Author of

• 20191

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  P3.12 - Pulmonology/Endoscopy (ID 728)

  • Event: WCLC 2017
  • Type: Poster Session with Presenters Present
  • Track: Pulmonology/Endoscopy
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)

  • 24150

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    P3.12-002 - Patients with Malignant Pleural Effusion who Succeeded Pleurodesis have a Longer Survival Rate - a 10-year Follow-up (ID 8149)

    09:30 - 09:30  |  Presenting Author(s): Li-Han Hsu
    • Abstract

    Background:
    Pleurodesis is often used to prevent re-accumulation of malignant pleural effusions (MPE). Intrapleural urokinase (IPUK) therapy facilitates lung re-expansion for patients with loculated MPE or trapped lung and allows subsequent pleurodesis. The MPE management has been traditionally regarded as a symptomatic treatment with rare mention of its impact on survival. Our preliminary study involved 26 patients showed successful pleurodesis translates into a longer survival. (BMC Cancer 2016;16:463) The successfully induced inflammatory response by sclerosing agent is supposed to prohibit tumor invasion and metastasis.
    
    Method:
    Part I. Three hundred and eighty-nine consecutive patients with symptomatic MPE underwent minocycline pleurodesis with (n = 184) and without (n = 205) antecedent IPUK therapy between September 2005, and August 2015, were recruited for pleurodesis outcome and survival analysis. Part II. The pleural fluid pro-inflammatory (IL-6, TNF-α), or anti-inflammatory (IL-1β, IL-10, TGF-β) cytokines before and after pleurodesis in fifteen patients with MPE between September 2015 and April 2016 were measured using Bio-Plex® Multiplex assays and correlated with the pleurodesis outcome and patient survival.
    
    Result:
    Part I. Patients numbering 109 (59.2%) responded to the IPUK therapy. The success rate of the subsequent pleurodesis was similar to that of the simple pleurodesis group (70.5% vs 69.0%; p = 0.804). In both groups, the patients who succeeded pleurodesis had a longer survival rate than those that failed (median, 259 vs 102 days; p < 0.001 and 414 vs 100 days; p < 0.001 respectively). Multivariate analysis showed that successful pleurodesis was an independent prognosticator (hazard ratio, 0.374; p < 0.001 and 0.271; p < 0.001 respectively). The differences remained when lung and breast cancer patients were studied separately. Part II. After instillation of sclerosing agent, pleural fluid IL-1β and IL-10, with a lesser degree were elevated in the group of successful pleurodesis. There was no discrimination in the TGF-β1, and IL-6 level between those succeeded and failed pleurodesis. No consistent change of TNF-α was observed in either group.
    
    Conclusion:
    Successful pleurodesis translates into a better survival rate promotes performing pleurodesis on lung re-expansion. The selective elevation of anti-inflammatory cytokines following pleurodesis suggests an anti-tumor effect. The change of TGF-β1 correlated with its dual role in cancer. While chronic inflammation might promote tumor formation, therapy induced acute inflammation might well hamper the process, and is indeed used therapeutically to inhibit tumor. Further studies are warranted to clarify the mechanism and provide opportunities to develop novel therapeutic strategies.