Clinical and Translational Science 2022 February 25 [Link]

Yuan Yang, Juan Du, Yi-Shan Wang, Han-YuJie Kang, Kan Zhai, Huan-Zhong Shi

Abstract

The exact role of pleural effusion in the prognosis of cancer patients remains unclear. We aimed to systematically review the prognostic value of pleural effusion in cancer patients. We performed a systematic review and meta-analysis with a systematic literature search. All cohort studies with available overall survival (OS) and progression-free survival (PFS) results for cancer patients with or without pleural effusion were included. The Mantel-Haenszel method was used to calculate the pooled hazard ratios (HRs) and 95% confidence intervals (CIs). Heterogeneity and publication bias were examined. Subgroup analysis and sensitivity analysis were performed. A total of 47 studies with 146117 patients were included in the analysis. For OS, pleural effusion was a prognostic factor associated with a poor prognosis for cancer patients (HR 1.58, 95% CI 1.43-1.75; I2 94.8%). In the subgroup analysis, pleural effusion was a prognostic factor associated with poor survival for patients with lung cancer (HR 1.44, 95% CI 1.35-1.54; I2 60.8%), hematological cancer (HR 2.79, 95% CI 1.63-4.77; I2 29.4%) and other types of cancer (HR 2.08, 95% CI 1.43-3.01; I2 55.1%). For PFS, pleural effusion was a prognostic factor associated with a poor prognosis for cancer patients (HR 1.61, 95% CI 1.28-2.03; I2 42.9%). We also observed that massive pleural effusion was a prognostic factor associated with a poorer prognosis compared to minimal pleural effusion. Pleural effusion had prognostic value in both OS and PFS of cancer patients, except for patients with malignant pleural mesothelioma, regardless of whether the malignant effusion was confirmed histologically or cytologically. However, future evidence of other pleural effusion characteristics is still needed.