Martínez-Moragón E, Aparicio J, Sanchis J, Menéndez R, Cruz Rogado M, Sanchis F
Department of Pneumology, Hospital Universitario La Fe, Valencia, Spain.
Respiration. 1998;65(2):108-13. doi: 10.1159/000029240.
Chemical pleurodesis is an effective treatment of malignant pleural effusions, but indications must be individualised to optimise its results. The aim of the present study was to investigate the relationship of various prognostic features with both the response rate to pleurodesis and the probability of patient survival. A non-concurrent cohort study was carried out in which 120 evaluable patients with malignant pleural effusion underwent pleurodesis. Lung (40%), breast (26.6%), and unknown primary site (12.5%) carcinomas were the most frequent neoplasms. Clinical data and pleural fluid parameters were analysed. Median overall survival was 9 months. Pleural fluid glucose (< 60 mg/dl), Karnofsky performance status (< 70), size of the effusion in chest radiographs (massive effusion), pleural fluid pH (< 7.20), presence of concomitant alterations in chest radiographs, and pleural lactic acid dehydrogenase levels (> 600 U/l) showed a significant association with the probability of failure. Patients with these features, along with those having non-chemosensitive tumours (in particular, non-small cell lung cancer), had a significantly worse actuarial survival. This study confirms that some pretreatment clinical data and pleural fluid parameters can predict both the outcome of pleurodesis and the survival of patients with malignant pleural effusion.
化学性胸膜固定术是治疗恶性胸腔积液的一种有效方法，但必须根据个体情况确定适应证以优化治疗效果。本研究的目的是探讨各种预后特征与胸膜固定术的反应率及患者生存概率之间的关系。我们进行了一项非同期队列研究，120例可评估的恶性胸腔积液患者接受了胸膜固定术。肺癌（40%）、乳腺癌（26.6%）和原发部位不明的肿瘤（12.5%）是最常见的肿瘤类型。我们分析了临床数据和胸腔积液参数。总体中位生存期为9个月。胸腔积液葡萄糖（<60mg/dl）、卡氏评分（<70）、胸部X线片上胸腔积液的大小（大量胸腔积液）、胸腔积液pH值（<7.20）、胸部X线片上是否存在伴随改变以及胸腔积液乳酸脱氢酶水平（>600U/l）与治疗失败概率显著相关。具有这些特征的患者，以及患有非化疗敏感肿瘤（特别是非小细胞肺癌）的患者，其精算生存率明显较差。本研究证实，一些治疗前临床数据和胸腔积液参数可以预测胸膜固定术的疗效以及恶性胸腔积液患者的生存情况。
