Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK.
Institute of Cancer Sciences, University of Glasgow, Glasgow, UK.
Respirology. 2020 Mar;25(3):298-304. doi: 10.1111/resp.13681. Epub 2019 Aug 21.
Non-expansile lung (NEL) frequently complicates management of malignant pleural effusion (MPE) and is an important factor in clinical practice and trials. NEL is frequently diagnosed on a single radiographic observation, but neither the inter-observer agreement of this approach nor the prognostic importance of NEL in MPE has been reported.
A multicentre retrospective cohort study was performed in two UK pleural centres. NEL was defined as <50% pleural re-apposition on post-drainage radiographs by primary and secondary assessors at each site. Inter-observer agreement was assessed by Cohen's kappa (κ). Kaplan-Meier methodology and multivariate Cox models were used to assess the prognostic impact of NEL versus no NEL and 'complete NEL' versus 'complete expansion', based on a single assessor's results from each site.
NEL was identified by the primary assessor in 33 of 97 (34%) in Cohort 1 and 15 of 86 (17%) in Cohort 2. Inter-observer agreement between assessors was only fair-to-moderate (Cohort 1 κ: 0.38 (95% CI: 0.21-0.55), Cohort 2 κ: 0.51 (95% CI: 0.30-0.72)). In both cohorts, NEL was associated with shorter median overall survival (Cohort 1: 188 vs 371 days, Cohort 2: 192 vs 412 days). This prognostic association was independent in Cohort 1 (hazard ratio (HR): 2.19, 95% CI: 1.31-3.66) but not in Cohort 2 (HR: 1.42, 95% CI: 0.71-2.87). Survival was inferior in both cohorts in cases of complete NEL versus complete expansion.
Radiographic NEL is common but inter-observer agreement is only fair-to-moderate. NEL is associated with adverse survival. These data do not support the use of single radiographic assessments to classify NEL.
非扩张性肺（NEL）常使恶性胸腔积液（MPE）的管理复杂化，是临床实践和试验中的一个重要因素。NEL 常通过单次影像学观察进行诊断，但目前尚没有报道该方法的观察者间一致性，也没有报道 NEL 在 MPE 中的预后意义。
本研究在英国的两个胸腔中心进行了一项多中心回顾性队列研究。NEL 定义为在每个中心，主要评估者和次要评估者在引流后 X 线片上观察到的胸膜再附着小于 50%。采用 Cohen's kappa（κ）评估观察者间的一致性。采用 Kaplan-Meier 方法和多变量 Cox 模型，根据每个中心的单一评估者的结果，评估 NEL 与无 NEL 以及“完全 NEL”与“完全扩张”之间的预后影响。
在队列 1 中，33 例（34%）患者由主要评估者识别为 NEL，在队列 2 中，15 例（17%）患者由主要评估者识别为 NEL。评估者之间的观察者间一致性仅为中等至适度（队列 1κ：0.38（95%CI：0.21-0.55），队列 2κ：0.51（95%CI：0.30-0.72））。在两个队列中，NEL 均与中位总生存期较短相关（队列 1：188 天 vs 371 天，队列 2：192 天 vs 412 天）。该预后相关性在队列 1 中是独立的（风险比（HR）：2.19，95%CI：1.31-3.66），但在队列 2 中不是（HR：1.42，95%CI：0.71-2.87）。在两个队列中，完全 NEL 与完全扩张相比，生存情况更差。
X 线 NEL 很常见，但观察者间的一致性仅为中等至适度。NEL 与不良生存相关。这些数据不支持使用单次影像学评估来对 NEL 进行分类。
