Characteristics and survival impact of polymorphonuclear leucocyte-predominant malignant pleural effusions secondary to lung cancer
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Jaehee Lee1, Yong Hoon Lee1, Hyewon Seo1
1Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
Introduction:
In comparison with mononuclear leucocyte (MNL)-predominant malignant pleural effusions (MPEs), polymorphonuclear leucocyte (PMNL)-predominant MPEs have rarely been investigated and may be associated with a poorer prognosis.
Objectives:
To investigate the characteristics and survival impact of PMNL-predominant MPEs secondary to lung cancer.
Methods:
This retrospective study included patients with MPE secondary to lung cancer, which were classified into the PMNL- and MNL-predominant groups according to cellular predominance in the pleural fluid. Clinical, hematological, radiological, and pleural fluid data were compared between the groups, and the survival impact of PMNL predominance in MPE was evaluated.
Results:
Of the 193 MPEs included, 37 (19%) were characterised by PMNL predominance. Compared to the MNL-predominant group, the PMNL-predominant group showed significantly poorer patient performances (P = .001), higher white blood cell counts (P = .009), higher neutrophil counts, higher blood neutrophil-to-lymphocyte ratio (P = .046), higher serum C-reactive protein (P = .003), lower serum albumin (P < .001), lower pleural fluid pH (P = .002) and higher pleural fluid lactate dehydrogenase (P = .029) levels. In contrast, most clinical and radiological findings, including the duration of symptoms, showed no significant intergroup differences. A shift towards MNL predominance was observed in only 38% of the PMNL-predominant patients who underwent repeat thoracentesis. Overall survival of the PMNL-predominant group was significantly shorter than the MNL-predominant group (P = .003).
Conclusions:
PMNL predominance in MPEs secondary to lung cancer may be observed in variable phases with respect to the duration of symptoms and the time of thoracentesis. Overall, PMNL-predominant MPEs were associated with more advanced stages and poorer survival outcomes, compared to MNL-predominant MPEs.
Insights
Polymorphonuclear leucocyte (PMNL)-predominant malignant pleural effusions (MPEs) in lung cancer patients are associated with worse clinical indicators and poorer survival. These PMNL-predominant MPEs indicate more advanced disease stages.
Area of Science:
- Pulmonology
- Oncology
- Cell Biology
Background:
- Malignant pleural effusions (MPEs) are common in lung cancer.
- Polymorphonuclear leucocyte (PMNL)-predominant MPEs are less studied than mononuclear leucocyte (MNL)-predominant MPEs.
- PMNL-predominant MPEs may indicate a poorer prognosis.
Purpose of the Study:
- To investigate the clinical characteristics of PMNL-predominant MPEs in lung cancer patients.
- To evaluate the survival impact of PMNL predominance in MPEs secondary to lung cancer.
Main Methods:
- Retrospective study of 193 lung cancer patients with MPE.
- Classification into PMNL-predominant and MNL-predominant groups based on pleural fluid cytology.
- Comparison of clinical, hematological, radiological, and pleural fluid data; survival analysis.
Main Results:
- 19% of MPEs were PMNL-predominant.
- PMNL-predominant MPEs showed poorer performance status, higher WBC, neutrophil counts, NLR, CRP, lower albumin, lower pleural fluid pH, and higher LDH.
- Overall survival was significantly shorter in the PMNL-predominant group.
Conclusions:
- PMNL predominance in lung cancer-related MPEs is associated with more advanced disease.
- PMNL-predominant MPEs correlate with significantly poorer survival outcomes compared to MNL-predominant MPEs.
- Cellular predominance in MPEs can vary over time and with thoracentesis.
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