Ricardo Mingarini Terra1,2, Leila Antonangelo3, Alessandro Wasum Mariani4,5, Ricardo Lopes Moraes de Oliveira4, Lisete Ribeiro Teixeira6, Paulo Manuel Pego-Fernandes4. 1. Thoracic Surgery Division, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, Avenida Dr. Eneas de Carvalho Aguiar, 44 - 2o Andar Sala 9, São Paulo, SP, CEP 05403-000, Brazil. rmterra@uol.com.br. 2. Thoracic Surgery, Centro Oncológico do Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil. rmterra@uol.com.br. 3. Pathology Division, Heart Institute, University of São Paulo Medical School, São Paulo, SP, Brazil. 4. Thoracic Surgery Division, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, Avenida Dr. Eneas de Carvalho Aguiar, 44 - 2o Andar Sala 9, São Paulo, SP, CEP 05403-000, Brazil. 5. Thoracic Surgery, Centro Oncológico do Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil. 6. Pulmonology Division, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, SP, Brazil.
Abstract
PURPOSE: Systemic and local inflammations have been described as relevant prognostic factors in patients with cancer. However, parameters that stand for immune activity in the pleural space have not been tested as predictors of survival in patients with malignant pleural effusion. The objective of this study was to evaluate pleural lymphocytes and Adenosine Deaminase (ADA) as predictors of survival in patients with recurrent malignant pleural effusion. METHODS: Retrospective cohort study includes patients who underwent pleurodesis for malignant pleural effusion in a tertiary center. Pleural fluid protein concentration, lactate dehydrogenase, glucose, oncotic cytology, cell count, and ADA were collected before pleurodesis and analyzed. Survival analysis was performed considering pleurodesis as time origin, and death as the event. Backwards stepwise Cox regression was used to find predictors of survival. RESULTS: 156 patients (out of 196 potentially eligible) were included in this study. Most were female (72 %) and breast cancer was the most common underlying malignancy (53 %). Pleural fluid ADA level was stratified as low (<15 U/L), normal (15 ≤ ADA < 40), and high (≥40). Low and high ADA levels were associated with worse survival when compared to normal ADA (logrank: 0.0024). In multivariable analysis, abnormal ADA (<15 or ADA ≥ 40) and underlying malignancies different from lymphoma, lung, or breast cancer were associated with worse survival. Pleural fluid cell count and lymphocytes number and percentage did not correlate with survival. CONCLUSIONS: Pleural fluid Adenosine Deaminase levels (<15 or ≥40 U/L) and neoplasms other than lung, breast, or lymphoma are independent predictors of worse survival in patients with malignant pleural effusion who undergo pleurodesis.
PURPOSE: Systemic and local inflammations have been described as relevant prognostic factors in patients with cancer. However, parameters that stand for immune activity in the pleural space have not been tested as predictors of survival in patients with malignant pleural effusion. The objective of this study was to evaluate pleural lymphocytes and Adenosine Deaminase (ADA) as predictors of survival in patients with recurrent malignant pleural effusion. METHODS: Retrospective cohort study includes patients who underwent pleurodesis for malignant pleural effusion in a tertiary center. Pleural fluid protein concentration, lactate dehydrogenase, glucose, oncotic cytology, cell count, and ADA were collected before pleurodesis and analyzed. Survival analysis was performed considering pleurodesis as time origin, and death as the event. Backwards stepwise Cox regression was used to find predictors of survival. RESULTS: 156 patients (out of 196 potentially eligible) were included in this study. Most were female (72 %) and breast cancer was the most common underlying malignancy (53 %). Pleural fluid ADA level was stratified as low (<15 U/L), normal (15 ≤ ADA < 40), and high (≥40). Low and high ADA levels were associated with worse survival when compared to normal ADA (logrank: 0.0024). In multivariable analysis, abnormal ADA (<15 or ADA ≥ 40) and underlying malignancies different from lymphoma, lung, or breast cancer were associated with worse survival. Pleural fluid cell count and lymphocytes number and percentage did not correlate with survival. CONCLUSIONS:Pleural fluid Adenosine Deaminase levels (<15 or ≥40 U/L) and neoplasms other than lung, breast, or lymphoma are independent predictors of worse survival in patients with malignant pleural effusion who undergo pleurodesis.
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