Translational lung cancer research · 2026
Pleural effusion volume as a novel biomarker for prognostic and therapeutic stratification in small cell lung cancer: a translationally-focused cohort study.
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Lu Wanjun, Wu Qiuxia, Liu Xin, Jiang Yuxin, Song Yong, Zhan Ping, Lv Tangfeng
Аннотация
BACKGROUND: Malignant pleural effusion (MPE) in small cell lung cancer (SCLC) is uniformly classified as extensive-stage disease. However, the prognostic heterogeneity based on effusion volume remains uncharacterized, leading to potential overtreatment of low-risk patients. This study aimed to define the distinct prognostic impact of effusion volume and identify survival determinants in the immunotherapy era.
METHODS: We analyzed 1,026 consecutive SCLC patients treated at Nanjing Jinling Hospital (2008-2024). MPE was cytologically confirmed. Effusion volume was radiographically categorized: small and moderate or greater pleural effusion (PE). The primary outcome was overall survival (OS). Multivariable Cox regression identified independent prognostic factors in the MPE cohort.
RESULTS: PE was present in 36.4% (373/1,026) of patients. Cytologically confirmed MPE via an indwelling catheter was identified in 75 patients (7.3%), all of whom had moderate or greater effusions. Strikingly, in the entire cohort stratified by radiographic volume, patients with small PEs had a median OS of 13.8 months, which was statistically indistinguishable from those with no effusion (14.8 months, P=0.54). Both groups fared significantly better than patients with moderate or greater PE (median OS 5.2 months, P<0.001). In the subgroup of cytologically confirmed MPE (n=75, all moderate or greater), multivariable analysis identified Eastern Cooperative Oncology Group performance status (ECOG PS) ≥2 [hazard ratio (HR) =4.64, 95% confidence interval (CI): 1.11-19.39, P=0.03], and elevated serum neuron-specific enolase (s-NSE >45.1 µg/L, HR =4.78, 95% CI: 1.14-19.97, P=0.03) as independent predictors of poor OS. Importantly, immunotherapy use was associated with a profound survival benefit (HR =0.18, 95% CI: 0.04-0.76, P=0.02).
CONCLUSIONS: MPE in SCLC is a prognostically heterogeneous condition. Effusion volume is a critical stratifier: small PE does not confer worse survival compared to no effusion, whereas moderate or greater PE is a strong independent predictor of poor outcome. Immunotherapy provides a significant survival benefit in MPE patients. These findings position radiographic effusion volume as a practical, clinically actionable biomarker.
METHODS: We analyzed 1,026 consecutive SCLC patients treated at Nanjing Jinling Hospital (2008-2024). MPE was cytologically confirmed. Effusion volume was radiographically categorized: small and moderate or greater pleural effusion (PE). The primary outcome was overall survival (OS). Multivariable Cox regression identified independent prognostic factors in the MPE cohort.
RESULTS: PE was present in 36.4% (373/1,026) of patients. Cytologically confirmed MPE via an indwelling catheter was identified in 75 patients (7.3%), all of whom had moderate or greater effusions. Strikingly, in the entire cohort stratified by radiographic volume, patients with small PEs had a median OS of 13.8 months, which was statistically indistinguishable from those with no effusion (14.8 months, P=0.54). Both groups fared significantly better than patients with moderate or greater PE (median OS 5.2 months, P<0.001). In the subgroup of cytologically confirmed MPE (n=75, all moderate or greater), multivariable analysis identified Eastern Cooperative Oncology Group performance status (ECOG PS) ≥2 [hazard ratio (HR) =4.64, 95% confidence interval (CI): 1.11-19.39, P=0.03], and elevated serum neuron-specific enolase (s-NSE >45.1 µg/L, HR =4.78, 95% CI: 1.14-19.97, P=0.03) as independent predictors of poor OS. Importantly, immunotherapy use was associated with a profound survival benefit (HR =0.18, 95% CI: 0.04-0.76, P=0.02).
CONCLUSIONS: MPE in SCLC is a prognostically heterogeneous condition. Effusion volume is a critical stratifier: small PE does not confer worse survival compared to no effusion, whereas moderate or greater PE is a strong independent predictor of poor outcome. Immunotherapy provides a significant survival benefit in MPE patients. These findings position radiographic effusion volume as a practical, clinically actionable biomarker.