, Australia
- National Centre for Asbestos Related Disease, Health and Medical Science, University of Western Australia, Perth, Australia
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
- * E-mail:
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16
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Zhang T, Chen X, Wan B, Xu Y, Liu H, Lv T, Zhan P, Song Y. Development of RECLS score to predict survival in lung cancer patients with malignant pleural effusion. Transl Lung Cancer Res 2021; 10:1318-1326. [PMID: 33889512 PMCID: PMC8044486 DOI: 10.21037/tlcr-20-1191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Malignant pleural effusion (MPE) is usually caused by lung cancer, and the prognostic factors are poorly understood. We aimed to develop models to predict the survival of lung cancer patients and lung adenocarcinoma patients with MPE. Methods We enrolled lung cancer patients with MPE in Nanjing Jinling Hospital from January 2008 to June 2018 into our study. We selected risk factors using multivariable Cox proportional-hazards analysis in the development cohort. The risk models were created according to the risk ratio (RR) value. The participants were categorized into low-risk, moderate-risk, and high-risk groups according to the sum of every risk factor. Results A total of 367 lung cancer patients were included in the development cohort. The scoring systems RECLS (relapse or not, ECOG PS, CRP, pleural LDH, and TNM stage) and RECLSAM (relapse or not, ECOG PS, CRP, pleural LDH, TNM stage, albumin-globulin ratio, and activating gene mutation) were created for lung cancer patients with MPE and lung adenocarcinoma patients with MPE. The area under the curve (AUC) values for the RECLS model were 0.911, 0.845, and 0.754, respectively, at 1 month, 6 months, and 12 months. Conclusions This study developed prognostic models for lung cancer patients with MPE. The RECLS and RECLSAM scores are practical, clinically applicable models to help guide the selection of optimal treatment strategies.
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Affiliation(s)
- Tianli Zhang
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Xi Chen
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Bing Wan
- Department of Respiratory and Critical Care Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Yangyang Xu
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Jinling Clinical College of Nanjing Medical University, Nanjing, China
| | - Hongbing Liu
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Southeast University, Nanjing, China.,Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.,Department of Respiratory and Critical Care Medicine, Jinling Hospital, Jinling Clinical College of Nanjing Medical University, Nanjing, China
| | - Tangfeng Lv
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Southeast University, Nanjing, China.,Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.,Department of Respiratory and Critical Care Medicine, Jinling Hospital, Jinling Clinical College of Nanjing Medical University, Nanjing, China
| | - Ping Zhan
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Southeast University, Nanjing, China.,Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.,Department of Respiratory and Critical Care Medicine, Jinling Hospital, Jinling Clinical College of Nanjing Medical University, Nanjing, China
| | - Yong Song
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Southeast University, Nanjing, China.,Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.,Department of Respiratory and Critical Care Medicine, Jinling Hospital, Jinling Clinical College of Nanjing Medical University, Nanjing, China
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17
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Raimundo S, Loureiro AI, Vieira F, Fernandes A. LENT Score: Predicting the Survival of Malignant Pleural Effusion – A Prospective Study of Three Years. Arch Bronconeumol 2020. [DOI: 10.1016/j.arbres.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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18
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Raimundo S, Loureiro AI, Vieira F, Fernandes A. LENT Score: Predicting the Survival of Malignant Pleural Effusion - A Prospective Study of Three Years. Arch Bronconeumol 2020; 56:465-466. [PMID: 35373760 DOI: 10.1016/j.arbr.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/08/2020] [Indexed: 06/14/2023]
Affiliation(s)
- Sara Raimundo
- Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal.
| | - Ana Isabel Loureiro
- Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | | | - Ana Fernandes
- Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
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19
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Karpathiou G, Dumollard JM, Peoc'h M. Laryngeal Tumor Microenvironment. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1296:79-101. [PMID: 34185287 DOI: 10.1007/978-3-030-59038-3_5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Tumor microenvironment has been extensively studied in various forms of cancer, like head and neck squamous cell carcinoma. Progress in the field revealed the prognostic significance of the various components of the tumor's ecosystem and led to changes in treatment strategies, like including immunotherapy as an important tool. In this chapter, the microenvironment of tumors with a special interest in laryngeal cancer will be described. The issues assessed include innate immune response factors, like neutrophils, neutrophil extracellular traps (NET), platelets, macrophages M1 or M2, dendritic cells, natural killer cells, as well as adaptive immunity aspects, like cytotoxic, exhausted and regulatory T cells, and immune checkpoints (PD-1/PD-L1, CTLA4). Also, stroma-associated factors, like fibroblasts, fibrosis, extracellular matrix, vessels and perineural invasion, hypoxia and cancer metabolism aspects, as well as the pre-metastatic niche, exosomes and cGAS-STING, are reviewed.
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Affiliation(s)
- Georgia Karpathiou
- Pathology Department, North Hospital, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Jean Marc Dumollard
- Pathology Department, North Hospital, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Michel Peoc'h
- Pathology Department, North Hospital, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
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20
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Chen F, Dai L, An J, Zeng N, Chen L, Shen Y. Diagnostic accuracy of E-cadherin for malignanteffusions: a systematic review and meta-analysis. Postgrad Med J 2019; 96:530-536. [PMID: 31818872 DOI: 10.1136/postgradmedj-2019-137025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/17/2019] [Accepted: 11/17/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND The differential diagnosis of malignant effusion remains a clinical challenge. We aim to summarise all relevant literature studies in order to determine the overall clinical value of E-cadherin in the diagnosis of malignant effusion by meta-analysis. METHODS PubMed, the Cochrane Library Database, Medline (Ovid), Web of Science, CNKI, WANFANG and WEIPU databases are thoroughly searched up to 15 March2018. The calculated pooled sensitivity, specificity, likelihood ratio (LR), diagnostic OR(DOR) and the summary receiver operating characteristic (SROC) curve were plotted. RESULTS A total of 15 studies were included in the analysis. The sensitivity and specificity of E-cadherin in the diagnosis of malignant effusion were determined to be high, with a sensitivity of 0.83(95%CI0.79 to 0.87) and a specificity of 0.96(95%CI0.90 to 0.98). The positive LR was determined to be 21.10(95%CI 8.54 to 52.11), the negative LR was determined to be 0.17(95% CI 0.14 to 0.22) and the DOR was determined to be 121.34(95%CI 49.11 to 299.80). The SROC curve exhibited a high overall diagnostic, with the area under the curve measured to be 0.91(95% CI 0.89 to 0.93). Subgroup analysis showed the method (cell blocks or smears), sample size (≥100 or<100), geographical location (Asia, Europe or USA) and impact factor of each article (≥3 or<3) were not the sources of overall heterogeneity. CONCLUSION E-cadherin exhibits very good diagnostic accuracy for the diagnosis for malignant effusion; thus, it can be helpful in the process of clinical decisions.
