Malign Plevral Effüzyonlarda Sıvı Miktarı, Histopatoloji, Radyoloji ve Plöredez Durumu Sağkalımı Etkiliyor mu?

GİRİŞ ve AMAÇ: Bu çalışmanın birincil amacı, malign plevral efüzyona (MPE) yol açan en yaygın plevral maligniteleri belirlemektir. İkincil amaç, sıvı miktarı ile radyolojik bulgular, etiyolojiler, tedavi yöntemleri ve sağkalım arasındaki ilişkiyi değerlendirmektir. YÖNTEM ve GEREÇLER: Çalışmamıza retrospektif olarak doku tanısı almış MPE vakalarını dahil ettik. BULGULAR: MPE’nin en yaygın nedenleri akciğer kanseri (% 73), meme kanseri (% 8.3) ve mezotelyoma (% 7) idi. Kimyasal plöredez önerilen hastalarda plöredez yaklaşık% 31.1 oranında başarılı olmuştur. Plevral sıvı miktarı ile hücre tipi, sağkalım, pulmoner, ekstrapulmoner malignite ve mezotelyoma arasında ilişki bulunmadı, hastalar plöredez başarılı ise daha uzun sağkalıma sahipti (p= 0.005). Pulmoner, ekstrapulmoner ve mezotelyoma nedeniyle MPE’li hastaların medyan sağkalımı sırasıyla 77 ± 12.8, 150 ± 48.4 ve 365 ± 0 gündü. Mezotelyomalı hastaların sağkalımı diğerlerine göre anlamlı olarak daha uzundu (P: 0.000). TARTIŞMA ve SONUÇ: MPE’nin ana nedeni akciğer kanseriydi, ardından meme kanseri, primer bilinmeyen maligniteler ve mezotelyoma geldi. Kimyasal plöredez, MPE için geçerli bir palyatif önlemdi. Başarılı plöredezin sağkalıma önemli bir katkısı vardı.

Do the Amount of Fluid, Histopathology, Radiology and Pleurodesis Status Affect the Survival in Malignant Pleural Effusions?

INTRODUCTION: The primary objective of this study was to identify the most common pleural malignancies leading to malign pleural effusion (MPE). The secondary objective was to evaluate the relationship between the amount of fluid and radiological findings, etiologies, treatment methods and survival. METHODS: We retrospectively included cases of MPE with a tissue diagnosis. RESULTS: The most common causes of MPE were lung cancer (73%), breast cancer (8.3%) and mesothelioma (7%). In patients who were offered chemical pleurodesis, pleurodesis was successful in nearly 31.1%. No relation wasfound between the amount of pleural fluid and cell type,survival, pulmonary, extrapulmonary malignancy and mesothelioma, Patients live longer if pleurodesis was successful (p = 0.005). Median survival of patients with MPE due to pulmonary, extrapulmonary and mesothelioma, ORCID: 0000-0002-8939-336X respectively were 77 ± 12.8, 150 ± 48.4 and 365 ± 0 days. The survival of the patients with mesothelioma was significantly longer than others (P: 0.000). DISCUSSION AND CONCLUSION: The main cause of MPE was lung cancer, followed by breast cancer, unknown primary and mesothelioma. Chemical pleurodesis was a viable palliative measure for MPE. Successful pleurodesis had a significant contribution to the survival.

