ERS/EACTS statement on the management of malignant pleural effusions
ERS/EACTS statement on the management of malignant pleural effusions
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DOI：
10.1093/ejcts/ezy258
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发表时间：
2019-01-01
影响因子：
3.4
通讯作者：
Cardillo, Giuseppe
中科院分区：
文献类型：
--
作者：
Bibby, Anna C.;Dorn, Patrick;Cardillo, Giuseppe
恶性胸腔积液（MPE）是一种常见的病理，由呼吸内科医生和胸外科医生治疗。近年来，一些设计良好的随机临床试验已经发表，改变了MPE管理的景观。欧洲呼吸学会（ERS）和欧洲胸外科协会（ESTO）建立了一个多学科合作的临床医生与专业知识的管理MPE的目的是产生一个全面的审查的科学文献。确定了六个感兴趣的领域，包括症状性MPE的最佳管理，MPE中的困肺管理，分叶状MPE的管理，MPE中的预后因素，MPE干预前是否有肿瘤治疗的作用，以及MPE中是否总是需要组织学诊断。文献显示滑石粉胸膜固定术和留置胸膜导管可有效控制MPE症状。关于困肺或分叶状MPE的管理证据有限。LENT评分被认为是预测MPE生存率的有效工具，Brims预后评分在间皮瘤诊断中具有实用性。没有证据支持使用肿瘤治疗作为MPE引流的替代方法，文献支持使用组织活检作为诊断和治疗计划的金标准。在过去的十年中，恶性胸腔积液的管理选择已经取得了进展，高质量的随机试验证据在许多领域为实践提供了信息。然而，不确定性仍然存在，需要进一步研究http://ow.ly/rNt730jOxOS
Malignant pleural effusions (MPE) are a common pathology, treated by respiratory physicians and thoracic surgeons alike. In recent years, several well-designed randomized clinical trials have been published that have changed the landscape of MPE management. The European Respiratory Society (ERS) and the European Association for Cardio-Thoracic Surgery (EACTS) established a multidisciplinary collaboration of clinicians with expertise in the management of MPE with the aim of producing a comprehensive review of the scientific literature. Six areas of interest were identified, including the optimum management of symptomatic MPE, management of trapped lung in MPE, management of loculated MPE, prognostic factors in MPE, whether there is a role for oncological therapies prior to intervention for MPE and whether a histological diagnosis is always required in MPE. The literature revealed that talc pleurodesis and indwelling pleural catheters effectively manage the symptoms of MPE. There was limited evidence regarding the management of trapped lung or loculated MPE. The LENT score was identified as a validated tool for predicting survival in MPE, with Brims' prognostic score demonstrating utility in mesothelioma prognostication. There was no evidence to support the use of oncological therapies as an alternative to MPE drainage, and the literature supported the use of tissue biopsy as the gold standard for diagnosis and treatment planning. Management options for malignant pleural effusions have advanced over the past decade, with high-quality randomized trial evidence informing practice in many areas. However, uncertainties remain and further research is required http://ow.ly/rNt730jOxOS