To study some clinical and para-clinical symptoms of patients with malignant pleural effusion treated in the Respiratory Center, 103 Military Hospital in 5 years (2014 - 2019).
Journal of military pharmaco-medicine no9-2019 STUDY CHARACTERISTICS OF MALIGNANT PLEURAL EFFUSION IN THE RESPIRATORY CENTER, 103 MILITARY HOSPITAL IN YEARS (2014 - 2019) Dao Ngoc Bang1; Bach Quoc Tuan1; Nguyen Huy Luc1 SUMMARY Objectives: To study some clinical and para-clinical symptoms of patients with malignant pleural effusion treated in the Respiratory Center, 103 Military Hospital in years (2014 - 2019) Subjects and methods: A prospective study, cross-sectional descriptions was carried out on 203 inpatients with malignant pleural effusion, underwent pleural endoscopy in the Respiratory Center, 103 Military Hospital in years (2014 - 2019) Results: 203 patients had the higher proportion of male in comparison with female (1.57/1) and high mean of average age (64 ± 11.56) Parietal pleura, congestive pleura and candle streak followed by 55.67%, 56.65% and 56.65%, respectively The highest proportion belonged to lung cancer (72.91%), following by breast cancer (9.85%) The rate of pleural mesothelioma was only 1.97% The proportions of adenocarcinoma and small cell lung cancer were 41.22% and 2.03% Conclusions: Characteristics of malignant pleural effusion are valuable in the following strategy to manage patients In patients with maglignant pleural effusion caused by lung cancer, tumour biopsy is necessary to diagnose phenotypes of cancer * Keywords: Malignant pleural effusion; Pleural endoscopy INTRODUCTION Malignant pleural effusion is a syndrome, often seen in patients with advanced stage of cancer It affects much the quality of life as well as relates to mortality and survival time of patients Its main cause is lung cancer, following by breast cancer, lymphoma, cancer of uterus and ovary… The proportion of adenocarcinoma of lung and breast is about 50 - 65% of malignant pleural effusion About 30% of lung cancer patients will have malignant pleural effusion [1, 5] The early diagnosis of its cause plays an important role in the decision of methods applied for patients, in which palliative treatment proved its effectiveness in clinical practice Therefore, this research was carried out with the aim: To study some clinical and para-clinical characteristics of patients with malignant pleural effusion treated in the Respiratory Center, 103 Military Hospital in years (2014 - 2019) SUBJECTS AND METHODS Subjects 203 inpatients with malignant pleural effusion in the Respiratory Center, 103 Military Hospital from May 2014 to May 2019 103 Military Hospital Corresponding author: Dao Ngoc Bang (bsdaongocbang@gmail.com) Date received: 13/08/2019 Date accepted: 21/11/2019 235 Journal of military pharmaco-medicine no9-2019 * Selection criteria: Patients were diagnosed with malignant pleural effusion based on the result of pleural pathohistotogy by blind pleural biopsy, having indication to pleural endoscopy, co-operated with this study * Exclusion criteria: Patients had contraindications to pleural endoscopy, such as: severe heart failure, renal failure, disorders of coagulation, and so on Patients did not agree to undergo pleural endoscopy Methods * Design of study: A prospective study, cross-sectional descriptions * Content of study: Patients underwent clinical examination, tests of biochemical blood and blood cells marker, tumour markers, chest X-ray and computed tomography scan (CT-scan), taking of pleural effusion to test biochemiacal indexes and cells, pleural biopsy to pleural pathohistology They also underwent bronchoscopy before pleural endoscopy Pleural biopsy was indicated for patients, lacking of diagnosis of cancer or phenotypes of cancer Assessment of characteristics of pleural effusion, images of pleural lesions and pleural pathohistology Management and statistical analysis was performed by the SPSS 20.0 software RESULTS AND DISCUSSION Characteristics of patients Table 1: Characteristics of age and gender Gender Male Female Total Age n % n % n % < 40 4.03 1.27 2.96 43 - 50 10 8.06 8.86 17 8.37 51 - 60 30 24.19 19 24.05 49 24.14 61 - 70 38 30.65 29 36.71 67 33.00 71 - 80 38 30.65 15 18.98 53 26.11 > 80 2.42 10.13 11 5.42 124 100 79 100 203 100 Total X ± SD 63.69 ± 11.88 64.48 ± 11.09 64 ± 11.56 The proportion