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1. Azzopardi M, Porcel MJM, Koegelenberg CFN, Lee YCG, Fysh ETH. Current controversies in the management of malignant pleural effusions. Semin Respir Crit Care Med 2014;35(6):723-31.
2. Fitzgerald DB, Koegelenberg CFN, Yasufuku K, Lee YCG. Surgical and non-surgical management of malignant pleural effusions. Expert Rev Respir Med. 2018;12(1):15-26. https://doi.org/10.1080/17476348.2018.1398085
3. Antony VB, Loddenkemper R,Astoul P, Boutin C, Goldstraw P, Hott J, et al. Management of malignant pleural effusions. Eur Respir J 2001;18(2):402-19.
4. C F N Koegelenberg , S M Bennji, E Boer, P T Schubert, J A Shaw, B W Allwood, et al. The current aetiology of malignant pleural effusion in the Western Cape Province,South Africa S Afr Med J 2018;108(4):275-7. https://doi.org/10.7196/SAMJ.2018.v108i4.12936
5. Hsu C. Cytologic detection of malignancy pleural effusion: a review of 5,255 samples from 3,811 patients. Diagn Cytopathol 1987; 3: 8-12. https://doi.org/10.1002/dc.2840030103
6. Hooper C, Lee YC, Maskell N, BTS Pleural Guideline Group. Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010; 65(2): ii4-17.
7. A A Renshaw , B R Dean, K H Antman, D J Sugarbaker, E S Cibas. The role of cytologic evaluation of pleural fluid in the diagnosis of malignant mesothelioma. Chest 1997; 111: 106-9. https://doi.org/10.1378/chest.111.1.106
8. van Zandwijk N, Clarke C, Henderson D, Musk AW, Fong K, Nowak A,et al. Guidelines for the diagnosis and treatment of malignant pleural mesothelioma. J Thorac Dis 2013; 5: E254-307. doi: 10.3978/j.issn.2072-1439.2013.11.28. PMID: 24416529; PMCID: PMC3886874.
9. Scherpereel A, Astoul P, Baas P, Berghmans T, Clayson H, de Vuyst P, et al. Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma. Eur Respir J 2010; 35: 479-95. https://doi.org/10.1183/09031936.00063109
10. Segal A, Sterrett GF, Frost FA, Shilkin KB, Olsen NJ, Musk AW, et al. A diagnosis of malignant pleural mesothelioma can be made by effusion cytology: results of a 20 year audit. Pathology 2013; 45: 44-8. https://doi.org/10.1097/PAT.0b013e32835bc848
11. Henderson DW, Reid G, Kao SC, van Zandwijk N, Klebe S. Challenges and controversies in the diagnosis of mesothelioma: Part 1. Cytology-only diagnosis, biopsies, immunohistochemistry, discrimination between mesothelioma and reactive mesothelial hyperplasia, and biomarkers. J Clin Pathol. 2013 Oct;66(10):847-53. doi: 10.1136/jclinpath-2012-201303. Epub 2013 Jun 27. PMID: 3814259. https://doi.org/10.1136/jclinpath-2012-201303
12. Gordon CE, Feller-Kopman D, Balk EM, Smetana GW. Pneumothorax following thoracentesis: a systematic review and meta-analysis. Arch Intern Med 2010; 170: 332-9. https://doi.org/10.1001/archinternmed.2009.548
13. Havelock T, Teoh R, Laws D, Gleeson F; BTS Pleural Disease Guideline Group. Pleural procedures and thoracic ultrasound: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010; 65(2): ii61-76. https://doi.org/10.1136/thx.2010.137026
14. Bugalho A, Ferreira D, Dias SS, Schuhmann M, Branco JC, Marques Gomes MJ . The diagnostic value of transthoracic ultrasonographic features in predicting malignancy in undiagnosed pleural effusions: a prospective observational study. Respiration 2014; 87: 270-8. https://doi.org/10.1159/000357266
15. Ost DE, Niu J, Zhao H, Grosu HB, Giordano SH. Quality gaps and comparative effectiveness of management Strategies for recurrent malignant pleural effusions. Chest 2018; 153: 438-52. https://doi.org/10.1016/j.chest.2017.08.026
16. Roberts ME, Neville E, Berrisford RG, Antunes G, Ali NJ, BTS Pleural Disease Guideline Group. . Management of a malignant pleural effusion: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010; 65( 2): ii32-40. https://doi.org/10.1136/thx.2010.136994
17. Koegelenberg CFN , Jane A. Shaw, Elvis M. Irusen and Y. C. Gary Lee. Contemporary best practice in the management of malignant pleural effusion. Ther Adv Respir Disn 2018; 12: 1-13. https://doi.org/10.1177/1753466618785098
18. Dresler CM, Olak J, Herndon JE 2nd, Richards WG, Scalzetti E, Fleishman SB, et al. Phase III intergroup study of talc poudrage vs talc slurry sclerosis for malignant pleural effusion. Chest 2005;127(3):909-15. https://doi.org/10.1378/chest.127.3.909
19. Pilling JE, Dusmet ME, Ladas G, Goldstraw P. Prognostic factors for survival after surgical palliation of malignant pleural effusion. J Thorac Oncol 2010; 5: 1544-50. https://doi.org/10.1097/JTO.0b013e3181e95cb8