Related Experiment Video

Updated: Nov 2, 2025

Implantation and Monitoring by PET/CT of an Orthotopic Model of Human Pleural Mesothelioma in Athymic Mice

Implantation and Monitoring by PET/CT of an Orthotopic Model of Human Pleural Mesothelioma in Athymic Mice

Published on: December 21, 2019

The Association Between Pleural Fluid Exposure and Survival in Pleural Mesothelioma

Rachelle Asciak¹, Nikolaos I Kanellakis², Anna Bibby³

¹Laboratory of Pleural and Lung Cancer Translational Research, Nuffield Department of Medicine, University of Oxford, Oxford, England; Pleural Unit, Churchill Hospital, Oxford University Hospitals Foundation Trust, Oxford, England; Mater Dei Hospital, Msida, Malta.

|June 13, 2021

Abstract

Background:

Most patients with malignant pleural mesothelioma (MPM) seek treatment with malignant pleural effusion (MPE). In vitro evidence suggests that MPE may not be a simple bystander of malignancy, but rather potentially has biological properties that improve cancer cell survival and promote cancer progression. If this is the case, MPE management may need to shift from current symptomatic strategies to aggressive fluid removal to impact survival.

Research Question:

Is there an association between pleural fluid exposure and survival in MPM?

Study Design And Methods:

Data from 761 patients who received a diagnosis of MPM between 2008 and 2018 were collected from patient medical records in three UK pleural units. Data included factors previously identified as influencing prognosis in MPM. Medical imaging was reviewed for presence, size, and duration of pleural effusion. Time-dependent covariate analysis of pleural fluid exposure and survival (model included weight loss, serum albumin, hemoglobin, MPM subtype, performance status, chemotherapy, and age) and multivariate Cox regression analysis of pleurodesis and survival were conducted.

Results:

Median overall survival was 278 days (interquartile range, 127-505 days; 95% CI, 253-301 days). Pleural fluid exposure duration showed no association with survival (hazard ratio, 1.0; 95% CI, 1.0-1.0). Median survival was 473, 378, and 258 days with complete, partial, and no pleurodesis (P = .008).

Interpretation:

Pleurodesis success seems to be associated with improved survival; however, it is unclear whether duration of MPM exposure to pleural fluid is associated with survival within the limitations of this retrospective study. Future prospective studies are required to assess this potentially important mechanism.

Insights

Malignant pleural effusion (MPE) in malignant pleural mesothelioma (MPM) may not be a bystander. Pleurodesis success improved survival, but fluid exposure duration did not significantly impact outcomes in this retrospective study.

Area of Science:

Oncology
Thoracic Surgery
Pleural Medicine

Background:

Malignant pleural effusion (MPE) is common in malignant pleural mesothelioma (MPM) patients.
Emerging evidence suggests MPE may actively promote cancer cell survival and progression.
Current MPE management focuses on symptom relief, potentially overlooking survival impact.

Purpose of the Study:

To investigate the association between pleural fluid exposure and survival in MPM patients.
To evaluate the impact of pleurodesis on survival in MPM.

Main Methods:

Retrospective analysis of 761 MPM patients diagnosed between 2008-2018.
Inclusion of prognostic factors: weight loss, albumin, hemoglobin, MPM subtype, performance status, chemotherapy, and age.
Time-dependent covariate and multivariate Cox regression analyses were performed.

Main Results:

Median overall survival was 278 days.
No significant association was found between pleural fluid exposure duration and survival (HR 1.0).
Median survival varied with pleurodesis success: 473 days (complete), 378 days (partial), and 258 days (none) (P=.008).

Conclusions:

Pleurodesis success appears linked to improved survival in MPM.
The role of pleural fluid exposure duration in MPM survival remains uncertain.
Further prospective research is needed to clarify the biological role of MPE in MPM progression.

Read full analysis

Keywords:

effusion malignant pleural mesothelioma pleural survival

More Related Videos

Generation and Expansion of Primary, Malignant Pleural Mesothelioma Tumor Lines

Generation and Expansion of Primary, Malignant Pleural Mesothelioma Tumor Lines

Published on: April 21, 2022

Orthotopic Implantation and Peripheral Immune Cell Monitoring in the II-45 Syngeneic Rat Mesothelioma Model

Orthotopic Implantation and Peripheral Immune Cell Monitoring in the II-45 Syngeneic Rat Mesothelioma Model

Published on: October 2, 2015

Related Concept Videos

Pleural Disorders: Types and Brief Description

Pleural Disorders: Types and Brief Description

The pleura is a vital part of the respiratory system. It's a double-layered membrane surrounding the lungs and lining the chest cavity. The two layers of the pleura are:

Pleural Effusion I: Introduction

Pleural Effusion I: Introduction

Pleural effusion is an abnormal fluid accumulation in the pleural cavity, a narrow space between the lungs and the chest wall. It is not a disease per se but rather a symptom or indication of an underlying disease. In normal circumstances, this space contains a small amount of fluid (5 to 15 mL), a lubricant facilitating the non-frictional movement of the pleural surfaces.
There are two main types of pleural effusion: transudative and exudative. They are differentiated using Light's...

Pleural Effusion II: Symptoms and Management

Pleural Effusion II: Symptoms and Management

Pleural Effusion Overview
A pleural effusion is the abnormal collection of fluid between the parietal and visceral pleura layers of tissue that form the lining of the lungs and chest cavity. It can occur independently or due to surrounding parenchymal diseases, such as infection, malignancy, or inflammatory conditions.
Clinical Manifestations:

Pleura of the Lungs

Pleura of the Lungs

The lungs are nestled in a cavity, shielded by the pleura. The pleura, a form of serous membrane, wraps around each lung. This membrane arrangement consists of two layers: the visceral and parietal pleurae. The visceral pleura lines the surface of the lungIn contrast, the parietal pleura is the outer layer and contacts to the thoracic wall, the mediastinum, and the diaphragm. The hilum is the point of connection between the visceral and parietal layers. The space between the parietal and...

Pneumothorax-II

Pneumothorax-II

Pneumothorax is a medical condition defined by the buildup of air in the pleural space between the lungs and the chest wall. This accumulation of air can lead to partial or complete lung collapse, resulting in a range of clinical manifestations. Understanding the clinical presentation and effective management strategies is crucial for healthcare professionals in providing timely and appropriate care to individuals with pneumothorax.
Clinical Manifestations:

Articles linked to this work by shared authors, journal, and citation graph.

Community-acquired pneumonia in adults: acute and long-term complications.

The lancet. Healthy longevity·2026

Safety Profile of Tozorakimab (an Anti-IL-33 Monoclonal Antibody): Data from the FRONTIER Phase 2 Program.

Biologics : targets & therapy·2026

Real-world outcomes of stage III non-small cell lung cancer in the durvalumab era: insights from a socioeconomically deprived population.

Clinical and translational radiation oncology·2026

Phase III LUNA clinical programme: design of four randomised, double-blind, placebo-controlled studies assessing the efficacy and safety of tozorakimab in patients with symptomatic COPD and a high risk of exacerbations.

BMJ open respiratory research·2026

Preclinical characterization and phase 1 clinical testing of targeting mitochondrial peroxiredoxin 3 in cancer.

Nature communications·2026

Protocol for Mesothelioma Observational study of Risk prediction and Generation of paired benign-meso tissue samples, Including a Nested MRI Substudy (Meso-ORIGINS).

BMJ open respiratory research·2026

See all related articles