Original article
General thoracic
Persistent Lung Expansion After Pleural Talc Poudrage in Non-Surgically Resected Malignant Pleural Mesothelioma

https://doi.org/10.1016/j.athoracsur.2014.11.050Get rights and content

Background

To investigate the prognostic effect of persistent lung expansion after pleural talcage and other variables in non-surgically resected malignant pleural mesothelioma (MPM) patients.

Methods

All consecutive patients submitted to video-assisted thoracoscopic (VAT) pleurodesis by talc poudrage for MPM between 2006 and 2011 were studied. The following parameters were prospectively recorded: age; sex; smoking history; asbestos exposure; C-reactive protein (CRP) levels; platelet (PLT) count; Eastern Cooperative Oncology Group performance status (ECOG PS); histologic subtype; clinical stage (cStage); chemotherapy; pleural fluid volume; and persistence of lung expansion at 3 months follow-up. Survival was assessed in June 2013.

Results

A total of 172 patients were considered; 146 of 172 patients demonstrated a complete lung expansion at discharge, whereas only 85 of 172 patients had persistent expanded lung on the affected side at the 3-month follow-up chest x-ray. Median survival was 11.5 months (95% confidence interval [CI], 10% to 14%) and 2-year disease-specific survival was 13% (95% CI, 7% to 24%) for the entire cohort. Multivariate analysis showed that non-epithelioid histology (hazard ratio [HR], 2.81; 95% CI, 1.82% to 5.09%), pleural fluid recurrence (HR 2.54; 95% CI, 1.73% to 4.40%), cStage greater than II (HR 2.36; 95% CI, 1.50% to 4.32%), ECOG PS greater than 1 (HR 2.19; 95% CI, 1.26% to 4.23%), CRP greater than 5 mg/L (HR 2.01; 95% CI, 1.18% to 4.12%), and PLT count greater than 400,000 (HR 1.76; 95% CI 1.14% to 3.92%) were independent predictors of poor prognosis.

Conclusions

Persistent lung expansion after pleural talc poudrage and absence of fluid recurrence is demonstrated to be a stronger factor in predicting survival rather than clinical stage and other clinical variables in not surgically resected MPM patients.

Section snippets

Patients and Methods

Clinical and pathologic data of all patients referred to the Thoracic Surgery Unit of Novara (Italy) between January 2006 and December 2011 for video-assisted thoracoscopic (VAT) pleural biopsy and pleurodesis for pleural effusion were collected prospectively and analyzed retrospectively. The present study was approved by the Institutional Research Ethics Board and patient consent was deemed not necessary due to the retrospective nature of the study.

Patients with preoperative diagnosis of

Patient Characteristics

Among 172 patients affected by MPM submitted to VAT pleural biopsy and pleurodesis by talc poudrage 24 underwent surgery with a previous diagnosis of MPM, whereas the remaining (n = 148) had MPM diagnosis at the time of the procedure. Twenty-six patients did not have complete lung expansion at discharge, whereas the other 146 patients (84%) had demonstrated a complete lung expansion after chest drain removal. Table 1 shows the main demographic, clinical, and pathologic characteristics of the

Comment

In this study focusing on pleurodesis outcome in patients with MPM, all our patients received pleural talc insufflation during VAT. Pleurodesis success rate at follow-up was suboptimal. When only patients with complete lung expansion at discharge were considered, 58% patients had complete control of their MPM related effusion; if the entire population of patients submitted to VAT and pleurodesis was considered (172 patients), the success rate was lower (about 49%). The low success rate reported

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