CHEST Guidelines-Malignant-Pleural-Effusion-in-Malignant-Pleural-Me

Malignant-Pleural-Effusion-in-Malignant-Pleural-Me

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This article discusses the complex relationship between malignant pleural effusion (MPE) and malignant pleural mesothelioma (MPM), a cancer with poor prognosis and limited survival. MPE is the first and most common presentation of MPM, affecting 95% of individuals with this disease. Currently, treatment of MPE in MPM is focused mainly on symptom relief rather than survival extension, with the clinical course of MPE varying significantly among patients.<br /><br />A study by Asciak et al. involving 761 patients with MPM showed no direct correlation between pleural fluid exposure and survival, once adjusted for known survival-affecting variables. However, significant survival differences were found based on the completeness of pleurodesis—a procedure to obliterate the pleural space to prevent fluid accumulation. Patients with complete pleurodesis survived longer than those with partial or no pleurodesis. This finding suggests that effective pleurodesis could potentially extend survival, possibly due to the antitumor properties of talc, the sclerosing agent typically used.<br /><br />While existing prognostic models, such as the LENT score, focus on systemic and inflammatory factors reflecting the disease state, they do not account for pleural fluid properties. Mishra et al. indicated a relationship between breathlessness and survival in MPE patients, but the duration of MPE exposure’s impact on survival remains unexplored.<br /><br />The article also emphasizes the speculative nature of current conclusions due to the retrospective design of most studies, highlighting the need for future prospective research to explore the causative and mechanistic roles of pleural effusion in MPM. These future studies could potentially reshape management paradigms, especially regarding the potential benefits of symptomatic management and pleurodesis outcomes in MPM.

Keywords

malignant pleural effusion

malignant pleural mesothelioma

pleurodesis

survival differences

talc sclerosing agent

prognostic models

LENT score

symptom relief

retrospective studies

prospective research