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Affiliation(s)
- Fangying Chen
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China.,Department of Tuberculosis, The Third People's Hospital of Tibet Autonomous Region, Lhasa, Tibet, China
| | - Luqi Dai
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Jing An
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Ni Zeng
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Lei Chen
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China ,
| | - Yongchun Shen
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China ,
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21
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Bibby AC, Dorn P, Psallidas I, Porcel JM, Janssen J, Froudarakis M, Subotic D, Astoul P, Licht P, Schmid R, Scherpereel A, Rahman NM, Maskell NA, Cardillo G. ERS/EACTS statement on the management of malignant pleural effusions. Eur J Cardiothorac Surg 2019; 55:116-132. [PMID: 30060030 DOI: 10.1093/ejcts/ezy258] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 03/28/2018] [Indexed: 12/26/2022] Open
Abstract
Malignant pleural effusions (MPE) are a common pathology, treated by respiratory physicians and thoracic surgeons alike. In recent years, several well-designed randomized clinical trials have been published that have changed the landscape of MPE management. The European Respiratory Society (ERS) and the European Association for Cardio-Thoracic Surgery (EACTS) established a multidisciplinary collaboration of clinicians with expertise in the management of MPE with the aim of producing a comprehensive review of the scientific literature. Six areas of interest were identified, including the optimum management of symptomatic MPE, management of trapped lung in MPE, management of loculated MPE, prognostic factors in MPE, whether there is a role for oncological therapies prior to intervention for MPE and whether a histological diagnosis is always required in MPE. The literature revealed that talc pleurodesis and indwelling pleural catheters effectively manage the symptoms of MPE. There was limited evidence regarding the management of trapped lung or loculated MPE. The LENT score was identified as a validated tool for predicting survival in MPE, with Brims' prognostic score demonstrating utility in mesothelioma prognostication. There was no evidence to support the use of oncological therapies as an alternative to MPE drainage, and the literature supported the use of tissue biopsy as the gold standard for diagnosis and treatment planning.Management options for malignant pleural effusions have advanced over the past decade, with high-quality randomized trial evidence informing practice in many areas. However, uncertainties remain and further research is required http://ow.ly/rNt730jOxOS.
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Affiliation(s)
- Anna C Bibby
- Academic Respiratory Unit, University of Bristol Medical School Translational Health Sciences, Bristol, UK
- North Bristol Lung Centre, North Bristol NHS Trust, Bristol, UK
| | - Patrick Dorn
- Division of Thoracic Surgery, University Hospital Bern, Bern, Switzerland
| | | | - Jose M Porcel
- Pleural Medicine Unit, Arnau de Vilanova University Hospital, IRB Lleida, Lleida, Spain
| | - Julius Janssen
- Department of Pulmonary Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Marios Froudarakis
- Department of Respiratory Medicine, Medical School of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dragan Subotic
- Clinic for Thoracic Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Phillippe Astoul
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hospital North Aix-Marseille University, Marseille, France
| | - Peter Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Ralph Schmid
- Division of Thoracic Surgery, University Hospital Bern, Bern, Switzerland
| | - Arnaud Scherpereel
- Pulmonary and Thoracic Oncology Department, Hospital of the University (CHU) of Lille, Lille, France
| | - Najib M Rahman
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- Oxford Centre for Respiratory Medicine, University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Nick A Maskell
- Academic Respiratory Unit, University of Bristol Medical School Translational Health Sciences, Bristol, UK
- North Bristol Lung Centre, North Bristol NHS Trust, Bristol, UK
- Task force chairperson
| | - Giuseppe Cardillo
- Task force chairperson
- Department of Thoracic Surgery, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
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23
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Kleontas A, Sioga A, Pandria N, Barbetakis N, Lazopoulos A, Katsikas I, Asteriou C, Paliouras D, Kamperis E, Ikonomou D, Papamitsou T, Filippou D, Destouni C, Ikonomou L, Zarogoulidis K, Papagiannopoulos K. Clinical factors affecting the survival of patients diagnosed with non-small cell lung cancer and metastatic malignant pleural effusion, treated with hyperthermic intrathoracic chemotherapy or chemical talc pleurodesis: a monocentric, prospective, randomized trial. J Thorac Dis 2019; 11:1788-1798. [PMID: 31285871 DOI: 10.21037/jtd.2019.05.25] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background There is a plethora of treatment algorithms for managing patients with malignant pleural effusions (MPEs), sharing many common points and principles. Our study aims to compare hyperthermic intrapleural chemotherapy (HITHOC) and talc pleurodesis (TALC), as treatment options for patients with non-small cell lung cancer (NSCLC) and metastatic MPE. Methods This prospective, randomized trial was conducted at a single thoracic surgery center, the "Theagenio" Cancer Institute, in Greece, under the identification code NCT01409551 and was completed. All 40 patients enrolled were adults with histologically proven metastatic, unilateral, MPE caused by NSCLC. Exclusion criteria included patients >80 years, trapped lung, and major comorbidities. Patients were randomly and equally assigned 1:1 to either HITHOC (group A) or TALC (group B) by video assisted thoracic surgery (VATS). The primary outcome was the median overall survival (OS) from trial intervention to death, while secondary outcome was the identification of clinical factors affecting the survival. Results The patients were followed up for 45 months. The OS of the full group was 8 months (95% CI: 7.046-8.954). Participants who underwent HITHOC had an OS of 8 months (95% CI: 7.141-8.859), whereas the participants of TALC had an OS of 9 months (95% CI: 7.546-10.454), with no significant difference between groups. Among fifty-four factors that were tested for their effects on survival, only TNM stage and creatinine values both preoperatively and 7 days postoperatively could be regarded as risk-factors for survival. Other recorded parameters, which had significant variance between the two groups, were urea levels, C-reactive protein, white blood cells and total in hospital length of stay (LOS). Conclusions Both HITHOC and TALC are equally effective and safe therapeutic options in treating patients with MPE and NSCLC with acceptable survival. The study revealed independent clinical risk factors influencing survival, which could be utilized as starting points for larger clinical studies. Keywords Pleurodesis; pleural effusion; malignant; carcinoma; non-small cell lung; hyperthermia.
