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.

Abstract

PURPOSE: To determine the prognostic value of pleural fluid pH, pleural fluid glucose, extent of pleural carcinomatosis (EPC) score, and Karnofsky Performance 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 recurrent symptomatic malignant pleural effusions who were referred to the interventional pulmonary service for thoracoscopic pleurodesis. MEASUREMENTS: Pleural fluid pH, pleural fluid glucose, EPC score, and KPS score. RESULTS: The KPS score was the only statistically significant predictor variable. Patients with a KPS score >/= 70 had a median survival of 395 days, as opposed to a median survival of only 34 days for patients with a KPS score </= 30. No prognostic advantage was evident when patients were categorized by pleural fluid pH, pleural fluid glucose, or EPC score. CONCLUSION: When assessing the prognosis of a patient with a recurrent symptomatic malignant pleural effusion, only the KPS score at the time of thoracoscopy is predictive of survival. Pleural fluid pH, pleural fluid glucose, and EPC scores are not as reliable as initially reported. For patients with a KPS score >/= 70, it may be very reasonable to proceed with thoracoscopic talc pleurodesis for management of their malignant pleural effusions.