Division of Pulmonary Disease and Critical Care Medicine, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA,
Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA,
Respiration. 2019;98(3):198-202. doi: 10.1159/000499372. Epub 2019 May 23.
Malignant pleural effusion (MPE) is commonly seen in patients with non-small cell lung cancer. However, the prevalence of MPE at presentation in small-cell lung cancer (SCLC) is not reported and the clinical impact of MPE at presentation on patients with SCLC remains largely unknown.
The objective of this study is to assess the occurrence rate of MPE and its prognostic implications at presentation in patients with SCLC.
We used the Surveillance Epidemiology and End Results (SEER) registry to extract data from patients with SCLC diagnosed between 2004 and 2014. The Kaplan-Meier method was used to estimate the overall survival and the Cox proportional hazard model was used to evaluate whether MPE was an independent risk for outcome.
Among the 68,443 patients with SCLC, MPE was present in 7,639 (11.16%). The probability of MPE was higher in older patients with larger tumors and mediastinal lymph node involvement at presentation. Median overall survival (3 vs. 7 months), estimated 1-year survival (17 vs. 30%), and 2-year survival (6 vs. 14%) were significantly lower in patients with MPE than without MPE, respectively (hazard ratio [HR] 1.46, 95% confidence interval [CI] 1.41-1.50, p< 0.001). MPE was also an independent factor for worse survival in multivariate analysis (HR 1.36, 95% CI 1.32-1.41, p < 0.001).
MPE is common at presentation (11%) in patients with SCLC and may be associated with decreased survival. Additional studies are required to assess the treatment-adjusted survival rate in the setting of MPE.
恶性胸腔积液（MPE）在非小细胞肺癌患者中很常见。然而，小细胞肺癌（SCLC）患者初诊时 MPE 的发生率尚未报道，初诊时 MPE 对 SCLC 患者的临床影响也知之甚少。
本研究旨在评估 SCLC 患者初诊时 MPE 的发生率及其对预后的影响。
我们使用监测、流行病学和最终结果（SEER）数据库从 2004 年至 2014 年间诊断为 SCLC 的患者中提取数据。采用 Kaplan-Meier 法估计总生存期，采用 Cox 比例风险模型评估 MPE 是否为独立的预后因素。
在 68443 例 SCLC 患者中，7639 例（11.16%）存在 MPE。初诊时 MPE 发生率随患者年龄的增加、肿瘤体积的增大和纵隔淋巴结受累程度的增加而升高。与无 MPE 患者相比，有 MPE 患者的中位总生存期（3 个月 vs. 7 个月）、估计 1 年生存率（17% vs. 30%）和 2 年生存率（6% vs. 14%）均显著降低（风险比 [HR] 1.46，95%置信区间 [CI] 1.41-1.50，p<0.001）。多因素分析显示，MPE 也是影响生存的独立因素（HR 1.36，95% CI 1.32-1.41，p<0.001）。
SCLC 患者初诊时 MPE 发生率较高（11%），且可能与生存时间缩短相关。需要进一步研究评估 MPE 患者治疗调整后的生存率。
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