Survival of lung adenocarcinoma patients with malignant pleural effusion

Abstract

In the era of targeted therapy, the association between lung adenocarcinoma patient survival and malignant pleural effusions (MPEs) remains unclear. This study investigated the clinical characteristics, survival and epidermal growth factor receptor (EGFR) gene (EGFR) mutation status of lung adenocarcinoma patients with MPE.From June 2005 to December 2010, consecutive pleural effusions were collected prospectively. Patient clinical characteristics, EGFR mutation status, and overall survival were analysed.We collected MPEs from 448 patients in stage IV lung adenocarcinoma at initial diagnosis. Median overall survival for patients with MPEs at initial diagnosis and following disease progression were 14.3 months and 21.4 months, respectively (p50.001). There were 296 (66.1%) patients harbouring EGFR mutations, the mutation rates among patients with an MPE at initial diagnosis and one following disease progression were 68.2% and 56.6%, respectively (p50.044); the L858R mutation rate was also higher among the former (32.6% versus 18.1%; p50.009). Multivariate analysis revealed that patients who: developed MPEs following disease progression, harboured EGFR mutations, and received EGFR-tyrosine kinase inhibitor therapy, had longer overall survival. Patients in stage IV lung adenocarcinoma with MPEs at initial diagnosis have shorter overall survival and higher EGFR mutation rate, especially for L858R, than patients who develop MPEs following disease progression.

Impact of metastatic status on the prognosis of EGFR mutation‑positive non‑small cell lung cancer patients treated with first‑generation EGFR‑tyrosine kinase inhibitors

“…Wu et al (17) reported that lung adenocarcinoma patients with Stage IV disease and malignant PE at the time of diagnosis have poorer OS times than patients who develop malignant PE following disease progression. However, the difference was only statistically significant in patients with distant metastases.…”

“…The toxicities of EGFR-TKIs are decreased compared with those of cytotoxic drugs and patients can achieve a good quality of life while using them (8,12). In patients treated with first generation EGFR-TKIs, brain, bone and liver metastasis and pleural effusion (PE) predicted a poorer prognosis compared with patients without these metastasis (13)(14)(15)(16)(17). However, few reports concern the association between the site of metastasis and prognosis (18,19).…”

Mast cells mediate malignant pleural effusion formation

“…No treatment exists, and palliative attempts may cause further morbidity and mortality (19,20). MPE was recently reclassified as a separate stage of lung cancer, since it was acknowledged to represent a distinct form of metastatic disease with very short survival (18,21,22). Simultaneously, we and others used mouse models to hypothesize that MPE is primarily an immune-and vascularMast cells (MCs) have been identified in various tumors; however, the role of these cells in tumorigenesis remains controversial.…”

Epidermal Growth Factor Receptor Gene Mutation in Pleural Lavage Cytology Findings of Primary Lung Adenocarcinoma Cases

“…They reported that the group with pleuritis discovered at the first consultation had a higher rate of EGFR mutation positivity, especially for the Exon21 L858R mutation. 7) However, opinions vary regarding the relationship between carcinomatous pleuritis and pleural lavage cytology findings. Higashiyama et al 11) reported that carcinomatous pleuritis at the site of recurrence was more frequent in their lavage cytology-positive group (23.5% vs 2.4%).…”

“…[3][4][5] It has also been shown that EGFR gene mutation-positive lung cancer patients frequently have malignant pleural effusion 6) that develops during the postoperative follow-up course. 7) Thus, an association between EGFR gene mutation positivity and carcinomatous pleuritis has been pointed out. Although patients with positive pleural lavage cytology findings do not always develop carcinomatous pleuritis, pleural lavage cytology positivity and carcinomatous pleuritis might not be identical.…”