Risk factors for pleural effusion recurrence in patients with malignancy

Horiana B. Grosu, Sofia Molina, Roberto Casal, Juhee Song, Liang Li, Javier Diaz-Mendoza, Chakravarthy Reddy, Lonny Yarmus, Dante Schiavo, Michael Simoff, Jared Johnstun, Abu Awwad Raid, David Feller-Kopman, Hans J Lee, Sarina Sahetya, Finbar Foley, Fabien Maldonado, Xin Tian, Laila Noor, Russell MillerLakshmi Mudambi, Timothy Saettele, Macarena Vial-Rodriguez, Gerogie A. Eapen, David E. Ost

Research output: Contribution to journalArticle

Abstract

Background and objective: The main purpose of treatment in patients with malignant pleural effusion (MPE) is symptom palliation. Currently, patients undergo repeat thoracenteses prior to receiving a definitive procedure as clinicians are not aware of the risk factors associated with fluid recurrence. The primary objective of this study was to identify risk factors associated with recurrent symptomatic MPE. Methods: Retrospective multicentre cohort study of patients who underwent first thoracentesis was performed. The primary outcome was time to fluid recurrence requiring intervention in patients with evidence of metastatic disease. We used a cause-specific hazard model to identify risk factors associated with fluid recurrence. We also developed a predictive model, utilizing Fine-Gray subdistribution hazard model, and externally validated the model. Results: A total of 988 patients with diagnosed metastatic disease were included. Cumulative incidence of recurrence was high with 30% of patients recurring by day 15. On multivariate analysis, size of the effusion on chest X-ray (up to the top of the cardiac silhouette (hazard ratio (HR): 1.84, 95% CI: 1.21-2.80, P=0.004) and above the cardiac silhouette (HR: 2.22, 95% CI: 1.43-3.46, P=0.0004)), larger amount of pleural fluid drained (HR: 1.06, 95% CI: 1.04-1.07, P<0.0001) and higher pleural fluid LDH (HR: 1.008, 95% CI: 1.004-1.011, P<0.0001) were associated with increased hazard of recurrence. Negative cytology (HR: 0.52, 95% CI: 0.43-0.64, P<0.0001) was associated with decreased hazard of recurrence. The model had low prediction accuracy. Conclusion: Pleural effusion size, amount of pleural fluid drained, LDH and pleural fluid cytology were found to be risk factors for recurrence.

Original languageEnglish (US)
JournalRespirology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Pleural Effusion
Recurrence
Neoplasms
Malignant Pleural Effusion
Proportional Hazards Models
Cell Biology
Multicenter Studies
Cohort Studies
Thorax
Multivariate Analysis
X-Rays
Incidence

Keywords

  • Effusion recurrence
  • Malignant pleural effusion
  • Pleural effusion
  • Thoracentesis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Grosu, H. B., Molina, S., Casal, R., Song, J., Li, L., Diaz-Mendoza, J., ... Ost, D. E. (Accepted/In press). Risk factors for pleural effusion recurrence in patients with malignancy. Respirology. https://doi.org/10.1111/resp.13362

Risk factors for pleural effusion recurrence in patients with malignancy. / Grosu, Horiana B.; Molina, Sofia; Casal, Roberto; Song, Juhee; Li, Liang; Diaz-Mendoza, Javier; Reddy, Chakravarthy; Yarmus, Lonny; Schiavo, Dante; Simoff, Michael; Johnstun, Jared; Raid, Abu Awwad; Feller-Kopman, David; Lee, Hans J; Sahetya, Sarina; Foley, Finbar; Maldonado, Fabien; Tian, Xin; Noor, Laila; Miller, Russell; Mudambi, Lakshmi; Saettele, Timothy; Vial-Rodriguez, Macarena; Eapen, Gerogie A.; Ost, David E.

In: Respirology, 01.01.2018.

Research output: Contribution to journalArticle

Grosu, HB, Molina, S, Casal, R, Song, J, Li, L, Diaz-Mendoza, J, Reddy, C, Yarmus, L, Schiavo, D, Simoff, M, Johnstun, J, Raid, AA, Feller-Kopman, D, Lee, HJ, Sahetya, S, Foley, F, Maldonado, F, Tian, X, Noor, L, Miller, R, Mudambi, L, Saettele, T, Vial-Rodriguez, M, Eapen, GA & Ost, DE 2018, 'Risk factors for pleural effusion recurrence in patients with malignancy', Respirology. https://doi.org/10.1111/resp.13362
Grosu HB, Molina S, Casal R, Song J, Li L, Diaz-Mendoza J et al. Risk factors for pleural effusion recurrence in patients with malignancy. Respirology. 2018 Jan 1. https://doi.org/10.1111/resp.13362
Grosu, Horiana B. ; Molina, Sofia ; Casal, Roberto ; Song, Juhee ; Li, Liang ; Diaz-Mendoza, Javier ; Reddy, Chakravarthy ; Yarmus, Lonny ; Schiavo, Dante ; Simoff, Michael ; Johnstun, Jared ; Raid, Abu Awwad ; Feller-Kopman, David ; Lee, Hans J ; Sahetya, Sarina ; Foley, Finbar ; Maldonado, Fabien ; Tian, Xin ; Noor, Laila ; Miller, Russell ; Mudambi, Lakshmi ; Saettele, Timothy ; Vial-Rodriguez, Macarena ; Eapen, Gerogie A. ; Ost, David E. / Risk factors for pleural effusion recurrence in patients with malignancy. In: Respirology. 2018.
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author = "Grosu, {Horiana B.} and Sofia Molina and Roberto Casal and Juhee Song and Liang Li and Javier Diaz-Mendoza and Chakravarthy Reddy and Lonny Yarmus and Dante Schiavo and Michael Simoff and Jared Johnstun and Raid, {Abu Awwad} and David Feller-Kopman and Lee, {Hans J} and Sarina Sahetya and Finbar Foley and Fabien Maldonado and Xin Tian and Laila Noor and Russell Miller and Lakshmi Mudambi and Timothy Saettele and Macarena Vial-Rodriguez and Eapen, {Gerogie A.} and Ost, {David E.}",
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T1 - Risk factors for pleural effusion recurrence in patients with malignancy

