Predicting survival in patients with recurrent symptomatic malignant pleural effusions - An assessment of the prognostic values of physiologic, morphologic, and quality of life measures of extent of disease

Purose: To determine the prognostic value of pleural fluid pH, pleural flui d glucose, extent of pleural carcinomatosis (EPC) score, and Karnofsky Perf ormance Scale (KPS) score in patients with recurrent symptomatic malignant pleural effusions, Design: Prospective 53-month study. Setting: Referral center for interventional pulmonology. Patients: Eighty-five consecutive patients (42 men and 43 women) with recur rent symptomatic malignant pleural effusions who were referred to the inter ventional pulmonary service for thoracoscopic pleurodesis. Measurements: Pleural fluid pH, pleural fluid glucose, EPC score, and KPS s core. Results: The KPS score was the only statistically significant predictor var iable. Patients with a KPS score greater than or equal to 70 had a median s urvival of 395 days, as opposed to a median survival of only 34 days for pa tients with a KPS score less than or equal to 30, No prognostic advantage w as evident when patients were categorized bq pleural fluid pH, pleural flui d glucose, or EPC score. Conclusion: When assessing the prognosis of a patient with a recurrent symp tomatic malignant pleural effusion, only the KPS score at the time of thora coscopy is predictive of sunival. Pleural fluid pH, pleural fluid glucose, and EPC scores are not as reliable as initially reported, For patients with a KPS score greater than or equal to 70, it may be very reasonable to proc eed with thoracoscopic talc pleurodesis for management of their malignant p leural effusions.