Pleural Diseases Unit, Department of Internal Medicine, University Hospital Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida, Avda Alcalde Rovira Roure 80, 25198 Lleida, Spain.
Lung. 2011 Apr;189(2):151-5. doi: 10.1007/s00408-011-9283-6. Epub 2011 Feb 18.
Pleurodesis is commonly indicated for symptom relief in patients with malignant pleural effusions. A number of factors may influence pleurodesis outcome, but whether tumor type is one of them is a matter of debate. This study investigates the impact of tumor type on the efficacy of bedside doxycycline and thoracoscopic talc poudrage pleurodesis in order to determine which patients may benefit most from these procedures. A retrospective study of 138 and 450 doxycycline and talc poudrage pleurodesis procedures, respectively, evaluated their overall successes and failures, according to primary tumor types. In addition, a logistic regression model addressed whether the pleurodesis outcome in different tumor types was influenced by or attributable to pleural tumor burden. In the talc group, patients with lung cancer and mesothelioma had significantly lower complete response rates (63 and 61%, respectively) as compared with breast (77%) and other metastatic effusions (74%, p = 0.012). In the doxycycline group, the data followed the same trend in that complete response rates were lower in patients with lung carcinomas (31%) than in those with breast cancer (54%) or metastases from other primary sites (74%, p = 0.001). The regression analysis showed pleural burden and tumor type as independent predictors of pleurodesis failure in the talc group. The tumor type involving the pleural surfaces influences the success of a pleurodesis, regardless of the sclerosing agent used. Malignant effusions due to mesothelioma and lung cancer are particularly prone to a failed procedure.
胸膜固定术常用于缓解恶性胸腔积液患者的症状。许多因素可能会影响胸膜固定术的结果，但肿瘤类型是否是其中之一存在争议。本研究调查了肿瘤类型对床边多西环素和胸腔镜滑石粉胸膜固定术疗效的影响，以确定哪些患者最有可能从这些手术中受益。对分别接受 138 例和 450 例多西环素和滑石粉胸膜固定术的患者进行回顾性研究，根据原发肿瘤类型评估其总体成功率和失败率。此外，使用逻辑回归模型探讨不同肿瘤类型的胸膜固定术结果是否受到或归因于胸腔内肿瘤负担的影响。在滑石粉组中，肺癌和间皮瘤患者的完全缓解率明显低于乳腺癌（77%）和其他转移性胸腔积液（74%）（p=0.012）。在多西环素组中，数据也呈现出相同的趋势，即肺癌患者的完全缓解率（31%）低于乳腺癌患者（54%）或其他原发性肿瘤转移患者（74%）（p=0.001）。回归分析显示，在滑石粉组中，胸腔内肿瘤负担和肿瘤类型是胸膜固定术失败的独立预测因素。涉及胸膜表面的肿瘤类型会影响胸膜固定术的成功率，而与使用的硬化剂无关。间皮瘤和肺癌引起的恶性胸腔积液尤其容易导致手术失败。
