Malignant pleural effusions in lung cancer: the condition during the disease

Abstract

Introduction: Malignant pleural effusions are common pathology in clinical practice in patients with malignant disease .Malignant pleural effusion represents 40% of chronic pleural effusion and is the leading cause of recurrent pleural effusion, which has an additional impact on morbidity in patients with malignant disease. Lung cancer is the predominant cause of malignant pleural effusion confirmed by more research series. Primary lung cancer associated with malignant pleural effusion is metastatic disease (7-th edition of TNM classification of lung cancer at the American Cancer Committee). Primary lung cancer associated with malignant pleural effusion further increases the morbidity of these patients reducing therapeutic options and affect survival (a median survival of less than 4 months).Pleural metastases originating from bronchogenic origin appear relatively early in the disease unlike other primary visceral tumors and is sufficient reason to determine the incidence of pleural effusions among different histological types of primary lung cancer and the condition of the malignant pleural effusion in different histopathological types of lung cancer during the course of disease.

Material and methods: The study is a retrospective study in which data from 800 patients (35-75 years old) with primary lung cancer classified according to the recommendations of the WHO were processed over a period of three years from 2010 to 2013 at the Clinic of Oncology and Radiotherapy. The study included all patients with the presence of malignant pleural effusion associated with primary lung cancer regardless of the time of occurrence of pleural effusion. Data from patients for the purposes of the study were evaluated by the following parameters: Incidence of pleural effusion in evaluated lung cancer patients; Development of pleural effusion in certain histopathological types of lung cancer and Condition of the malignant pleural effusion in different histopathological types of lung cancer during the course of disease.

Results: Research has shown that malignant pleural effusion associated with primary lung cancer appeared in 193 patients/28.1%. The right lung malignant pleural effusion appeared with 54.4% of the total number of pleural effusions, and left with 43.5%, and 10.9% of the difference was statistically significant. The right lung showed no statistically significant trend in the separate histopathological type development pleural effusion, while only adenocarcinoma in the left lung showed a tendency to develop pleural effusion for 20.6% more than squamous cell carcinoma. In the right lung 59% of the effusions persisted,14.3% withdrew and 6.7% progressed, while 63.1% of the effusions in the left lung persisted,16.7% withdrew, 6% progressed during disease. In the right lung there wasn’t difference in the condition of pleural effusion between different histological types, but in the left lung adenocarcinoma effusions withdrew as much as they progressed during the disease (13,6%) and squamous cell carcinoma effusions didn’t progress.

Discussion: Pleural effusions in lung cancer are a major problem (appearing in 28%) given that they mostly persist during illness regardless of histological type which increases the problem in the treatment and in survival of those patients.

Keywords

lung cancer, malignant pleural effusion