Kasapoglu Umut Sabri, Arınç Sibel, Gungor Sinem, Irmak Ilim, Guney Pinar, Aksoy Ferda, Bandak Dilek, Hazar Armagan
Department of Chest Diseases, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
Department of Chest Diseases, Dr. Sureyya Adanali Goksun State Hospital, Kahramanmaras, Turkey.
Clin Respir J. 2016 Nov;10(6):791-799. doi: 10.1111/crj.12292. Epub 2015 Apr 15.
Lung cancer is the most common cause of malignant pleural effusions (MPEs). For patients with lung cancer and MPE, median survival is only 3-4 months. The aim of this study was to evaluate lung cancer patients with MPE by clinical and laboratory findings on admission, and determine 2-year survival rate and prognostic factors.
Between 2008 and 2011, we examined 199 cases of non-small cell lung carcinoma with MPE. Demographic factors of patients, tumor characteristics, treatment delivered and laboratory parameters affecting prognosis were evaluated. Survival rates were estimated by Kaplan-Meier method. Significance of each prognostic factors selected by univariate analysis were confirmed using Cox regression model.
The study included 139 (69.8%) male and 60 (30.2%) female patients with a median age of 64 (30-85) years. Median overall survival was 4.4 months. Adenocarcinoma was the leading cause of MPE with 80.4%. A univariate analysis showed that factors affecting mortality included gender (P < 0.001), MPE with distant metastasis (P = 0.025), lower serum albumin (P < 0.0001), lower pleural protein (P < 0.0001), increased serum lactate dehydrogenase (P = 0.003), increased serum C-reactive protein (CRP) (P < 0.0001), increased white blood cells (P < 0.0001), histopathological type (P = 0.004) and treatment decision (P < 0.0001). A multivariate analysis revealed that patients who had high level of serum CRP (P = 0.017), lower serum albumin (P = 0.009) and lower pleural protein (P = 0.003), MPE with distant metastasis (P = 0.003) and those who were chemotherapy naive (P < 0.0001) had shorter survival.
High level of serum CRP, lower serum albumin and lower pleural protein, MPE with distant metastasis were most important prognostic factors for non-small cell lung carcinoma in patients with MPEs.
肺癌是恶性胸腔积液（MPE）最常见的病因。对于肺癌合并MPE的患者，中位生存期仅为3 - 4个月。本研究旨在通过入院时的临床和实验室检查结果评估肺癌合并MPE的患者，并确定其2年生存率及预后因素。
2008年至2011年期间，我们检查了199例非小细胞肺癌合并MPE的患者。评估了患者的人口统计学因素、肿瘤特征、所接受的治疗以及影响预后的实验室参数。采用Kaplan - Meier法估计生存率。使用Cox回归模型确认单因素分析所选各预后因素的显著性。
该研究纳入了139例（69.8%）男性和60例（30.2%）女性患者，中位年龄为64岁（30 - 85岁）。中位总生存期为4.4个月。腺癌是MPE的主要病因，占80.4%。单因素分析显示，影响死亡率的因素包括性别（P＜ 0.001）、伴有远处转移的MPE（P = 0.025）、血清白蛋白水平较低（P＜ 0.0001）、胸腔积液蛋白水平较低（P＜ 0.0001）、血清乳酸脱氢酶升高（P = 0.003）、血清C反应蛋白（CRP）升高（P＜ 0.0001）、白细胞增多（P＜ 0.0001）以及组织病理学类型（P = 0.004）和治疗决策（P＜ 0.0001）。多因素分析显示，血清CRP水平高（P = 0.017）、血清白蛋白水平低（P = 0.009）、胸腔积液蛋白水平低（P = 0.003）、伴有远处转移的MPE（P = 0.003）以及未接受过化疗的患者（P＜ 0.0001）生存期较短。
血清CRP水平高、血清白蛋白水平低、胸腔积液蛋白水平低以及伴有远处转移的MPE是肺癌合并MPE患者非小细胞肺癌最重要的预后因素。
