Clinically important associations of pleurodesis success in malignant pleural effusion: Analysis of the TIME1 data set.
Aged
Aged, 80 and over
C-Reactive Protein
/ immunology
Female
Humans
Leukocyte Count
Male
Mesothelioma
/ complications
Middle Aged
Pain
/ immunology
Pleural Effusion, Malignant
/ etiology
Pleural Neoplasms
/ complications
Pleurodesis
/ methods
Randomized Controlled Trials as Topic
Talc
/ administration & dosage
Thoracoscopy
Treatment Outcome
chest tube
malignant pleural effusion
mesothelioma
pleurodesis
thoracoscopy
Journal
Respirology (Carlton, Vic.)
ISSN: 1440-1843
Titre abrégé: Respirology
Pays: Australia
ID NLM: 9616368
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
received:
19
08
2019
revised:
21
10
2019
accepted:
05
11
2019
pubmed:
18
12
2019
medline:
23
6
2021
entrez:
18
12
2019
Statut:
ppublish
Résumé
Chemical pleurodesis is performed for patients with MPE with a published success rate of around 80%. It has been postulated that inflammation is key in achieving successful pleural symphysis, as evidenced by higher amounts of pain or detected inflammatory response. Patients with mesothelioma are postulated to have a lower rate of successful pleurodesis due to lack of normal pleural tissue enabling an inflammatory response. The TIME1 trial data set, in which pleurodesis success and pain were co-primary outcome measures, was used to address a number of these assumptions. Pain score, systemic inflammatory parameters as a marker of pleural inflammation and cancer type were analysed in relation to pleurodesis success. In total, 285 patients were included with an overall success rate of 81.4%. There was a significantly higher rise in CRP in the Pleurodesis Success group compared with the Pleurodesis Failure group (mean difference: 19.2, 95% CI of the difference: 6.2-32.0, P = 0.004) but no significant change in WCC. There was no significant difference in pain scores or analgesia requirements between the groups. Patients with mesothelioma had a lower rate of pleurodesis success than non-mesothelioma patients (73.3% vs 84.9%, χ Change in CRP during pleurodesis is associated with successful pleurodesis but higher levels of pain are not associated. Patients with mesothelioma appear less likely to undergo successful pleurodesis than patients with other malignancies, but there is still a significant rise in systemic inflammatory markers. The mechanisms of these findings are unclear but warrant further investigation.
Sections du résumé
BACKGROUND AND OBJECTIVE
Chemical pleurodesis is performed for patients with MPE with a published success rate of around 80%. It has been postulated that inflammation is key in achieving successful pleural symphysis, as evidenced by higher amounts of pain or detected inflammatory response. Patients with mesothelioma are postulated to have a lower rate of successful pleurodesis due to lack of normal pleural tissue enabling an inflammatory response.
METHODS
The TIME1 trial data set, in which pleurodesis success and pain were co-primary outcome measures, was used to address a number of these assumptions. Pain score, systemic inflammatory parameters as a marker of pleural inflammation and cancer type were analysed in relation to pleurodesis success.
RESULTS
In total, 285 patients were included with an overall success rate of 81.4%. There was a significantly higher rise in CRP in the Pleurodesis Success group compared with the Pleurodesis Failure group (mean difference: 19.2, 95% CI of the difference: 6.2-32.0, P = 0.004) but no significant change in WCC. There was no significant difference in pain scores or analgesia requirements between the groups. Patients with mesothelioma had a lower rate of pleurodesis success than non-mesothelioma patients (73.3% vs 84.9%, χ
CONCLUSION
Change in CRP during pleurodesis is associated with successful pleurodesis but higher levels of pain are not associated. Patients with mesothelioma appear less likely to undergo successful pleurodesis than patients with other malignancies, but there is still a significant rise in systemic inflammatory markers. The mechanisms of these findings are unclear but warrant further investigation.
Substances chimiques
Talc
14807-96-6
C-Reactive Protein
9007-41-4
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
750-755Subventions
Organisme : Medical Research Council
ID : G0600475
Pays : United Kingdom
Organisme : Marie Curie
ID : MCCC-RP-14-A17178
Pays : United Kingdom
Informations de copyright
© 2019 Asian Pacific Society of Respirology.
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