Clinical features and survival of lung cancer with pleural effusions_West China Medical Journal

Authors：

SONG Juan , LIU Dan , LI Lei , ZHOU Ping , LI Yalun , JIN Jing ,  LI Weimin

Department of Respiratory and Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan 6100041, P. R. China;

Corresponding author：

LI Weimin, Email: weimin003@163.com

Keywords：

Lung cancer; Pleural effusion; Clinical feature; Survival analysis; Targeted therapy

DOI：

10.7507/1002-0179.201710066

Video：

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Objective To analyze the clinical features and survival of lung cancer with pleural effusions. Methods A total of 982 consecutive patients with a newly diagnosed lung cancer from January 2008 to December 2014 were retrospectively reviewed. To analyze the clinical features and survival differences, the total patients were divided into the following two groups: with (n=204) or without (n=778) pleural effusions. Results Lung cancer comprised 682 (69.5%) males and 300 (30.5%) females, with an average age of 59.74 years (19–93 years). There were 487(49.6%) squamous carcinoma, 254 (25.9%) adenocarcinoma and 166 (16.9%) small cell lung cancer; 113 (11.5%) lung cancer at early stage (Ⅰ–Ⅱ), 247 (25.2%) cases at stage Ⅲ and 567 (57.7%) at stage Ⅳ. The median survival time of all patients was 12 months. Patients with pleural effusions had a worse prognosis compared to patients without (median survival time: 11 vs.12 months, P=0.003), the median survival time could be reduced by 1 month in males (P=0.004), 3 months in elder patients over 60 years (P<0.001), 4 to 8 months in carcinoma and small cell lung cancer (P≤0.001), and 2 to 3 months in advanced lung cancer (stage Ⅲ and Ⅳ) (P<0.05). Any or combined treatment of surgery, radiotherapy, chemotherapy and targeted therapy was associated with an improved overall survival of about 2 months (P=0.009), and targeted therapy could even improve the median survival time by 1 to 8 months (P=0.002). Conclusions About 20.8% of the patients developed pleural effusion at the same time during the course of lung cancer. Pleural effusion is a poor prognostic factor of lung cancer.

Citation： SONG Juan, LIU Dan, LI Lei, ZHOU Ping, LI Yalun, JIN Jing, LI Weimin. Clinical features and survival of lung cancer with pleural effusions. West China Medical Journal, 2018, 33(1): 36-40. doi: 10.7507/1002-0179.201710066 Copy

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6.	Sugiura S, Ando Y, Minami H, et al. Prognostic value of pleural effusion in patients with non-small cell lung cancer. Clin Cancer Res, 1997, 3(1): 47-50.
7.	Morgensztern D, Waqar S, Subramanian J, et al. Prognostic impact of malignant pleural effusion at presentation in patients with metastatic non-small-cell lung cancer. J Thorac Oncol, 2012, 7(10): 1485-1489.
8.	William J, Lin HY, Lee J, et al. Revisiting stage ⅢB and Ⅳ non-small cell lung cancer analysis of the surveillance, epidemiology, and end results data. Chest, 2009, 136(3): 701-709.
9.	Naito T, Satoh H, Ishikawa H, et al. Pleural effusion as a significant prognostic factor in non-small cell lung cancer. Anticancer Res, 1997, 17(6D): 4743-4746.
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14.	Xu CH, Yu LK, Zhan P, et al. Elevated pleural effusion IL-17 is a diagnostic marker and outcome predictor in lung cancer patients. Eur J Med Res, 2014, 19(1): 1-6.
15.	Thomas R, Francis R, Davies HE, et al. Interventional therapies for malignant pleural effusions: the present and the future. Respirology, 2014, 19(6): 809-822.
16.	Sterman DH, Haas A, Moon E, et al. A trial of intrapleural adenoviral-mediated Interferon-α2b gene transfer for malignant pleural mesothelioma. Am J Respir Crit Care Med, 2011, 184(12): 1395-1399.
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1. Office of National Statistics. Cancer Statistics Registrations, England. Series MB1 no.41 London: Office for National Statistics, 2010.
2. Roberts ME, Neville E, Berrisford RG, et al. Management of a malignant pleural effusion: British Thoracic Society Pleural Disease Guideline 2010. Thorax, 2010, 65(Suppl 2): ii32-ii40.
3. American Thoracic Society. Management of malignant pleural effusions. Am J Respir Crit Care Med, 2000, 162(5):1987-2001.
4. Hooper C, LeeYC, Maskell N, et al. Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax, 2010, 65(Suppl 2): ii4-ii17.
5. Porcel JM, Gasol A, Bielsa S, et al. Clinical features and survival of lung cancer patients with pleural effusions. Respirology, 2015, 20(4): 654-659.
6. Sugiura S, Ando Y, Minami H, et al. Prognostic value of pleural effusion in patients with non-small cell lung cancer. Clin Cancer Res, 1997, 3(1): 47-50.
7. Morgensztern D, Waqar S, Subramanian J, et al. Prognostic impact of malignant pleural effusion at presentation in patients with metastatic non-small-cell lung cancer. J Thorac Oncol, 2012, 7(10): 1485-1489.
8. William J, Lin HY, Lee J, et al. Revisiting stage ⅢB and Ⅳ non-small cell lung cancer analysis of the surveillance, epidemiology, and end results data. Chest, 2009, 136(3): 701-709.
9. Naito T, Satoh H, Ishikawa H, et al. Pleural effusion as a significant prognostic factor in non-small cell lung cancer. Anticancer Res, 1997, 17(6D): 4743-4746.
10. Sahn SA. Pleural diseases related to metastatic malignancies. Eur Respir J, 1997, 10(8): 1907-1913.
11. Ryu JS, Ryu HJ, Lee SN, et al. Prognostic impact of minimal pleural effusion in non-small-cell lung cancer. J Clin Oncol, 2014, 32(9): 960-967.
12. Williams CD, Stechuchak KM, Zullig LL, et al. Influence of comorbidity on racial differences in receipt of surgery among US veterans with early-stage non-small-cell lung cancer. J Clin Oncol, 2013, 31(4): 475-481.
13. National Comprehensive Cancer Network. Non-small cell lung cancer. Clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2004, 2(2): 94-123.
14. Xu CH, Yu LK, Zhan P, et al. Elevated pleural effusion IL-17 is a diagnostic marker and outcome predictor in lung cancer patients. Eur J Med Res, 2014, 19(1): 1-6.
15. Thomas R, Francis R, Davies HE, et al. Interventional therapies for malignant pleural effusions: the present and the future. Respirology, 2014, 19(6): 809-822.
16. Sterman DH, Haas A, Moon E, et al. A trial of intrapleural adenoviral-mediated Interferon-α2b gene transfer for malignant pleural mesothelioma. Am J Respir Crit Care Med, 2011, 184(12): 1395-1399.
17. Sterman DH, Recio A, Haas AR, et al. A phaseⅠtrial of repeated intrapleural adenoviral-mediated interferon-beta gene transfer for mesothelioma and metastatic pleural effusions. Mol Ther, 2010, 18(4): 852-860.

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