Ahmed Shahid, Shahid Rabia K, Rimawi Rola, Siddiqui Anita K, Rossoff Leonard, Sison Cristina P, Steinberg Harry, Rai Kanti R
Saskatoon Cancer Center, University of Saskatchewan, Saskatoon, SK, Canada.
Leuk Lymphoma. 2005 Jul;46(7):1039-44. doi: 10.1080/00268970500096616.
In order to determine variables that correlate with malignant pleural effusion and mortality in patients with lymphoproliferative disorders and pleural effusion, a retrospective study was performed. Clinical data of hospitalized patients with a lymphoid malignancy and pleural effusion who underwent thoracentesis from January 1993 to December 2002 were collected. A logistic regression analysis was carried out to determine prognostic variables that predict malignant pleural effusion and hospital mortality. There were 86 patients who were admitted on 91 occasions. The median age was 70 years (range 4 - 92) and the male:female ratio was 44:42. Sixty-four patients (74%) had advanced disease, 43 (50%) had received prior chemotherapy and 9 (10%) were in remission. Of 91 cases of pleural effusions, 44 (48%) were bilateral, 80 (88%) were exudates and 48 (53%) were due to malignant involvement of pleura. In multivariate analysis, symptomatic pleural effusion (odds ratio 10.3, 95% confidence interval 1.7 - 98.3), pleural fluid mesothelial cell count < 5% (odds ratio 8.0, 95% confidence interval 1.4 - 58.2), pleural fluid:serum lactate dehydrogenase (LDH) > or =1 (odds ratio 6.4, 95% confidence interval 1.2 - 45.6) and pleural fluid lymphocyte percentage > or =50 (odds ratio 6.4, 95% confidence interval 1.2 - 50) were significantly correlated with malignant effusion. A secondary cancer (odds ratio 11.9, 95% confidence interval 2.3 - 88.8), pleural fluid:serum LDH > or =1 (odds ratio 10.9, 95% confidence interval 2.6 - 64.9), and pneumonia (odds ratio 6.4, 95% confidence interval 1.7 - 28.6) were significantly correlated with hospital mortality. In conclusion, malignant pleural effusion is the common etiology of pleural effusion in patients with lymphoid malignancy. Many clinical and cytochemical markers have discriminatory values in identifying malignant effusion. A high pleural fluid to serum LDH level correlates with malignant pleural involvement and hospital mortality.
为了确定与淋巴增殖性疾病合并胸腔积液患者的恶性胸腔积液及死亡率相关的变量，我们进行了一项回顾性研究。收集了1993年1月至2002年12月期间因淋巴系统恶性肿瘤合并胸腔积液而住院并接受胸腔穿刺术的患者的临床资料。进行逻辑回归分析以确定预测恶性胸腔积液和医院死亡率的预后变量。共有86例患者入院91次。中位年龄为70岁（范围4 - 92岁），男女比例为44:42。64例患者（74%）患有晚期疾病，43例（50%）曾接受过化疗，9例（10%）处于缓解期。在91例胸腔积液病例中，44例（48%）为双侧胸腔积液，80例（88%）为渗出液，48例（53%）是由于胸膜恶性受累所致。多因素分析显示，有症状的胸腔积液（比值比10.3，95%置信区间1.7 - 98.3）、胸腔积液间皮细胞计数<5%（比值比8.0，95%置信区间1.4 - 58.2）、胸腔积液:血清乳酸脱氢酶（LDH）>或 =1（比值比6.4，95%置信区间1.2 - 45.6）以及胸腔积液淋巴细胞百分比>或 =50（比值比6.4，95%置信区间1.2 - 50）与恶性胸腔积液显著相关。二次癌症（比值比11.9，95%置信区间2.3 - 88.8）、胸腔积液:血清LDH>或 =1（比值比10.9，95%置信区间2.6 - 64.9）以及肺炎（比值比6.4，95%置信区间1.7 - 28.6）与医院死亡率显著相关。总之，恶性胸腔积液是淋巴系统恶性肿瘤患者胸腔积液的常见病因。许多临床和细胞化学标志物在识别恶性胸腔积液方面具有鉴别价值。胸腔积液与血清LDH水平升高与恶性胸膜受累及医院死亡率相关。
