Clinical course of asymptomatic malignant pleural effusion in non-small cell lung cancer patients

Abstract

The British Thoracic Society guidelines recommend observation for patients with asymptomatic malignant pleural effusion (MPE). However, asymptomatic MPE can become symptomatic. This study examined the clinical course of asymptomatic MPE in patients with non-small cell lung cancer (NSCLC), including the incidence and timing of symptom development of asymptomatic MPE and the associated factors. Retrospective data of 4822 NSCLC patients between January 2012 and December 2017 were reviewed. Symptom development of asymptomatic MPE was defined as the development of symptoms requiring additional treatment, such as insertion of a chest tube, within 1 year in patients who lacked MPE symptoms at the time of diagnosis. Clinical information, pathological parameters, and radiological characteristics were reviewed. Patient data up to 1 year from the initial diagnosis were reviewed. Of 113 patients with asymptomatic MPE, 46 (41%) became symptomatic within 1 year despite appropriate anticancer treatment. The median time to symptom development was 4 months, and 38 patients (83%) developed symptoms within 6 months. Multivariate logistic regression showed that female sex (odds ratio [OR], 0.256; 95% confidence interval [CI], 0.101–0.649; P = .004) and the depth of pleural effusion on initial computed tomography (CT) (OR, 0.957; 95% CI, 0.932–0.982; P = .001) were independently associated with symptom development of asymptomatic MPE. A fraction of 41% of patients with asymptomatic MPE became symptomatic within 1 year. Female sex and larger MPE on initial CT were independently associated with symptom development of asymptomatic MPE.

Impact of thoracic tumor radiotherapy on survival in non‐small‐cell lung cancer with malignant pleural effusion treated with targeted therapy: Propensity score matching study

“…For all we know, this is the first research to report the role of thoracic tumor radiotherapy on OS in MPE‐NSCLC patients treated with targeted therapy. The clinical characteristics of these patients included male proportion of 48.6%, age ≤70 years in majority of the patients, distant metastasis site, and T 3–4 and N 3 for 68.9% and 56.1% of patients, respectively, which were analogous to those reported for stage IV NSCLC without MPE 27–29 . Treatment for MPE‐NSCLC mainly aims at controlling MPE to improve life quality based on systematic drug treatment.…”

“…The clinical characteristics of these patients included male proportion of 48.6%, age ≤70 years in majority of the patients, distant metastasis site, and T 3-4 and N 3 for 68.9% and 56.1% of patients, respectively, which were analogous to those reported for stage IV NSCLC without MPE. [27][28][29] Treatment for MPE-NSCLC mainly aims at controlling MPE to improve life quality based on systematic drug treatment. However, the prognosis was poor, with the mean survival time (MST) of 4 months for systematic chemotherapy 3,4 and 16-18 months for simple EGFR-TKIs.…”

Diagnose und Management von malignem Pleuraerguss: Ein Jahrzehnt im Rückblick

“…Die klinische Darstellung einer MPE kann sehr unterschiedlich aussehen. Obwohl Dyspnoe das häufigste Symptom ist, sind 25% der MPE-Patienten asymptomatisch, mit zufälligen Befunden bei einer Untersuchung oder Röntgenaufnahme [8-10]. Neben der Kompression des Lungenparenchyms durch den Erguss ist wahrscheinlich ein komplexes Zusammenspiel von Mediastinalverschiebung, verminderter Brustwand-Compliance, Zwerchfelldepression und Reflexstimulation von Lunge und Brustwand für das Gefühl der Dyspnoe verantwortlich [11, 12].…”

“…In einer kürzlich durchgeführten multizentrischen retrospektiven Studie, die minimale Ergüsse (<10 mm Tiefe) und Patienten, die innerhalb von 3 Monaten nach der Diagnose starben, ausschloss, wurden 41% der Patienten mit asymptomatischen MPEs als Folge eines nicht kleinzelligen Lungenkarzinoms innerhalb eines Jahres symptomatisch, wobei die mittlere Zeit bis zur Entwicklung der Symptome 4 Monate betrug. Weibliches Geschlecht und die MPE-Größe wurden unabhängig voneinander mit der zukünftigen Entwicklung von Symptomen in Verbindung gebracht, die einen Eingriff erforderlich machen [10].…”