TY - JOUR
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
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.
N1 - Publisher Copyright:
© 2018 Asian Pacific Society of Respirology
PY - 2019/1
Y1 - 2019/1
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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U2 - 10.1111/resp.13362
DO - 10.1111/resp.13362
M3 - Article
C2 - 29966171
AN - SCOPUS:85050453851
SN - 1323-7799
VL - 24
SP - 76
EP - 82
JO - Respirology
JF - Respirology
IS - 1
ER -