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Affiliation(s)
- Athanasios Kleontas
- Department of Thoracic Surgery, European Interbalkan Medical Center of Thessaloniki, Thessaloniki, Greece
| | - Antonia Sioga
- Laboratory of Histology-Embryology, Medical School of Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Niki Pandria
- Laboratory of Medical Physics, Medical School of Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Barbetakis
- Department of Thoracic Surgery, "Theagenio" Cancer Hospital of Thessaloniki, Thessaloniki, Greece
| | - Achilleas Lazopoulos
- Department of Thoracic Surgery, "Theagenio" Cancer Hospital of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Katsikas
- Department of Anesthesiology, Polyclinique Du Val De Loire, Nevers, France
| | - Christos Asteriou
- Department of Thoracic Surgery, Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Paliouras
- Department of Thoracic Surgery, "Theagenio" Cancer Hospital of Thessaloniki, Thessaloniki, Greece
| | - Efstathios Kamperis
- Department of Radiotherapy, "Papageorgiou" General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Ikonomou
- Department of Thoracic Surgery, European Interbalkan Medical Center of Thessaloniki, Thessaloniki, Greece
| | - Theodora Papamitsou
- Laboratory of Histology-Embryology, Medical School of Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Filippou
- Department of Thoracic Surgery, European Interbalkan Medical Center of Thessaloniki, Thessaloniki, Greece
| | - Chariklia Destouni
- Laboratory of Cytology, "Theagenio" Cancer Hospital of Thessaloniki, Thessaloniki, Greece
| | - Louiza Ikonomou
- Laboratory of Histology-Embryology, Medical School of Aristotle University of Thessaloniki, Thessaloniki, Greece
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Brun C, Gay P, Cottier M, Karpathiou G, Patoir A, Tiffet O, Barral FG, Vergnon JM, Froudarakis ME. Comment from the authors: the tests combination in patients with lung cancer and malignant pleural effusion. J Thorac Dis 2019; 11:E74-E75. [PMID: 31285914 PMCID: PMC6588792 DOI: 10.21037/jtd.2019.05.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Clement Brun
- Department of Pneumonology and Thoracic Oncology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Pierre Gay
- Department of Pneumonology and Thoracic Oncology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Michele Cottier
- Department of Cytology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Georgia Karpathiou
- Department of Pathology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Arnaud Patoir
- Department of Thoracic Surgery, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Olivier Tiffet
- Department of Thoracic Surgery, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Fabrice-Guy Barral
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Jean-Michel Vergnon
- Department of Pneumonology and Thoracic Oncology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Marios E Froudarakis
- Department of Pneumonology and Thoracic Oncology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
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25
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Brun C, Gay P, Cottier M, Karpathiou G, Patoir A, Tiffet O, Barral FG, Vergnon JM, Froudarakis ME. Comparison of cytology, chest computed and positron emission tomography findings in malignant pleural effusion from lung cancer. J Thorac Dis 2018; 10:6903-6911. [PMID: 30746236 DOI: 10.21037/jtd.2018.11.127] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Malignant pleural effusion (MPE) is a common medical problem in lung cancer (LC). Pleural fluid cytology (PFC), chest computed tomography (CCT) and positron emission tomography (PET) findings are helpful as first line approach. The objectives of this study were to evaluate whether there is a correlation between PFC, CCT and PET in patients with MPE due to LC. Methods We selected patients from our electronic files. Data of PFC, pleural biopsy (PB), CCT and PET have been recorded and analyzed. Results A total of 101 consecutive patients (66 males, 65.3%) with a mean age of 66.2±31 years were selected. Types of LC were adenocarcinoma in 71 patients (70.2%), squamous in 13 (12.8%), small-cell in 12 (11.8%) and large cell in 5 (4.9%). CCT showed nodules in 6 (5.9%), pleural thickening in 8 (7.9%) and both in 17 (16.8%) patients. PFC was positive in 55/91 thoracentesis (60.4%) and 32/52 thoracoscopy (61.5%), while PB in 38/40 performed (95%). PET fixation was found in 32/47 (68%) patients who had MPE at diagnosis. When we associate PFC to CCT and PET findings, the yield in our study becomes 90%. No correlation was observed between CCT findings and PFC (P=0.62) between PFC and PET fixation (P=0.63) or between CCT and PET (P=0.06). Conclusions In our cohort of LC patients with MPE, we observed a high sensitivity for PFC, while in most of the cases no findings were observed in CCT. PET had a relative low sensitivity. However, when all 3 methods were combined the yield was 90%.
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Affiliation(s)
- Clement Brun
- Departments of Pneumonology and Thoracic Oncology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Pierre Gay
- Departments of Pneumonology and Thoracic Oncology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Michele Cottier
- Departments of Cytology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Georgia Karpathiou
- Departments of Pathology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Arnaud Patoir
- Departments of Thoracic Surgery, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Oliviet Tiffet
- Departments of Thoracic Surgery, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Fabrice-Guy Barral
- Departments of Radiology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Jean-Michel Vergnon
- Departments of Pneumonology and Thoracic Oncology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Marios E Froudarakis
- Departments of Pneumonology and Thoracic Oncology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
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Bibby AC, Dorn P, Psallidas I, Porcel JM, Janssen J, Froudarakis M, Subotic D, Astoul P, Licht P, Schmid R, Scherpereel A, Rahman NM, Cardillo G, Maskell NA. ERS/EACTS statement on the management of malignant pleural effusions. Eur Respir J 2018; 52:13993003.00349-2018. [DOI: 10.1183/13993003.00349-2018] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 03/28/2018] [Indexed: 02/07/2023]
Abstract
Malignant pleural effusions (MPE) are a common pathology, treated by respiratory physicians and thoracic surgeons alike. In recent years, several well-designed randomised clinical trials have been published that have changed the landscape of MPE management. The European Respiratory Society (ERS) and the European Association for Cardio-Thoracic Surgery (EACTS) established a multidisciplinary collaboration of clinicians with expertise in the management of MPE with the aim of producing a comprehensive review of the scientific literature.Six areas of interest were identified, including the optimum management of symptomatic MPE, management of trapped lung in MPE, management of loculated MPE, prognostic factors in MPE, whether there is a role for oncological therapies prior to intervention for MPE and whether a histological diagnosis is always required in MPE.The literature revealed that talc pleurodesis and indwelling pleural catheters effectively manage the symptoms of MPE. There was limited evidence regarding the management of trapped lung or loculated MPE. The LENT score was identified as a validated tool for predicting survival in MPE, with Brims' prognostic score demonstrating utility in mesothelioma prognostication. There was no evidence to support the use of oncological therapies as an alternative to MPE drainage, and the literature supported the use of tissue biopsy as the gold standard for diagnosis and treatment planning.
