Bonnefoi H, Smith I E
Lung Unit, Royal Marsden NHS Trust, Sutton, Surrey, UK.
Br J Cancer. 1996 Sep;74(5):832-5. doi: 10.1038/bjc.1996.444.
The objective of the study was to review the natural history of patients with a malignant pleural effusion but without obvious evidence of a primary, to assess the value of investigations used to look for a primary and to assess the response to palliative chemotherapy. This was done by a retrospective study of patients' notes at the Lung Unit, Royal Marsden Hospital, Sutton, Surrey. Improvement in tumour-related symptoms (and duration) on chemotherapy was assessed by the patient before the first course of chemotherapy and following each course using simple descriptive criteria as follows: (1) complete disappearance of symptoms (CR); (2) good improvement in symptoms (PR); (3) minor or no change in symptoms (NC); (4) worse symptoms (PD). Pleural effusion objective response (and duration) according to Hamed definition: success defined as a continued absence of reaccumulation of pleural fluid on all follow-up radiographs; any reaccumulation was regarded as a treatment failure. Overall survival was measured from the date of histological/cytological diagnosis to death. The study included 42 patients, 27 males and 15 females with a median age of 55 years. A primary was found in 15 patients (36%), and considered to be lung cancer. A total of 11/32 (34%) had a thoracic computed tomography (CT) scan with abnormalities compatible with a diagnosis of lung primary. When thoracic CT scan was negative, fibre optic bronchoscopy was always negative (0/13). Abdominal and pelvic CT scan, abdominal ultrasound, pelvic ultrasound and mammograms failed to reveal the primary. Twenty-three patients underwent local treatment and 37 received systemic chemotherapy. A total of 29/37 (78%) patients achieved symptomatic improvement (median duration, 6 months) and 32/37 (86%) an objective response of their pleural effusion on chemotherapy (median duration, 6 months). The median survival of the whole group was 12 months (3-60+ months). In this series the thoracic CT led to a diagnosis of lung primary in 34% of the cases. Other radiological examinations and bronchoscopy were unhelpful. Chemotherapy achieved symptom relief in 78% of patients.
本研究的目的是回顾恶性胸腔积液但无明显原发灶证据患者的自然病史，评估用于寻找原发灶的检查的价值，并评估姑息化疗的疗效。这是通过对萨里郡萨顿皇家马斯登医院肺部病房患者病历的回顾性研究来完成的。化疗前及每疗程后，患者使用以下简单描述性标准评估肿瘤相关症状（及持续时间）的改善情况：（1）症状完全消失（CR）；（2）症状明显改善（PR）；（3）症状轻微或无变化（NC）；（4）症状恶化（PD）。根据哈米德定义评估胸腔积液客观反应（及持续时间）：成功定义为所有随访X光片上胸腔积液持续未再积聚；任何再积聚均视为治疗失败。总生存期从组织学/细胞学诊断日期至死亡进行测量。该研究纳入了42例患者，其中男性27例，女性15例，中位年龄55岁。15例患者（36%）发现了原发灶，考虑为肺癌。共有11/32（34%）的患者进行了胸部计算机断层扫描（CT），扫描结果显示异常，与肺部原发灶诊断相符。当胸部CT扫描为阴性时，纤维支气管镜检查也总是阴性（0/13）。腹部和盆腔CT扫描、腹部超声、盆腔超声和乳房X线照片均未发现原发灶。23例患者接受了局部治疗，37例接受了全身化疗。共有29/37（78%）的患者症状得到改善（中位持续时间为6个月），32/37（86%）的患者化疗后胸腔积液有客观反应（中位持续时间为6个月）。整个组的中位生存期为12个月（3 - 60 +个月）。在本系列研究中，胸部CT在34%的病例中诊断出肺部原发灶。其他放射学检查和支气管镜检查均无帮助。化疗使78%的患者症状得到缓解。
