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Observational Study
. 2015 Mar 28:15:29.
doi: 10.1186/s12890-015-0025-z.

Important prognostic factors for survival in patients with malignant pleural effusion

Mauro Musa Zamboni  1 , Cyro Teixeira da Silva Jr  2 , Rodrigo Baretta  3 , Edson Toscano Cunha  4 , Gilberto Perez Cardoso  5
Affiliations
Observational Study

Important prognostic factors for survival in patients with malignant pleural effusion

Mauro Musa Zamboni et al. BMC Pulm Med. .

Abstract

Background: The approach to palliative treatment of malignant pleural effusion (MPE) should be individualized because these patients generally have poor survival. Our study aimed to develop a model to identify prognostic factors or survival time in patients diagnosed with MPE.

Methods: This is a retrospective, descriptive, observational study to identify prognostic factors related to MPE in patients with a confirmed cancer diagnosis. Cox regression analysis was used to determine significant potential prognostic factors with respect to survival time. Survival time was defined as the time from pathological diagnosis to death.

Results: One hundred and sixty-five patients were included; 77 were men (47%) and 88 were women (53%). The median age was 60 years, and all of the patients were pathologically proven to have MPE. Non-small-cell lung cancer (36.0%), breast carcinoma (26%), and lymphoma (13.0%) were the most frequently diagnosed tumors. The median overall survival of patients from the initial diagnosis was 5 months (range: 1.0-96.0 months). Kaplan-Meier univariate analysis showed that survival was significantly related to the following prognostic factors: ECOG PS (hazard ratio [HR] 10.0, 95% confidence interval [95% CI] 5.96 to 18.50, p < 0.0001), primary cancer site (HR 1.99, 95% CI 1.23 to 3.22, p < 0.01), positive pleural cytology (HR 1.25, 95% CI 0.88 to 1.78, p = 0.04), and positive histology (HR 1.33, 95% CI 0.97 to 1.81, p = 0.04). Other potential independent diagnostic factors that were examined did not affect survival. Cox regression analysis showed that only the ECOG PS was highly predictive of survival (HR 73.58, 95% CI 23.44 to 230.95, p < 0.0001).

Conclusions: ECOG PS is an independent predictor of survival in patients with MPE at initial diagnosis. This prognostic factor can help physicians select patients for appropriate palliative treatment of this syndrome.

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Figures

Figure 1
Figure 1
Kaplan-Meier curve showing the survival of the 165 patients. The median survival for all patients in the group was five months (95% CI; range: 1.0-96.0). (time in months).
Figure 2
Figure 2
Kaplan-Meier curves showing the relationship between ECOG performance status (PS) and survival in patients with MPEs. A significant difference was observed in survival for patients with an ECOG grade of 1 to 4 (Chi-square = 242.15, p < 0.0001). ECOG scores of 1 (HR: 1.67, 95% CI: 0.93-3.01, p > .05), 2 (HR: 2.13, 95% CI: 1.24-3.67, p < .05), 3 (HR: 3.72, 95% CI: 2.26-6.11, p < .05) and 4 (HR: 10.50, 95% CI: 5.96-18.50, p < .05) are shown. (time in months).
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