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27
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Jeba J, Cherian RM, Thangakunam B, George R, Visalakshi J. Prognostic Factors of Malignant Pleural Effusion among Palliative Care Outpatients: A Retrospective Study. Indian J Palliat Care 2018; 24:184-188. [PMID: 29736123 PMCID: PMC5915887 DOI: 10.4103/ijpc.ijpc_183_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Malignant pleural effusion (MPE) has varied survival and indicates advanced disease. LENT prognostic score is the first validated score used for MPE. This study assessed the role of LENT among palliative care cancer patients and assessed different patient, tumor, and treatment related factors that may affect survival. Methods A retrospective study of advanced cancer patients with MPE, seen in palliative care outpatient clinic (2013-2015) until death, was done. LENT prognostic score could be calculated in 15 patients. Patient, tumor, and treatment related factors that affect survival were assessed. Results The study included 48 patients (70.8% female; 29.2% male) with a median age of 53 years. Lung (41.7%) was the most common primary, and adenocarcinoma (44.7%) was the most common histology. The median overall survival (OS) was 14.5 months (interquartile range [IQR]: 5.25-32.75) and median survival time (ST) was 3 months (IQR: 1-7.75). ST was significantly low with poor Eastern Cooperative Oncology Group (ECOG) performance status (P = 0.002), bilateral effusion (P < 0.001), and with no oncological treatment after MPE diagnosis (P < 0.001). OS and ST were significantly low with lung primary (P = 0.006 and 0.02, respectively). Age, gender, breathlessness, tumor histology, lung metastasis, and interventions for MPE did not significantly affect survival. The median ST in the moderate and high risk LENT groups was 6 and 3 months, respectively (P = 0.16). Conclusion ECOG performance status, bilateral effusion, and no oncological treatment after diagnosis of MPE were associated with poor ST. Lung primary was associated with shorter OS and ST. Small numbers precluded any definitive conclusion on the prognostic value of LENT in our group of patients, and hence larger studies are recommended.
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Affiliation(s)
- Jenifer Jeba
- Department of Medical Oncology, Christian Medical College Hospital, Alleppey, Kerala, India
| | - Renitha M Cherian
- Department of Radiation Oncology, Prathyasa Cancer Hospital, Alleppey, Kerala, India
| | | | - Reena George
- Department of Radiotherapy, Palliative Care Unit, Vellore, Tamil Nadu, India
| | - J Visalakshi
- Department of Biostatistics, Christian Medical College Hospital, Vellore, Tamil Nadu, India
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Alihodzic-Pasalic A, Maric V, Hadzismailovic A, Pilav A, Grbic K. Comparison of Efficiency of Pleurodesis Between Video Assisted Thoracoscopic Surgery (VATS) and Standard Thoracostomy. Acta Inform Med 2018; 26:185-189. [PMID: 30515010 PMCID: PMC6195412 DOI: 10.5455/aim.2018.26.185-189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Chemical pleurodesis is generally accepted palliative dyspnea therapy and preventive of re-accumulation of pleural fluid in patients with malignant pleural effusions. Aim Comparative analyses of efficiency of chemical pleurodesis between Video Assisted Thoracoscopic Surgery (VATS) and standard thoracostomy. Methods From 01.01.2016-01.01.2017 at the Clinic for Thoracic Surgery of University Clinical Center (UCC) Sarajevo retrospective analysis was performed. Studied patients underwent VATS pleurodesis (G1) and standard thoracostomy pleurodesis (G2), with 60 in each group, respecting defined inclusion and exclusion criteria. Pleurodesis success was examined radiologically over the next three months. Results Average age of all patients was 63.97±8.75 years. Gender related, 45% were men and 55% were women (F/M=1.47:1). Average hospitalization was 7.22±1.37 (G1: 6.68±1.16; G2: 7.44±1.40; Mann-Whitney U-test: p=0.0016) days. Average thoracic drainage duration was 5.45±1.69, (G1: 4.28±1.15,G2: 6.05±1.58; Mann-Whitney U-test p<0.0001) days. Pleurodesis success after first month was 98.30% in G1, 91.60% in G2 (G1 vs. G2; p=0.2089); after second month was 98.30% in G1, 78.30% in G2 (G1 vs. G2; p=0.0011) and after three months was 91.60% in G1, 63.30% in G2(G1 vs. G2; p=0.0006). Average dyspnea degree (0-5) after the pleurodesis was 0.050±0.22 in G1 and 0.62±0.76 in G2 (Mann-Whitney U-test; p=0.0001). Complication were noticed in 9.2% patients, in G1 3.3%, 15.0% in G2. Conclusion Difference in pleurodesis efficiency between the G1 and G2 was established after second month and was even more evident after third month in favor of G1. Results show the significant statistical improvement of the degree of dyspnea in G1 as opposite to the G2.
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Affiliation(s)
- Alma Alihodzic-Pasalic
- Clinic for Thoracic Surgery of University Clinic Centar Sarajevo, Sarajevo Bosnia and Hercegovina
| | - Veljko Maric
- Faculty of Medicine Foca, University of East Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Ademir Hadzismailovic
- Clinic for Thoracic Surgery of University Clinic Centar Sarajevo, Sarajevo Bosnia and Hercegovina
| | - Alen Pilav
- Clinic for Thoracic Surgery of University Clinic Centar Sarajevo, Sarajevo Bosnia and Hercegovina
| | - Kemal Grbic
- Clinic for Thoracic Surgery of University Clinic Centar Sarajevo, Sarajevo Bosnia and Hercegovina
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Abstract
PURPOSE OF REVIEW Patients with malignant pleural effusions (MPEs) are heterogenous in their disease course, symptom severity, responses to cancer therapies, fluid recurrence rates, and thus need for definitive fluid control measures. To tailor the most appropriate treatment for individual patients, clinicians need to 'phenotype' the patients and predict their clinical course. This review highlights the recent efforts to develop better predictive tools and knowledge gaps for further research. RECENT FINDINGS The LENT scoring system, which includes pleural fluid lactate dehydrogenase, performance status, serum neutrophil-to-lymphocyte ratio and tumor type, allows prediction of the survival of patients with MPE. Symptomatic response after therapeutic pleural drainage is highly variable; ongoing studies aim to identify those who would derive symptomatic benefit from fluid drainages. Multivariate analysis found that patients with low pleural fluid pH [odds ratio (OR) 37.04], large effusions (OR 3.31), and increasing age (OR 1.02) were more likely to require pleurodesis or indwelling pleural catheter placement for fluid control. Better predictive tools for rate of fluid recurrence and likelihood of successful pleurodesis would help guide clinical decision-making. SUMMARY Phenotyping MPE would guide the formulation of optimal management for individual MPE patients.
