Lung cancer

‘Non-expandable lung’ common finding in mesothelioma patients


The presence of ‘non-expandable’ lung in patients with mesothelioma may be more common than previously reported and is linked to shorter survival, according to UK researchers who carried out a ten-year study.

In an analysis of 229 patients, a team from the Academic Respiratory Unit at the University of Bristol, found that more than eight in ten patients (n=192) presenting at their clinic with malignant pleural mesothelioma had pleural effusion.

And of these, a third (n=64) had non-expandable lung, defined by the researchers as the failure of lung re-expansion for any reason after fluid removal.

Further analysis of the data collected between 2008 and 2019 showed that the presence of non-expandable lung was an independent risk factor for short survival even when tumour stage was taken into account (HR for mortality 1.80; 95% CI 1.16 to 2.80).

Patients with pleural effusions, both with and without underlying non-expandable lung, were more likely to have epithelioid disease, early-stage disease and to receive chemotherapy than those without the excess fluid, the researchers reported in the Annals of the American Thoracic Society.

Study leader Dr Anna Bibby, a consultant respiratory physician and research fellow said very little was known about the relatively recently recognised condition.

While some researchers had reported rates of non-expandable lung in trial populations, this was the first observational study to describe both the prevalence and clinical implications in a routine setting, she told the limbic.

“We also looked at the size of the effusion and degree of non-expansion to capture as much information as we could, which has not been done before,” she said.

The team found that breathlessness and cough were more frequent with pleural effusions, especially with underlying non-expandable lung, whilst chest pain was more common in patients without effusions.

The finding that non-expandable lung is an independent predictor of mortality suggests there may be characteristics of the tumour that are not captured in tumour staging, she explained.

“What we will probably do over the next few years is to do some analysis of pleural fluid in these patients to look at proteomic and genomic profiles that relate to non-expandable lung.

“And currently there is no definitive best treatment. The management pathway needs defining and we need a clinical trial and that is something we are working on.”

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