Etiology and prognostic evaluation of malignant pleural effusion

Sadhana Ramesh, Basanta Hazarika, Jogesh Sarma, Rahul Karwa


Background: Malignant pleural effusion is a common medical problem in patients with cancer. The survival of patients with malignant pleural effusion is generally poor. The objectives of our study were to reveal possible prognostic factors of malignant pleural effusion.

Methods: Fifty-three consecutive patients, 34 male and 19 female patients of malignant pleural effusion diagnosed by pleural fluid positive for malignant cytology and/or pleural tissue positive for malignancy by thoracoscopy biopsy. Performance status by the Eastern Cooperative Oncology Group (ECOG) score and LENT score was calculated at the time of diagnosis. Median survival time was calculated using Kaplan-Meier analysis curve. Survival time was defined as the time from diagnosis to death or the last follow-up.

Results: Most common cause of malignant pleural effusion was lung carcinoma 46 (86.79%). Adenocarcinoma was the most common 31 (58.5%) followed by NSCLC 10 (18.0%). Low, moderate and high-risk LENT score was found in 3 (5.7%), 35 (66%) and 15 (28.3%) respectively.  The median survival time of pleural fluid sugar less than 20 were 3 months. The median survival time of LENT low, medium and high risk was 12 months, 5.2 months and 2.5 months respectively. The median survival time of patients with ECOG score of 1 and 4 was 6.5 months and 1 month respectively. Patients with bilateral pleural fluid had a mean survival time of 2 months.

Conclusions: Adenocarcinoma lung is the most common etiology of malignant pleural effusion. The median overall survival time was 4 months. Higher ECOG score and LENT score are associated with shorter survival time.


Malignant pleural effusion, Median survival, Thoracoscopy, Malignant cytology

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Rahman NM, Ali NJ, Brown G. Local anaesthetic thoracoscopy: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65:54-60.

Mongardon N, Pinton-Gonnet C, Szekely B. Assessment of chronic pain after thoracotomy: a 1-year prevalence study. Clin J Pain. 2011;27(8):677-81.

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.

Roberts ME, Neville E, Berrisford RG. Management of a malignant pleural effusion: British Thorcic Society Pleural Disease Guideline 2010. Thorax. 2010;65:32-40.

Johnston WW. The malignant pleural effusion. A review of cytopathologic diagnoses of 584 specimens from 472 consecutive patients. Cancer. 1985;56(4):905-9.

Meyer PC. Metastatic carcinoma of the pleura. Thorax. 2119;66:437-43.

Andrews BS, Aroran S, Shadforth MF, Goldberg SK, Davis JS. The role of immune complexes in the pathogenesis of pleural effusions. Am Rev Respir Dis. 1981;124:115-20.

Antony VB, Loddenkemper R, Astoul P, Boutin C, Goldstraw P, Hott J, et al. Management of malignant pleural effusions. Eur Respir J. 2001;18:402-19.

Pilling JE, Dusmet ME, Ladas G. Prgnostic factors for survival after surgical palliation of malignant pleural effusion. J Thorac Oncol. 2010;5:1544-50.

Bielsa S, Salud A, Martinez M. Prognostic significance of pleural fluid data in patients with malignant effusion. Eur J Intern Med. 2008;19:334-9.

Burrows CM, Mathews WC, Colt HG. Predicting survival in patients with recurrent symptomatic malignant effusions: an assessment of the rognostic values of physiologic, morphologic, and quality of life measures of extent of disease. Chest. 2000;117:73-8.

Clive AO, Kahan BC, Hooper CE. Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score. Thorax. 2014;69:1098-104.

Saha K, Maikap MK. Demographic, clinical, biochemical, radiological and etiological characteristics of malignant pleural effusion from Eastern India. Indian J Cancer. 2017;54:257-61.

Chatterjee, Kshitij MD. Etiolgy of malignant pleural effusion and utilization of diagnostic and therapeutic procedures. J of Bronchology and Interven Pulmonology. 2017;24(1):10-2.

Moragon E, Aparicio J, Sanchis J. Malignant pleural effusion: prognostic factors for survival and response to chemical pleurodesis in a series of 120 cases. Respiration. 1998;65:108-13.

Amin Z, Iskandar SD, Sibli. Prognostic factors of 30 days survival of patients with malignant pleural effusion. Indian J Palliat Care. 2017;23(3):321-4.

Ari. LENT prognostic score for malignant pleural effusion: How does our cohort Compare. Lung cancer. 2018;115:51.

Jeba J, Cherian RM, Thangakunam B. Prognostic factors of malignant pleural effusion among palliative care outpatients: a retrospective study. Indian J Palliat Care. 2018;24:184-8.

Zambant. Important prognostic factors for survival in patients with malignant pleural effusion. BMJ Pulmonary Medicine. 2015;15:29.

Biasi EM, Pisani MA, Murphy TE, Araujo K, Kookoolis A, Argento AC, et al. Mortality among patients with pleural effusion undergoing thoracocentesis. Eur Respir J. 2015;46:495-502.