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Penz E, Watt KN, Hergott CA, Rahman NM, Psallidas I. Management of malignant pleural effusion: challenges and solutions. Cancer Manag Res 2017; 9:229-241. [PMID: 28694705 PMCID: PMC5491570 DOI: 10.2147/cmar.s95663] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Malignant pleural effusion (MPE) is a sign of advanced cancer and is associated with significant symptom burden and mortality. To date, management has been palliative in nature with a focus on draining the pleural space, with therapies aimed at preventing recurrence or providing intermittent drainage through indwelling catheters. Given that patients with MPEs are heterogeneous with respect to their cancer type and response to systemic therapy, functional status, and pleural milieu, response to MPE therapy is also heterogeneous and difficult to predict. Furthermore, the impact of therapies on important patient outcomes has only recently been evaluated consistently in clinical trials and cohort studies. In this review, we examine patient outcomes that have been studied to date, address the question of which are most important for managing patients, and review the literature related to the expected value for money (cost-effectiveness) of indwelling pleural catheters relative to traditionally recommended approaches.
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Affiliation(s)
- Erika Penz
- Division of Respirology, Department of Medicine, University of Saskatchewan, Saskatoon, SK
| | - Kristina N Watt
- Division of Respirology, Department of Medicine, University of Saskatchewan, Saskatoon, SK
| | - Christopher A Hergott
- Division of Respirology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Respiratory Trials Unit, Oxford University, Oxford, UK
| | - Ioannis Psallidas
- Oxford Centre for Respiratory Medicine, Respiratory Trials Unit, Oxford University, Oxford, UK
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31
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Froudarakis ME, Plojoux J, Kaspi E, Anevlavis S, Laroumagne S, Karpathiou G, Roca E, Adler D, Dutau H, Astoul P. Positive pleural cytology is an indicator for visceral pleural invasion in metastatic pleural effusions. CLINICAL RESPIRATORY JOURNAL 2017; 12:1011-1016. [DOI: 10.1111/crj.12619] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 01/24/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Marios E. Froudarakis
- Department of Respiratory Medicine, Medical School; Democritus University of Thrace; Alexandroupolis Greece
| | - Jerôme Plojoux
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord; Aix-Marseille University; Marseille France
- Division of Pulmonary Medicine; University Hospitals of Geneva; Geneva Switzerland
| | - Elise Kaspi
- INSERM, GMGF UMRS 910; Aix-Marseille University; Marseille France
- Hôpital la Timone; Service de Biologie Cellulaire; Marseille France
| | - Stavros Anevlavis
- Department of Respiratory Medicine, Medical School; Democritus University of Thrace; Alexandroupolis Greece
| | - Sophie Laroumagne
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord; Aix-Marseille University; Marseille France
| | - Georgia Karpathiou
- Department of Pathology; University Hospital of Ioannina; Ioannina Greece
| | - Elisa Roca
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord; Aix-Marseille University; Marseille France
| | - Dan Adler
- Division of Pulmonary Medicine; University Hospitals of Geneva; Geneva Switzerland
| | - Hervé Dutau
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord; Aix-Marseille University; Marseille France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord; Aix-Marseille University; Marseille France
- Aix-Marseille University; Marseille France
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Anevlavis S, Froudarakis ME. Advances in pleuroscopy. CLINICAL RESPIRATORY JOURNAL 2017; 12:839-847. [DOI: 10.1111/crj.12597] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 11/11/2016] [Indexed: 01/10/2023]
Affiliation(s)
- Stavros Anevlavis
- Department of Respiratory Medicine, Medical School of Alexandroupolis; Democritus University of Thrace; Greece
| | - Marios E. Froudarakis
- Department of Respiratory Medicine, Medical School of Alexandroupolis; Democritus University of Thrace; Greece
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Amin Z, Iskandar SD, Sibli. Prognostic Factors of 30-day Survival of Patients with Malignant Pleural Effusion. Indian J Palliat Care 2017; 23:321-324. [PMID: 28827939 PMCID: PMC5545961 DOI: 10.4103/ijpc.ijpc_2_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: Treatment of malignant pleural effusion (MPE) depends on the 1 month prognosis of patients. Until now, there is no study evaluate factors affecting 1 month survival. Aims: This study aims to determine the predictors of survival within 1 month. Methods: Prospective study of 102 patients with MPE. Biochemistry data of pleural fluid, characteristics of tumor, and massiveness of the effusion were analyzed to determine their effect on 30-day survival of the patients. Univariate analysis was performed using Chi-square. All prognostic factors that had P < 0.25 were included in multivariate analysis using Cox regression. Results: Median age of patients was 51 years, most of them were female (56%). Common primary sites of tumor were lung (31%), breast (19%), and lymphatic tissue (11%). In univariate analysis, factors that have P < 0.25 were low glucose concentration in pleural fluid (P = 0.01), high lactate dehydrogenase concentration in pleural fluid (P = 0.25), and high risk tumor (P = 0.24). In multivariate analysis, only low glucose concentration was significantly related to poor survival within 1 month (hazard ratio 2.85 [1.10–7.61], P = 0.03). Conclusions: Low level of glucose in pleural fluid is an important factor related to 30-day survival in patients with MPE. It can be used to determine prognosis-based treatment objectively.
