Hüseyin YILDIRIM, Emine DÜNDAR, Muzaffer METİNTAŞ, Sinan ERGİNEL, Füsun ALATAŞ, Güntülü AK, Selma METİNTAŞ

Pleurodesis in follow-up and treatment of malignant pleural mesothelioma patients

Bu çalışmada plörodezis uygulamasının endikasyonları, etkinliği ve güvenilirliğini belirleyerek, malign plevral mezotelyomalı hastaların takibinde ne kadar gerekli olduğunu ve yaşam süresine katkısı olup olmadığını tartışmayı amaçladık. Yüz doksan bir hasta retrospektif olarak değerlendirildi ve bunların 69 (%36)’una plörodezis endikasyonu konuldu. Plörodezisi kabul eden 42 hastada plörodezis başarısı değerlendirildi. Plörodezis başarısını etkileyen faktörler ve plörodezisin sağkalıma olan etkisi belirlendi. Plörodezis 42 hastanın 26 (%62)’sında başarılıydı. Plörodezisin başarılı olduğu grupta Kornofsky permons skoru (KPS) ve plevral sıvı pH’sı daha yüksekti (sırasıyla; p= 0.030, p= 0.032). KPS ≥ 80 olan hastalarda duyarlılık %76.9, özgüllük %50.0, pozitif prediktif değer %71.4 ve negatif prediktif değer %57.1 olarak belirlendi. Plevral sıvı pH > 7.27 olan hastalarda duyarlılık %92.9, özgüllük %50.0, pozitif prediktif değer %76.5 ve negatif prediktif değer %80.0 olarak belirlendi. Plörodezisin başarılı olduğu grupta median sağkalım daha uzundu (Log-rank: 11.2; p= 0.0008). Kemoterapiden bağımsız olarak, plörodezisi başarılı olan hastaların diğerlerine göre daha uzun yaşama şansları 2.6 kat daha fazlaydı. İşlem sırasında şiddetli bir komplikasyon gözlenmedi. Malign plevral mezotelyomalı hastalarda plörodezis düşünüldüğünden daha az sıklıkta uygulanmaktadır. KPS ≥ 80, plevral sıvı pH > 7.27 olan ve endikasyon doğan hastalarda plörodezis yapılmalıdır. Uygun hastalarda talk ile başarılı plörodezis malign plevral mezotelyomalı hastaların sağkalımını artırır ve güvenle uygulanabilir.

Malign plevral mezotelyomalı hastaların takip ve tedavisinde plörodezis

We analyzed the necessity of pleurodesis in the follow-up of the patients with malignant pleural mesothelioma (MPM), and how much it contributes to the survival period by determining the indications, efficiency, and reliability of the pleurodesis application. 191 patients were assessed retrospectively and 69 (36%) of them were established with a pleurodesis indication. In 42 patients accepting pleurodesis, the pleurodesis success was evaluated. Factors affecting the success of pleurodesis and the effect of pleurodesis on survival were assessed. Pleurodesis was a success in 26 (62%) of the 42 patients. In the group in which the pleurodesis process was a success, it was observed that KPS and pleural fluid pH were higher (p= 0.030, p= 0.032, respectively). In case of KPS ≥ 80, the sensitivity was: 76.9%, specificity: 50.0%, PPV: 71.4%, and NPV was established as 57.1%. In case of pleural fluid pH > 7.27, the sensitivity was: 92.9%, specificity: 50.0%, PPV: 76.5%, and NPV was observed as 80.0%. In the group in which pleurodesis was a success, the median survival was longer (Log-rank: 11.2; p= 0.0008). Independently from chemotherapy, the chance of living longer for patients whose pleurodesis was a success was 2.6 times higher. A severe complication concerning the process was not observed. Pleurodesis is performed less frequently than it is assumed on patients with MPM. In patients with KPS ≥ 80, pleural fluid pH > 7.27, and with indication, pleurodesis must be administered. In feasible patients, a successful pleurodesis with talc increases the survival of patients with MPM, and it can be safely administered.

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