Department of Medicine, Division of Medical Oncology, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA.
J Thorac Oncol. 2012 Oct;7(10):1485-9. doi: 10.1097/JTO.0b013e318267223a.
Despite its common occurrence, the influence of malignant pleural effusion (MPE) on the outcomes of patients with advanced non-small-cell lung cancer (NSCLC) with distant metastasis (M1b) is unknown. We evaluated the clinical characteristics associated with MPE at presentation and the prognostic impact of MPE at presentation in patients with stage M1b NSCLC.
We extracted data from the Surveillance Epidemiology and End Results (SEER) registry from patients with NSCLC diagnosed between 2004 and 2005. Odds-ratio estimates were calculated using logistic regression, and the Kaplan-Meier method was used to estimate the overall survival. Cox proportional hazard model was used to evaluate whether MPE was an independent risk for outcome.
Among the 57,685 patients, MPE was present in 9170 (15.9%), including 3944 out of 31,506 (12.5%) without distant metastases and 5226 (20.0%) out of 26,179 with M1b. The probability of MPE was higher in patients with larger tumors, mediastinal lymph node involvement, and adenocarcinoma, NSCLC not otherwise specified, or large-cell histology. In patients with stage M1b, median overall survival (3 months versus 5 months), estimated 1-year survival (12.6% versus 24.8%), and 2-year survival (5.4% versus 11.3%) were significantly lower in patients with MPE compared with those without MPE (hazards ratio 1.49, 95% confidence interval 1.44-1.54, p < 0.0001). MPE was also an independent factor for worse survival in multivariate analysis (hazards ratio 1.36, 95% confidence interval1.30-1.43, p < 0.001).
MPE is a common complication in patients with NSCLC and is associated with decreased survival in patients with distant metastases. If these data are validated, subsequent studies in patients with advanced NSCLC may consider stratification according to the MPE status.
尽管恶性胸腔积液（MPE）很常见，但它对远处转移（M1b）的晚期非小细胞肺癌（NSCLC）患者的结局的影响尚不清楚。我们评估了 MPE 患者在 presentation 时的临床特征，以及 MPE 在 M1b NSCLC 患者中的 presentation 时的预后影响。
我们从 2004 年至 2005 年诊断为 NSCLC 的患者的监测、流行病学和最终结果（SEER）注册中提取数据。使用逻辑回归计算优势比估计值，使用 Kaplan-Meier 方法估计总生存。Cox 比例风险模型用于评估 MPE 是否是结局的独立危险因素。
在 57685 例患者中，MPE 出现在 9170 例（15.9%），其中 31506 例（12.5%）无远处转移，26179 例（20.0%）M1b 患者。MPE 的概率在肿瘤较大、纵隔淋巴结受累、腺癌、非特指性 NSCLC 或大细胞组织学的患者中更高。在 M1b 期患者中，与无 MPE 患者相比，MPE 患者的中位总生存期（3 个月对 5 个月）、估计 1 年生存率（12.6%对 24.8%）和 2 年生存率（5.4%对 11.3%）显著降低（风险比 1.49，95%置信区间 1.44-1.54，p<0.0001）。在多变量分析中，MPE 也是生存较差的独立因素（风险比 1.36，95%置信区间 1.30-1.43，p<0.001）。
MPE 是 NSCLC 患者的常见并发症，与远处转移患者的生存降低相关。如果这些数据得到验证，随后在晚期 NSCLC 患者中的研究可能会考虑根据 MPE 状态进行分层。
