| Introduction:Malignant pleural effusion(MPE)predicts advanced disease and poor prognosis.Patients with MPE mostly suffer from significant dyspnea,poor exercise tolerance,or other complications related to recurrent pleural effusions.Patients with MPE were usually diagnosed by medical thoracoscopy,and Pleural tumor burden is assessed during thoracoscopy.Thoracoscopy is performed to obtain accurate diagnosis by obtaining histopathology,in addition to prevention of recurrent effusions in patients with symptomatic MPE by pleurodesis.It remains unclear whether the various representations visualized on thoracoscopy are reliable prognostic factors.The aim of this study was to evaluate prognostic factors for survival in patients who underwent thoracoscopy for MPE.Methods:We reviewed the medical records of consecutive patients with MPE who underwent medical thoracoscopy from 2007 to 2015 at a tertiary hospital.Patients were enrolled if pleural metastasis was confirmed by thoracoscopic pleural biopsy.Survival status,including PFS and OS,recorded on the basis of follow-up clinic visits or telephone calls.Patients with pleural metastasis were excluded if their survival status were uncertain;Patients were excluded if they were targeted therapies.Patients in our group were treated with traditional chemotherapy.Cisplatin combined with docetaxel,gemcitabine,or vinorelbine for traditional chemotherapy for NSCLC.The Kaplan-Meier method was employed to examine the prognostic value of individual predictors(age,gender,smoking status,histopathological type,appearance of PF,PF cytology,pleural brushing cytology,grade of adhesions,and pleural lesion rating).The 95%confidence intervals were calculated and compared using the log-rank test.Cox regression analysis was performed for multivariate survival analysis.Results:A total of 676 patients underwent thoracoscopy,of whom 294 patients were confirmed on tissue biopsy as having pleural metastasis.Further analysis was canducted in the 177 patients,including 125 with non-small cell lung cancer(NSCLC),10 with small cell lung cancer(SCLC),2 with undifferentiated lung cancer,6 with breast carcinoma,27 with mesothelioma and 7 with other malignancies.Median PFS and OS of the 177 patients were 6 months and 12.5 months,respectively.In NSCLC,factors adversely affecting overall survival(OS)in univariate analysis included EPC score(p = 0.031),grade of adhesions(p = 0.037),costoparietal pleural lesions(p＝0.035)and bloody MPE(p = 0.023);cox multivariate analysis revealed that EPC score(HR 1.121,95%CI 1.031-1.219;p=0.007)and grade of adhesions(HR 1.188,95%Cl 1.029-1.371;p =0.019)were independent predictors of OS.Conclusions:Under traditional chemotherapy,higher EPC score and higher grades of adhesions predicted poor prognosis in advanced NSCLC patients with pleural metastasis.Given these factors may allow doctors to make more accurate predictions and provide individual therapy when treating patients with MPE. |