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Affiliation(s)
- Zulkifli Amin
- Department of Respirology and Critical Illness, Faculty of Medicine University of Indonesia, Jakarta, Indonesia
| | - Stephen Diah Iskandar
- Department of Respirology and Critical Illness, Faculty of Medicine University of Indonesia, Jakarta, Indonesia
| | - Sibli
- Department of Respirology and Critical Illness, Faculty of Medicine University of Indonesia, Jakarta, Indonesia
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Bambara AT, Ouédraogo SM, Maïga S, Sondo KA, Boncoungou/Nikièma K, Ouédraogo G, Koumbem B, Ouédraogo AS, Djibril M, Badoum G, Ouédraogo AR, Ouédraogo M. [Survival of malignant and paramalignant pleural effusions in Ouagadougou]. REVUE DE PNEUMOLOGIE CLINIQUE 2016; 72:346-352. [PMID: 27776946 DOI: 10.1016/j.pneumo.2016.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 08/22/2016] [Accepted: 08/27/2016] [Indexed: 06/06/2023]
Abstract
This study aimed to present the survival of patients with malignant and paramalignant pleural effusion (MPE) in a context of resource-limited countries. We retrospectively studied patients received for malignant and paramalignant pleural effusion in three health facilities in Ouagadougou from 1st August 2009 to 30 July 2015. Survival was analyzed according to various characteristics related to patients and disease. Eighty patients with a mean age of 54 years were selected. The sex-ratio was 0.9. Sixteen patients had comorbidities. Pleural effusion was revealing, synchronous and metachronous in respectively 55 %, 26.3 % and 17.5 % of cases. Lung cancer was the most common cause of MPE (27.5 %), followed by breast cancer (18.7 %). The median overall survival was 3 months; it varied between primary cancers: 5 months for primary cancer unknown, 4 months for lung cancers and 2 months for breast cancers. Sex and the presence of comorbidities were independent factors influencing survival of patients. In this study, patient survival length is strongly compromised by inadequacies of medical technical equipment.
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Affiliation(s)
- A T Bambara
- Unité de formation et de recherche en sciences de la santé, BP 7021, Ouagadougou, Burkina Faso; Service de cancérologie, CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso.
| | - S M Ouédraogo
- Service de médecine interne, CHU Souro Sanou, Bobo-Dioulasso, Burkina Faso; Institut supérieur des sciences de la santé, Bobo-Dioulasso, Burkina Faso
| | - S Maïga
- Service de pneumophtisiologie, CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - K A Sondo
- Unité de formation et de recherche en sciences de la santé, BP 7021, Ouagadougou, Burkina Faso; Service de maladies infectieuses, CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - K Boncoungou/Nikièma
- Unité de formation et de recherche en sciences de la santé, BP 7021, Ouagadougou, Burkina Faso; Service de pneumophtisiologie, CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - G Ouédraogo
- Unité de formation et de recherche en sciences de la santé, BP 7021, Ouagadougou, Burkina Faso; Service de pneumophtisiologie, CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - B Koumbem
- Service de pneumophtisiologie, CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - A S Ouédraogo
- Unité de formation et de recherche en sciences de la santé, BP 7021, Ouagadougou, Burkina Faso; Service d'anatomie pathologique, CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - M Djibril
- Service de réanimation médicale, CHU Sylvanus Olympio, Lomé, Togo
| | - G Badoum
- Unité de formation et de recherche en sciences de la santé, BP 7021, Ouagadougou, Burkina Faso; Service de pneumophtisiologie, CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - A R Ouédraogo
- Unité de formation et de recherche en sciences de la santé, BP 7021, Ouagadougou, Burkina Faso; Service de pneumophtisiologie, CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - M Ouédraogo
- Unité de formation et de recherche en sciences de la santé, BP 7021, Ouagadougou, Burkina Faso; Service de pneumophtisiologie, CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso
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Karpathiou G, Giroult JB, Forest F, Fournel P, Monaya A, Froudarakis M, Dumollard JM, Prades JM, Gavid M, Peoc'h M. Clinical and Histologic Predictive Factors of Response to Induction Chemotherapy in Head and Neck Squamous Cell Carcinoma. Am J Clin Pathol 2016; 146:546-553. [PMID: 27694130 DOI: 10.1093/ajcp/aqw145] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Induction chemotherapy (IC) is occasionally used in head and neck cancer, leading to less extensive surgery and reduced need for irradiation. Factors predicting the response to IC have not been determined. In this study, we investigated the clinical and histopathologic factors that predict the response to IC. METHODS Head and neck squamous cell carcinomas from 81 patients were analyzed; clinical factors, histologic parameters, and expression of p16 and p53 were correlated with response to chemotherapy and prognosis. RESULTS Factors predicting a good response to IC were the nonoropharyngeal localization, a rich lymphocytic tissue response, and a low platelet-to-lymphocyte blood ratio before treatment. Response to IC did not correlate with prognosis, whereas a low neutrophil-to-lymphocyte ratio (NLR), the absence of a desmoplastic reaction, a rich lymphocytic tissue response, and the overexpression of p53 were associated with better prognosis. CONCLUSIONS Lymphocytic tissue response, NLR, and nonoropharyngeal localization are factors predictive of response to IC.
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Affiliation(s)
| | | | | | | | | | - Marios Froudarakis
- Department of Pneumonology, North Hospital, University Hospital of St-Étienne, St-Étienne, France; and
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Verma A, Phua CK, Sim WY, Algoso RE, Tee KS, Lew SJW, Lim AYH, Goh SK, Tai DYH, Kor AC, Ho B, Abisheganaden J. Pleural LDH as a prognostic marker in adenocarcinoma lung with malignant pleural effusion. Medicine (Baltimore) 2016; 95:e3996. [PMID: 27368006 PMCID: PMC4937920 DOI: 10.1097/md.0000000000003996] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
To study the performance of serum and pleural lactate dehydrogenase (LDH) level in predicting survival in patients with adenocarcinoma lung presenting with malignant pleural effusions (MPE) at initial diagnosis.Retrospective cohort study of the patient hospitalized for adenocarcinoma lung with MPE in year 2012.Univariate analyses showed lower pleural fluid LDH 667 (313-967) versus 971 (214-3800), P = 0.04, female gender 9 (100%) versus 27 (41.5%), P = 0.009, never smoking status 9 (100%) versus 36 (55.3%), P = 0.009, and epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) therapy 8 (89%) versus 26 (40%), P = 0.009 to correlate with survival of more than 1.7 year versus less than 1.7 year. In multivariate analysis, low pleural fluid LDH and female gender maintained significance. The pleural LDH level of ≤1500 and >1500 U/L discriminated significantly (P = 0.009) between survival.High pleural LDH (>1500 IU/L) predicts shorter survival (less than a year) in patients with adenocarcinoma lung presenting with MPE at the time of initial diagnosis. This marker may be clinically applied for selecting therapeutic modality directed at prevention of reaccumulation of MPE. Patients with low pleural LDH may be considered suitable for measures that provide more sustained effect on prevention of reaccumulation such as chemical pleurodesis or tunneled pleural catheter.
