MALIGNANT PLEURAL EFFUSION - PROGNOSTIC FACTORS FOR SURVIVAL AND RESPONSE TO CHEMICAL PLEURODESIS IN A SERIES OF 120 CASES

Chemical pleurodesis is an effective treatment of malignant pleural ef fusions, but indications must be individualised to optimise its result s. The aim of the present study was to investigate the relationship of various prognostic features with both the response rate to pleurodesi s and the probability of patient survival. A non-concurrent cohort stu dy was carried out in which 120 evaluable patients with malignant pleu ral effusion underwent pleurodesis. Lung (40%), breast (26.6%), and un known primary site (12.5%) carcinomas were the most frequent neoplasms . Clinical data and pleural fluid parameters were analysed. Median ove rall survival was 9 months. Pleural fluid glucose (<60 mg/dl), Karnofs ky 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 dehydrogena se levels (>600 U/l) showed a significant association with the probabi lity 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 t hat some pretreatment clinical data and pleural fluid parameters can p redict both the outcome of pleurodesis and the survival of patients wi th malignant pleural effusion.