For a study, it was determined that Tunneled pleural catheter (TPC) management may be deferred from patients with malignant or part malignant pleural effusions (MPEs or PMPEs) due to infection concerns linked with immunosuppression associated with antineoplastic medication. Determine the incidence of infections linked to TPC usage, as well as the association between antineoplastic therapy, immune system competency, and overall survival (OS). From 2008 to 2016, researchers conducted a multinational, multi-institutional study of patients with MPEs or PMPEs who were treated with TPC. Patients were divided into groups based on whether or not they had received antineoplastic therapy and/or if they were immunocompromised. Researchers used cumulative incidence functions and multivariable competing risk regression models to find independent predictors of TPC-related infection. Researchers used the Kaplan-Meier technique and multivariable Cox proportional hazards modeling to look for independent influences on OS.
TPCs were implanted in 1,318 patients for a total of 1,408 TPCs. Patients with antineoplastic therapy and an immunocompromised state reported a significant overlap rate (75–83%). There was no difference in TPC-related infection rates between subsets of patients stratified by antineoplastic therapy or immunological state in the overall (6–7%), deep pleural (3–5%), or superficial (3–4%) infection rates.
After TPC implantation, the median time to infection was 41 days (interquartile range, 19–87). Longer TPC duration was linked to a higher risk of TPC-related infection (subdistribution hazard ratio, 1.03; 95% CI, 1.00–1.06; P=0.028), according to multivariable competing risk analysis. Antineoplastic therapy was linked to an improved overall survival rate (hazard ratio, 0.84; 95% confidence interval, 0.73–0.97; P=0.015) in a Cox proportional hazards analysis. Antineoplastic therapy or being immunocompromised do not appear to raise the likelihood of TPC-related infection. Overall infection rates are low, comparable to those seen in immunocompetent patients who have not had anticancer medication. These findings support TPC palliation for MPE or PMPs, regardless of antineoplastic therapy regimens.
Reference:www.atsjournals.org/doi/full/10.1513/AnnalsATS.202007-886OC