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Affiliation(s)
- Akash Verma
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
- Correspondence: Akash Verma, Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore (e-mail: )
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Chaussende A, Hermant C, Tazi-Mezalek R, Favrolt N, Hureaux J, Fournier C, Lorut C, Paganin F, Ngo MT, Vandemoortele T, Anevlavis S, Froudarakis ME, Vergnon JM. Endobronchial metastases from melanoma: a survival analysis. CLINICAL RESPIRATORY JOURNAL 2016; 11:1006-1011. [PMID: 26789129 DOI: 10.1111/crj.12456] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 12/31/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Metastatic spread to the tracheobronchial tree from other than bronchopulmonary tumors is a common clinical problem. However, malignant melanoma, a highly metastatic potential tumor, is rarely metastasing in the airways. Therefore little is known about survival of patients with endobronchial metastasis from melanoma. OBJECTIVES The aim of our study was to assess survival of patients with endobronchial metastasis of melanomas according to clinical and radiological features, to determine any possible factor affecting survival. METHODS This retrospective study included 19 patients who underwent a bronchoscopy from 11 different hospitals. Data about patients' demographics, symptoms, radiographic, endoscopic findings and treatment were investigated to evaluate any possible impact on survival. RESULTS Endobronchial metastases occurred at a median of 48 months (range 0-120) following the diagnosis of the primary tumor. About 73.7% of patients had other proven metastases when the endobronchial involvement was diagnosed. Symptoms are not specific as well as radiological features. Median overall survival of the studied population was 6 months (range 1-46). Factors of poor survival were multiple metastatic sites (P = 0.019), pleural (P = 0.0014) and soft tissue metastasis (P = 0.024). Different treatment modalities applied in our patients showed no effect on survival. CONCLUSION Patients with endobronchial metastasis have overall poor survival, affected by multiple organ involvement, the presence of pleural and soft tissue disease, while no impact on survival has been shown by any treatment applied.
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Affiliation(s)
| | | | | | - Nicolas Favrolt
- Service de Pneumologie, Hôpital du Bocage, CHU, Dijon, France
| | - José Hureaux
- Service de Pneumologie, CHU d'Angers, Angers, France
| | | | | | - Fabrice Paganin
- Group Hospitalier Sud La Réunion, Saint Pierre, La Reunion, France
| | - Minh-Triet Ngo
- Service de Pneumologie, Hôpital Foch, CHU, Paris, France
| | | | - Stavros Anevlavis
- Service de Pneumologie, CHU Alexandroupolis, Alexandroupolis, Grèce, and the GELF (Group d'Endoscopie de Langue Française)
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Abrao FC, Peixoto RD, de Abreu IRLB, Janini MC, Viana GG, de Oliveira MC, Younes RN. Prognostic factors in patients with malignant pleural effusion: Is it possible to predict mortality in patients with good performance status? J Surg Oncol 2016; 113:570-4. [PMID: 26751412 DOI: 10.1002/jso.24168] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 12/28/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to identify predictors of mortality only in patients with malignant pleural effusion (MPE) showing good performance status which required pleural palliative procedures. METHODS All patients with MPE submitted to pleural palliative procedure were enrolled in a prospective study between 2013 and 2014. Patients with Eastern cooperative oncology group (ECOG) score zero, one, and two were considered with good performance status. The possible prognostic factors were tested for significance using the log-rank test (Kaplan-Meier method) and those with significance on univariate analysis were entered into a multivariable Cox model. RESULTS A total of 64 patients were included in the analysis. Median follow-up time for surviving patients was 263 days. Median survival for the entire cohort was not reached yet. In the multivariate analysis, gastrointestinal primary site (P = 0.006), low albumin concentration in the pleural fluid (P = 0.017), and high serum NLR (P = 0.007) were associated with mortality. CONCLUSION In our cohort of ECOG 0-2 patients with MPE submitted to pleural palliative procedures, gastrointestinal malignancy compared to other sites, low pleural fluid albumin and high NLR were significantly associated with mortality. The identification of these prognostic factors may assist the choice of the optimal palliative technique. J. Surg. Oncol. 2016;113:570-574. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | | | | | | | | | | | - Riad Naim Younes
- Department of Thoracic Surgery of Hospital São José, São Paulo, Brazil
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Abrao FC, de Abreu IRLB, Fogarolli M, Caxeiro G, Bezerra CBS, de Cerqueira Cesar FP, Rocha PS, Younes RN. Prognostic Factors of 30-Day Mortality After Palliative Procedures in Patients with Malignant Pleural Effusion. Ann Surg Oncol 2015; 22:4083-4088. [DOI: 10.1245/s10434-015-4491-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Giarnieri E, Bellipanni G, Macaluso M, Mancini R, Holstein AC, Milanese C, Giovagnoli MR, Giordano A, Russo G. Review: Cell Dynamics in Malignant Pleural Effusions. J Cell Physiol 2015; 230:272-7. [PMID: 25205557 DOI: 10.1002/jcp.24806] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 09/05/2014] [Indexed: 12/29/2022]
Abstract
Malignant pleural effusions (MPEs) are a common manifestation found in patients with lung cancer. After cytological and histological confirmation of malignancy, talc pleurodesis still remains the treatment of choice in patients with MPEs resistant to chemotherapy. Despite this, primary challenges include reduced quality of life and life expectancy in general. Therefore, a better understanding of the cell biology of MPEs, along with improvements in treatment is greatly needed. It has recently been demonstrated that MPEs may represent an excellent source for identification of molecular mechanisms within the tumor and its environment. The present review summarizes the current understanding of MPEs cells and tumor microenvironment, and particularly focuses on dissecting the cross-talk between MPEs and epithelial to mesenchymal transition (EMT), inflammation and cancer stem cells.