of male was higher than female (1.57/1), with the high mean of age (64 ± 11.56) and there was no difference in age between groups The highest proportion was seen in the group of patients at the age from 61 to 70 years old (30.65% of male, 36.71% of female) There were patients (2.96%) in both groups, being at the age under 40 years old The characteristics of age were similar to the previous studies in Vietnam and in the world: Nguyen Manh Tuong et al (2005) [2], Janssen J.P et al (2007) [6] and so on 236 Journal of military pharmaco-medicine no9-2019 The patients at these ages usually had many malignant diseases The female proportion in this study was significant higher than that in the study by Nguyen Huy Luc (2010), with the ratio of male/female being 4.6/1 [3] This characteristic proved that there was a change of the structure of diseasae However, the femle rate was lower than that in many studies in the world, such as: Janssen J.P et al (2007 [6]), Yoon D.W et al (2016) [7] and so on This difference may relate to risk factors of cancer In the EuropeanAmerican countries, the proportion of smoking in female is often high, being an important risk factor of lung cancer, a main cause of malignant pleural effusion Table 2: Characteristics of smoking habit Gender Male Female Total n % n % n % Yes 107 86.29 0 107 52.71 No 17 13.71 79 100 96 47.29 124 100 79 100 203 100 Smoking Total All of smoking patients were male, with the proportion of 86.29% in the male group and 52.71% of total studied patients According to Collins L.G et al (2007), smoking makes the risk of lung cancer increase to 10 - 30 times in comparison with non-smoker [8] Therefore, the male proportion in this study was higher than female Chart 1: Duration of disease Most of patients had duration of disease less than month (46.31%) The proportion of patients having duration of disease more than months was only 19.7% This characteristic was similar to studies by Nguyen Manh Tuong (2005) [2], Nguyen Vu Hoang Viet (2011) [4] This reflected that malignant patients usually hospitalized late That could be explained that the symptoms of malignant pleural effusion usually develop steadly and not affect patient’s life for the first time Besides, the awareness of patients and development of local medical care were also factors, affecting this characteristic 237 Journal of military pharmaco-medicine no9-2019 Characteristics of malignant pleural effusion * Severity of pleural effusion: Small: patients (4.43%); moderate: 135 patients (66.51%); large: 59 patients (9.06%) This result was similar to the result of the study by Nguyen Vu Hoang Viet (2011) [4] Patients usually hospitalized when they had many clinical symptoms, corresponding to moderate or maximal pleural effusion Table 3: Characteristics of glucose, LDH in pleural effusion Indexes of pleural effusion Glucose (mmol/L) LDH (U/L) n (n = 203) % X ± SD Min Max Low 30 14.78 5.47 ± 2.32 0.03 13.8 Normal 173 85.22 < 1,000 178 87.68 587.96 ± 622.04 31 5,076 ≥ 1,000 25 12.32 ’ Mean of glucose in pleural effusion belonged to normal limitation while mean of LDH increased highly 14.78% of studied patients decreased glucose in pleural effusion and 12.32% of patients had increased LDH, being more than 1,000 U/L The characteristics of LDH in pleural effusion were similar to the results of other previous studies However, glucose in pleural effusion was different in each study [9] This difference could relate to the time of taking pleural effusion (before or after the meal), the sending time of pleural effusion to labo and so on * Pleural image in the endoscopy: Smooth tumour: 73 patients (35,96%); scabrous tumour: 71 patients (34,98%); parietal pleura: 113 patients (55,67%); congestive pleura: 115 patients (56,65%); candle streak: 115 patients (56,65%) These characteristics were similar to the results of other previous studies by Nguyen Huy Luc et al (2010) [3], Wu Y.B et al (2017) [7]…, with the image of parietal pleura being often seen in pleural endoscopy in patients with malignant pleural effusion Chart 2: Causes of malignant pleural effusion 238 Journal of military pharmaco-medicine no9-2019 Lung cancer had the highest rate (72.91%), following by breast cancer (9.85%) The result was similar to the results of other studies in Vietnam and in the world by Nguyen Manh Tuong (2005) [2], Yoon D.W et al (2016), with most causes being lung cancer and breast cancer In this study, the proportion of pleural mesothelioma was only 1.97% Following to the results of many researches in the world, pleural mesothelioma is rare, with the proportion of male being more than female due to each study The rate of unknown primary cancer was 1.48% This proportion was lower in comparison with the results of previous studies This characteristic showed that the efficacy of pleural biopsy via endoscopy and the development of pathohistological diagnosis to diagnose causes of malignant pleural effusion * Classification of pathohistological lung cancer: Adenocarcinoma: 61 patients (41.22%); squamous carcinoma: 15 patients (10.14%); small cell lung cancer: patients (2.03%); unknown phenotypes: 69 patients (46.61%) Of the patients with lung cancer, the proportion of adenocarcinoma was the highest This characteristic was suitable with the results of other studies in the world, with the highest proportion being often seen in adenocarcionoma However, 46.61% of patients could not define the phenotypes of cancer with pleural biopsy This characteristic proved the need of lung tumour biopsy in diagnosis of cancer phenotypes Based on that result, the doctor could determine the best strategy of treatment for patients CONCLUSIONS Studying 203 inpatients with malignant pleural effusion in the Respiratory Center, 103 Military Hospital in years (2014 2019), we had some conclusions: - The proportion of male was higher than female (1.57/1), high mean of age (64 ± 11.56 years old) The highest proportion was seen in the group of patients at the age from 61 to 70 years old - The rates of parietal pleura, congestive pleura and candle streak were 55.67%, 56.65% and 56.65%, respectively Lung cancer had the highest rate (72.91%), following by breast cancer (9.85%) The proportion of pleural mesothelioma was only 1.97% The proportion of adenocarcinoma was 41.22% The rate of small cell lung cancer was 2.03% - Characteristics of malignant pleural effusion are valuable in the following strategy to manage patients Tumour biopsy is necessary to diagnose the phenotypes of lung cancer REFERENCES Đỗ Quyết Tràn dịch màng phổi Bệnh màng phổi Nhà xuất Y học Hà Nội 2013, tr.145-177 Nguyễn Mạnh Tường Nghiên cứu chẩn đốn gây dính màng phổi qua nội soi tràn dịch màng phổi ác tính Luận văn Thạc sỹ Y học Học viện Quân y Hà Nội 2005 Nguyễn Huy Lực, Mai Xuân Khẩn Nghiên cứu nguyên nhân kết gây dính màng phổi qua nội soi màng phổi bệnh nhân tràn dịch màng phổi ác tính Tạp chí Y học thực hành 2010, (723), tr.40-42 239 Journal of military pharmaco-medicine no9-2019 Nguyễn Vũ Hồng Việt Vai trò nội soi màng phổi chẩn đoán tràn dịch màng phổi ác tính Luận văn Tốt nghiệp Bác sỹ nội trú Trường Đại học Y Hà Nội 2011 Penz E, Watt K.N, Hergott C.A et al Management of malignant pleural effusion: Challenges and solutions Cancer Management and Research 2017, 9, pp.229-241 Janssen J.P, Collier G, Astoul P et al Safety of pleurodesis with talc poudrage in malignant pleural effusion: A prospective cohort study Lancet 2007, 369 (9572), pp.1535-1539 Wu Y.B, Xu L.L, Wang X.J et al Diagnostic value of medical thoracoscopy in 240 malignant pleural effusion BMC Pulmonary Medicine 2017, 17, p.109 Collins L.G, Haines C, Perkel R et al Lung cancer: Diagnosis and management American Family Physician 2007, 75 (1), pp.56-63 10 Sahn S.A, Huggins J.T Malignant pleural effusions Fishman’s Pulmonary Diseases and Disorders Fifth edition 2015, pp.1188-1197 11 Yoon D.W, Cho J.H, Choi Y.S et al Predictors of survival in patients who underwent video assisted thoracic surgery talc pleurodesis for malignant pleural effusion Thoracic Cancer 2016, (4), pp.393-398 ... [7]…, with the image of parietal pleura being often seen in pleural endoscopy in patients with malignant pleural effusion Chart 2: Causes of malignant pleural effusion 238 Journal of military pharmaco-medicine... factors of cancer In the EuropeanAmerican countries, the proportion of smoking in female is often high, being an important risk factor of lung cancer, a main cause of malignant pleural effusion. .. 14.78% of studied patients decreased glucose in pleural effusion and 12.32% of patients had increased LDH, being more than 1,000 U/L The characteristics of LDH in pleural effusion were similar to the