Cobanoglu Ufuk, Kemik Ozgur, Celik Sebahattin, Sayir Fuat
Department of Thoracic Surgery, University of Yuzuncu Yil, Van, Turkey.
Department of Surgical Oncology, University of Yuzuncu Yil, Van, Turkey.
Arch Med Sci. 2018 Oct;14(6):1404-1415. doi: 10.5114/aoms.2017.72543. Epub 2018 Jan 4.
The effective control of malignant pleural effusion (MPE) is of paramount importance in the treatment of patients with disseminated cancer. In this study, we compared two different approaches (early pleurodesis versus late pleurodesis) to MPE.
Patients (188 cases) whose primary tumor type was known and who were confirmed to have MPE, were included in the study and were separated into two groups. One group consisted of patients who were asymptomatic and who underwent early phase pleurodesis (group I, = 79). The other group (group II, = 109) was composed of patients who were symptomatic and whose pleurodesis was performed later. In all cases, pleural effusion was evaluated by means of direct radiography. Computed tomography was performed with the goal of confirming the parenchymal or mediastinal lesions accompanying the pleural fluid.
The rate of complete success in group I cases was observed to be higher, while the rate of recurrence was lower ( = 0.001 and = 0.002, respectively) than group II. In multiple logistic regression analysis, co-morbidities and the group that patient belong were found to be significant in terms of pleurodesis success ( = 0.02 and = 0.03). There was a significant difference in survival time between group I and group II, with group I exhibiting longer average survival time (log rank test < 0.001).
We observed that the success rate was lower and the rate of recurrence higher in the late pleurodesis group, whose members already had greater volumes of pleural effusion.
有效控制恶性胸腔积液（MPE）在播散性癌症患者的治疗中至关重要。在本研究中，我们比较了两种不同的MPE治疗方法（早期胸膜固定术与晚期胸膜固定术）。
本研究纳入了188例原发性肿瘤类型已知且确诊为MPE的患者，并将其分为两组。一组由无症状且接受早期胸膜固定术的患者组成（第一组，n = 79）。另一组（第二组，n = 109）由有症状且其胸膜固定术在更晚时候进行的患者组成。在所有病例中，通过直接放射成像评估胸腔积液。进行计算机断层扫描以确认伴随胸腔积液的实质或纵隔病变。
观察到第一组病例的完全成功率更高，而复发率低于第二组（分别为P = 0.001和P = 0.002）。在多因素逻辑回归分析中，发现合并症和患者所属组在胸膜固定术成功方面具有显著意义（P = 0.02和P = 0.03）。第一组和第二组之间的生存时间存在显著差异，第一组的平均生存时间更长（对数秩检验P < 0.001）。
我们观察到晚期胸膜固定术组的成功率较低且复发率较高，该组患者已经有更大体积的胸腔积液。