AU - Grosu, Horiana B.

AU - Molina, Sofia

AU - Casal, Roberto

AU - Song, Juhee

AU - Li, Liang

AU - Diaz-Mendoza, Javier

AU - Reddy, Chakravarthy

AU - Yarmus, Lonny

AU - Schiavo, Dante

AU - Simoff, Michael

AU - Johnstun, Jared

AU - Raid, Abu Awwad

AU - Feller-Kopman, David

AU - Lee, Hans J

AU - Sahetya, Sarina

AU - Foley, Finbar

AU - Maldonado, Fabien

AU - Tian, Xin

AU - Noor, Laila

AU - Miller, Russell

AU - Mudambi, Lakshmi

AU - Saettele, Timothy

AU - Vial-Rodriguez, Macarena

AU - Eapen, Gerogie A.

AU - Ost, David E.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background and objective: The main purpose of treatment in patients with malignant pleural effusion (MPE) is symptom palliation. Currently, patients undergo repeat thoracenteses prior to receiving a definitive procedure as clinicians are not aware of the risk factors associated with fluid recurrence. The primary objective of this study was to identify risk factors associated with recurrent symptomatic MPE. Methods: Retrospective multicentre cohort study of patients who underwent first thoracentesis was performed. The primary outcome was time to fluid recurrence requiring intervention in patients with evidence of metastatic disease. We used a cause-specific hazard model to identify risk factors associated with fluid recurrence. We also developed a predictive model, utilizing Fine-Gray subdistribution hazard model, and externally validated the model. Results: A total of 988 patients with diagnosed metastatic disease were included. Cumulative incidence of recurrence was high with 30% of patients recurring by day 15. On multivariate analysis, size of the effusion on chest X-ray (up to the top of the cardiac silhouette (hazard ratio (HR): 1.84, 95% CI: 1.21-2.80, P=0.004) and above the cardiac silhouette (HR: 2.22, 95% CI: 1.43-3.46, P=0.0004)), larger amount of pleural fluid drained (HR: 1.06, 95% CI: 1.04-1.07, P<0.0001) and higher pleural fluid LDH (HR: 1.008, 95% CI: 1.004-1.011, P<0.0001) were associated with increased hazard of recurrence. Negative cytology (HR: 0.52, 95% CI: 0.43-0.64, P<0.0001) was associated with decreased hazard of recurrence. The model had low prediction accuracy. Conclusion: Pleural effusion size, amount of pleural fluid drained, LDH and pleural fluid cytology were found to be risk factors for recurrence.

AB - Background and objective: The main purpose of treatment in patients with malignant pleural effusion (MPE) is symptom palliation. Currently, patients undergo repeat thoracenteses prior to receiving a definitive procedure as clinicians are not aware of the risk factors associated with fluid recurrence. The primary objective of this study was to identify risk factors associated with recurrent symptomatic MPE. Methods: Retrospective multicentre cohort study of patients who underwent first thoracentesis was performed. The primary outcome was time to fluid recurrence requiring intervention in patients with evidence of metastatic disease. We used a cause-specific hazard model to identify risk factors associated with fluid recurrence. We also developed a predictive model, utilizing Fine-Gray subdistribution hazard model, and externally validated the model. Results: A total of 988 patients with diagnosed metastatic disease were included. Cumulative incidence of recurrence was high with 30% of patients recurring by day 15. On multivariate analysis, size of the effusion on chest X-ray (up to the top of the cardiac silhouette (hazard ratio (HR): 1.84, 95% CI: 1.21-2.80, P=0.004) and above the cardiac silhouette (HR: 2.22, 95% CI: 1.43-3.46, P=0.0004)), larger amount of pleural fluid drained (HR: 1.06, 95% CI: 1.04-1.07, P<0.0001) and higher pleural fluid LDH (HR: 1.008, 95% CI: 1.004-1.011, P<0.0001) were associated with increased hazard of recurrence. Negative cytology (HR: 0.52, 95% CI: 0.43-0.64, P<0.0001) was associated with decreased hazard of recurrence. The model had low prediction accuracy. Conclusion: Pleural effusion size, amount of pleural fluid drained, LDH and pleural fluid cytology were found to be risk factors for recurrence.

KW - Effusion recurrence

KW - Malignant pleural effusion

KW - Pleural effusion

KW - Thoracentesis

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