Prevalence, clinical characteristics, and outcome of pleural effusions in ovarian cancer

Objectives: The prevalence, clinical characteristics and prognosis of pleural effusions (PEs) associated with ovarian cancer (OC) have seldom been addressed systematically, as in the current investigation.

Methods: All records of consecutive women with a newly diagnosed OC in our institution over a 13-year period were retrospectively reviewed. Features of PEs on CT scans, pleural fluid analyses, need for definitive therapy of PEs, and the influence of PEs on the overall survival (OS) and progression-free survival (PFS) were evaluated.

Results: PEs were observed in 81 (43%) of 189 women with OC, either at presentation of cancer (55 patients) or during the course of the disease (26 patients). The causes of PEs were malignancy (55.5%), unknown (37%), or surgery-related (7.4%). The sensitivity of the cytologic diagnosis of malignant PEs was 79.1%. Sixty percent of malignant PEs required pleurodesis or indwelling pleural catheters for symptomatic relief. The presence of ascites strongly predicted PE development (odds ratio 43.2). Women with PEs fared much worse compared with those without PEs, in terms of OS (26.7 vs. 90.4 months), PFS (9.8 vs. 55.3 months) and tumor recurrences (86.4 vs. 43%). In multivariate analyses, PE remained as a relevant independent variable associated with poor outcome (hazard ratio 9.73 for OS, and 3.87 for PFS). Notably, PEs small enough to preclude tapping, and thus of unknown origin, had a similar bad prognosis as malignant PEs.

Conclusions: OC patients with PEs experience decreased survival, including those with trace effusions not amenable to tapping.