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Association between Tunneled Pleural Catheter Use and Infection in Patients Immunosuppressed from Antineoplastic
Candice L Wilshire1, Shu-Ching Chang2, Christopher R Gilbert1
1Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington.
Abstract:
Rationale: Patients with malignant or paramalignant pleural effusions (MPEs or PMPEs) may have tunneled pleural catheter (TPC) management withheld because of infection concerns from immunosuppression associated with antineoplastic therapy.Objectives: To determine the rate of infections related to TPC use and to determine the relationship to antineoplastic therapy, immune system competency, and overall survival (OS).Methods: We performed an international, multiinstitutional study of patients with MPEs or PMPEs undergoing TPC management from 2008 to 2016. Patients were stratified by whether or not they underwent antineoplastic therapy and/or whether or not they were immunocompromised. Cumulative incidence functions and multivariable competing risk regression analyses were performed to identify independent predictors of TPC-related infection. Kaplan-Meier method and multivariable Cox proportional hazards modeling were performed to examine for independent effects on OS.Results: A total of 1,408 TPCs were placed in 1,318 patients. Patients had a high frequency of overlap between antineoplastic therapy and an immunocompromised state (75-83%). No difference in the overall (6-7%), deep pleural (3-5%), or superficial (3-4%) TPC-related infection rates between subsets of patients stratified by antineoplastic therapy or immune status was observed. The median time to infection was 41 (interquartile range, 19-87) days after TPC insertion. Multivariable competing risk analyses demonstrated that longer TPC duration was associated with a higher risk of TPC-related infection (subdistribution hazard ratio, 1.03; 95% confidence interval [CI], 1.00-1.06; P = 0.028). Cox proportional hazards analysis showed antineoplastic therapy was associated with better OS (hazard ratio, 0.84; 95% CI, 0.73-0.97; P = 0.015).Conclusions: The risk of TPC-related infection does not appear to be increased by antineoplastic therapy use or an immunocompromised state. The overall rates of infection are low and comparable with those of immunocompetent patients with no relevant antineoplastic therapy. These results support TPC palliation for MPE or PMPEs regardless of plans for antineoplastic therapy.
Insights
Tunneled pleural catheters (TPCs) are safe for patients with malignant pleural effusions (MPEs) or paramalignant pleural effusions (PMPEs), even with antineoplastic therapy or immunosuppression. Infection rates are low and do not increase with these treatments, supporting TPC use for symptom relief.
Area of Science:
- Pulmonology
- Oncology
- Infectious Diseases
Background:
- Malignant or paramalignant pleural effusions (MPEs/PMPEs) often require palliative management.
- Concerns exist regarding infection risk with tunneled pleural catheters (TPCs) in patients undergoing antineoplastic therapy or with compromised immune systems.
Purpose of the Study:
- To assess the infection rate associated with TPC use in MPE/PMPE patients.
- To determine the relationship between TPC infections, antineoplastic therapy, immune status, and overall survival (OS).
Main Methods:
- International, multiinstitutional study of 1,318 patients with MPEs/PMPEs from 2008-2016.
- Patients stratified by antineoplastic therapy and immune status.
- Statistical analyses included competing risk regression and Cox proportional hazards modeling.
Main Results:
- No significant difference in TPC-related infection rates (overall, deep, or superficial) was observed between patients receiving antineoplastic therapy or those who were immunocompromised.
- Longer TPC duration was associated with a slightly increased risk of infection.
- Antineoplastic therapy was linked to improved overall survival.
Conclusions:
- TPC-related infection risk is not elevated in patients with MPEs/PMPEs undergoing antineoplastic therapy or with compromised immune status.
- TPC insertion is a safe and effective palliative option for MPE/PMPE management, irrespective of treatment or immune status.
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