Letter to the Editor Published online: June 14, 2014
Prognostic Factors in Patients with Malignant Pleural Effusion Deepak Aggarwal, Varinder Saini Department of Pulmonary Medicine, Government Medical College and Hospital, Chandigarh, India
We read with interest the study by Anevlavis et al. [1] in which they shortlisted 3 prognostic factors that determine survival in malignant pleural effusion. Certain points need discussion for better interpretation. The authors specifically enrolled patients in whom pleural effusion was the initial presentation of an underlying malignant disease. It is logical that such treatment-naïve patients without any obvious primary tumor are more likely to have a better performance status, as was concluded in the study. However, an important group of patients was excluded, i.e. those who already had a histopathologically confirmed primary tumor and were secondarily found to have malignant pleural effusion. Secondly, pleural fluid in malignancy can also occur secondary to the enlargement of mediastinal lymph nodes and thoracic duct obstruction, which may not be picked up by thoracoscopy. Inclusion of these patient groups might have given different and more relevant results. The neutrophil-to-lymphocyte ratio was considered as an independent prognostic factor in the study. This ratio is a marker of systemic inflammation [2] and can be affected by past (
Prognostic Factors in Patients with Malignant Pleural Effusion Deepak Aggarwal, Varinder Saini Department of Pulmonary Medicine, Government Medical College and Hospital, Chandigarh, India
We read with interest the study by Anevlavis et al. [1] in which they shortlisted 3 prognostic factors that determine survival in malignant pleural effusion. Certain points need discussion for better interpretation. The authors specifically enrolled patients in whom pleural effusion was the initial presentation of an underlying malignant disease. It is logical that such treatment-naïve patients without any obvious primary tumor are more likely to have a better performance status, as was concluded in the study. However, an important group of patients was excluded, i.e. those who already had a histopathologically confirmed primary tumor and were secondarily found to have malignant pleural effusion. Secondly, pleural fluid in malignancy can also occur secondary to the enlargement of mediastinal lymph nodes and thoracic duct obstruction, which may not be picked up by thoracoscopy. Inclusion of these patient groups might have given different and more relevant results. The neutrophil-to-lymphocyte ratio was considered as an independent prognostic factor in the study. This ratio is a marker of systemic inflammation [2] and can be affected by past (
