Alexander Matthew, Ishisaka Yoshiko, Miyakawa Lina, Rothman Adam
Department of Medicine, Mount Sinai Morningside-West.
Department of Medicine, Mount Sinai Beth Israel.
J Bronchology Interv Pulmonol. 2024 Jan 1;31(1):39-48. doi: 10.1097/LBR.0000000000000926.
Malignant pleural effusion is a common finding in patients with advanced cancer and is a frequent cause of dyspnea. Current guidelines indicate thoracentesis for symptomatic patients, while indwelling pleural catheters (IPC) are recommended for patients who develop pleural fluid re-accumulation. IPC maintenance, however, requires a significant level of financial and social support. This study aims to analyze potential influencing factors that may play a role in the decision for placing IPCs in patients with recurrent malignant pleural effusions.
This study retrospectively collected baseline sociodemographic and laboratory data in patients who underwent thoracentesis for malignant pleural effusion from August 2016 to October 2021, and selected patients who presented with re-accumulation of pleural fluid within 30 days or had a pulmonary physician's note documenting that IPC is a potential management option. Of these selected patients (IPC candidates), we stratified patients who underwent IPC placement and those who did not, and performed statistical analysis between these 2 groups.
One hundred seventy-six patients who underwent thoracentesis were regarded as IPC candidates. Almost all baseline sociodemographic characteristics, including ethnicity ( P =0.637), sex ( P =0.655), and marital status ( P =0.773) were similar between the 2 groups, but significantly higher ECOG scores ( P =0.049) were noted in the IPC group. No statistically significant differences were noted in age, body mass index, platelet, PTT, international normalized ratio, creatinine, white blood cell, red blood cells, fluid protein, or fluid lactate dehydrogenase. Fluid albumin ( P =0.057) and serum neutrophil:lymphocyte ratio ( P =0.003) were significantly higher in patients without IPC placement.
This study did not recognize any baseline sociodemographic factors that may contribute to the decision to place IPCs.
恶性胸腔积液是晚期癌症患者常见的表现，也是呼吸困难的常见原因。目前的指南表明，对于有症状的患者进行胸腔穿刺术，而对于出现胸腔积液再积聚的患者则推荐使用留置胸腔导管（IPC）。然而，IPC 的维护需要大量的财务和社会支持。本研究旨在分析可能影响复发性恶性胸腔积液患者放置 IPC 的决策的潜在影响因素。
本研究回顾性收集了 2016 年 8 月至 2021 年 10 月期间因恶性胸腔积液行胸腔穿刺术的患者的基线社会人口统计学和实验室数据，并选择了在 30 天内出现胸腔积液再积聚或有肺科医生记录表明 IPC 是一种潜在治疗选择的患者。在这些选定的患者（IPC 候选者）中，我们对接受 IPC 放置的患者和未接受 IPC 放置的患者进行分层，并对这两组患者进行统计学分析。
176 例接受胸腔穿刺术的患者被视为 IPC 候选者。两组患者的几乎所有基线社会人口统计学特征，包括种族（P=0.637）、性别（P=0.655）和婚姻状况（P=0.773）均相似，但 IPC 组的 ECOG 评分显著较高（P=0.049）。两组患者的年龄、体重指数、血小板、PTT、国际标准化比值、肌酐、白细胞、红细胞、积液蛋白或积液乳酸脱氢酶均无统计学差异。但未放置 IPC 的患者的积液白蛋白（P=0.057）和血清中性粒细胞：淋巴细胞比值（P=0.003）显著较高。
本研究未发现任何可能影响放置 IPC 决策的基线社会人口统计学因素。