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Affiliation(s)
- Enrico Giarnieri
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University La Sapienza, Rome, Italy
| | - Gianfranco Bellipanni
- Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, BioLife Science Bldg., Philadelphia, Pennsylvania
| | - Marcella Macaluso
- Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, BioLife Science Bldg., Philadelphia, Pennsylvania
| | - Rita Mancini
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University La Sapienza, Rome, Italy
| | - Adam Carl Holstein
- Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, BioLife Science Bldg., Philadelphia, Pennsylvania
| | - Carla Milanese
- Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, BioLife Science Bldg., Philadelphia, Pennsylvania
| | - Maria Rosaria Giovagnoli
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University La Sapienza, Rome, Italy
| | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, BioLife Science Bldg., Philadelphia, Pennsylvania.,INT-CROM, "Pascale Foundation" National Cancer Institute-Cancer Research Center, Mercogliano (AV), Italy.,Department of Medical and Surgical Sciences and Neurosciences, University of Siena, Siena, Italy
| | - Giuseppe Russo
- Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, BioLife Science Bldg., Philadelphia, Pennsylvania
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Clive AO, Bhatnagar R, Psallidas I, Maskell NA. Individualised management of malignant pleural effusion. THE LANCET RESPIRATORY MEDICINE 2015; 3:505-6. [DOI: 10.1016/s2213-2600(15)00183-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 04/02/2015] [Accepted: 05/01/2015] [Indexed: 01/19/2023]
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Zamboni MM, da Silva CT, Baretta R, Cunha ET, Cardoso GP. Important prognostic factors for survival in patients with malignant pleural effusion. BMC Pulm Med 2015; 15:29. [PMID: 25887349 PMCID: PMC4379612 DOI: 10.1186/s12890-015-0025-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 03/17/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND 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. METHODS This 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. RESULTS One 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). CONCLUSIONS ECOG 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.
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Affiliation(s)
- Mauro Musa Zamboni
- Pulmonology and Thoracic Surgery Division, Hospital do Câncer I, Instituto Nacional de Câncer/Ministério da Saúde, Rio de Janeiro, RJ, Brazil.
| | - Cyro Teixeira da Silva
- Pulmonology Division, Hospital Antonio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brazil.
| | - Rodrigo Baretta
- Pulmonology and Thoracic Surgery Division, Hospital do Câncer I, Instituto Nacional de Câncer/Ministério da Saúde, Rio de Janeiro, RJ, Brazil.
| | - Edson Toscano Cunha
- Pulmonology and Thoracic Surgery Division, Hospital do Câncer I, Instituto Nacional de Câncer/Ministério da Saúde, Rio de Janeiro, RJ, Brazil.
| | - Gilberto Perez Cardoso
- Pulmonology Division, Hospital Antonio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brazil.
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Clive AO, Kahan BC, Hooper CE, Bhatnagar R, Morley AJ, Zahan-Evans N, Bintcliffe OJ, Boshuizen RC, Fysh ETH, Tobin CL, Medford ARL, Harvey JE, van den Heuvel MM, Lee YCG, Maskell NA. Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score. Thorax 2014; 69:1098-104. [PMID: 25100651 PMCID: PMC4251306 DOI: 10.1136/thoraxjnl-2014-205285] [Citation(s) in RCA: 261] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Malignant pleural effusion (MPE) causes debilitating breathlessness and predicting survival is challenging. This study aimed to obtain contemporary data on survival by underlying tumour type in patients with MPE, identify prognostic indicators of overall survival and develop and validate a prognostic scoring system. METHODS Three large international cohorts of patients with MPE were used to calculate survival by cell type (univariable Cox model). The prognostic value of 14 predefined variables was evaluated in the most complete data set (multivariable Cox model). A clinical prognostic scoring system was then developed and validated. RESULTS Based on the results of the international data and the multivariable survival analysis, the LENT prognostic score (pleural fluid lactate dehydrogenase, Eastern Cooperative Oncology Group (ECOG) performance score (PS), neutrophil-to-lymphocyte ratio and tumour type) was developed and subsequently validated using an independent data set. Risk stratifying patients into low-risk, moderate-risk and high-risk groups gave median (IQR) survivals of 319 days (228-549; n=43), 130 days (47-467; n=129) and 44 days (22-77; n=31), respectively. Only 65% (20/31) of patients with a high-risk LENT score survived 1 month from diagnosis and just 3% (1/31) survived 6 months. Analysis of the area under the receiver operating curve revealed the LENT score to be superior at predicting survival compared with ECOG PS at 1 month (0.77 vs 0.66, p<0.01), 3 months (0.84 vs 0.75, p<0.01) and 6 months (0.85 vs 0.76, p<0.01). CONCLUSIONS The LENT scoring system is the first validated prognostic score in MPE, which predicts survival with significantly better accuracy than ECOG PS alone. This may aid clinical decision making in this diverse patient population.
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Affiliation(s)
- Amelia O Clive
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Brennan C Kahan
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Clare E Hooper
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Rahul Bhatnagar
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Anna J Morley
- North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Natalie Zahan-Evans
- North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Oliver J Bintcliffe
- North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Rogier C Boshuizen
- Thoracic Oncology, The Netherlands Cancer Institute, Antonie van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Edward T H Fysh
- Respiratory Department, Sir Charles Gairdner Hospital, Perth, Australia
- Centre for Asthma, Allergy & Respiratory Research, School of Medicine & Pharmacology, University of Western Australia, Perth, Australia
| | - Claire L Tobin
- Respiratory Department, Sir Charles Gairdner Hospital, Perth, Australia
| | - Andrew R L Medford
- North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - John E Harvey
- North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Michel M van den Heuvel
- Thoracic Oncology, The Netherlands Cancer Institute, Antonie van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Y C Gary Lee
- Respiratory Department, Sir Charles Gairdner Hospital, Perth, Australia
- Centre for Asthma, Allergy & Respiratory Research, School of Medicine & Pharmacology, University of Western Australia, Perth, Australia
| | - Nick A Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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Aggarwal D, Saini V. Prognostic factors in patients with malignant pleural effusion. ACTA ACUST UNITED AC 2014; 88:175. [PMID: 24943479 DOI: 10.1159/000362886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Deepak Aggarwal
- Department of Pulmonary Medicine, Government Medical College and Hospital, Chandigarh, India
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Froudarakis ME. Should we really compare indwelling pleural catheters to any pleurodesis? Respiration 2014; 88:18-21. [PMID: 24821005 DOI: 10.1159/000362693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Marios E Froudarakis
- Department of Pneumonology, Medical School of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
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Anevlavis S, Froudarakis ME. Authors' Reply. Respiration 2014; 88:176. [DOI: 10.1159/000362895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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