Pleural effusion in breast cancer: A review of 105 cases

Abstract

This paper reviews 105 patients with breast cancer who had a pleural effusion as a direct consequence of metastatic disease. The mean lag time between diagnosis of primary tumor and presentation of the effusion was 41.5 months. Mean survival time after development of an effusion was 15.7 months. Of the 99 patients with unilateral breast tumors, 50% had ipsilateral effusions, 40% were contralateral, and 10% were bilateral. Forty-two percent of the patients had pleural effusion as the first evidence of recurrence. No particular group of women, based on age, menopausal status, or parity could be identified as being at risk of developing a subsequent effusion. However, there was a significantly higher proportion of patients who had central and medial tumors and who had Stage III cancers. Other tumor features, such as size, histologic type, or grade, did not predict the development of pleural metastasis. The success rate of a variety of treatment methods, local, general, or a combination of both, was 17% in achieving control of effusions. There may be a place for more aggressive treatment of pleural effusion at first presentation so that the quality of life could be improved during the patient's remaining months of survival.

A gene expression signature associated with metastatic cells in effusions of breast carcinoma patients

“…Breast cancer relapses in the form of serous malignant effusions for about one half of patients. 11,12 Clinical samples may be available from palliative treatment of breast cancer patients, allowing the characterization of metastatic cells in effusions. Recent studies have described genotypic 13 and phenotypic 14,15 alterations for some metastasis-associated and regulatory molecules in breast primary tumors and pleural effusions.…”

Fatores clínicos e anatomopatológicos que influenciam a sobrevida de pacientes com câncer de mama e derrame pleural neoplásico

“…Among the patients with malignant Such variation might be attributed to the calendar year studied, the region of the country in which the patients were treated, the study methodology, or the population studied. Fentiman et al (8) found that the mean interval between the diagnosis of the primary tumor and the presentation of pleural effusion was 41.5 months, and that the mean survival after the presentation of pleural effusion was 15.7 months. However, van Galen et al (11) reported a longer mean time from the diagnosis of breast cancer to the detection of pleural effusion (63.6 months) and a shorter mean survival (9.3 months), findings that are in stark contrast with those of our study (20 months and 6 months, respectively).…”

“…Studies of the spread of breast cancer have shown that a longer interval free of pleural metastases is an indicator of a worse prognosis, (8,10,11) and this poor prognosis has been associated with factors such as the site of the metastasis and the identification of malignant cells in the pleural fluid (23) ; the expression of c-erbB-2 (21) ; the triple-negative phenotype (11,(15)(16)(17) ; and Ki-67 protein expression, which has been shown to be present in 63% of patients with malignant pleural effusion. (18,24,25) The worst breast cancer survival rates are in developing countries.…”

“…(26,27) Survival in malignant pleural effusion has also been widely studied. (8,10,11) In the present study, mean survival was shorter than that reported in studies conducted in developed countries, which might be attributable to more aggressive forms of the disease, limited access to appropriate treatment, (21) or even to delayed diagnosis of the primary tumor (i.e., diagnosis at an advanced stage), which could account for the shorter interval free of pleural metastases and for the shorter survival.…”

“…(7) In breast cancer patients, pleural and pericardial effusions are common and, when present, occur frequently over the course of the disease. (8,9) Such pulmonary metastases have been associated with a poor prognosis. (10,11) Because the lungs are common sites of metastatic disease, (12) the identification of malignant cells in the pleural fluid, together with the results of a biopsy of the parietal pleura, can provide evidence that the primary disease has spread or progressed, and such progression has been associated with decreased life expectancy.…”