Clinical Factors Influencing Spontaneous Pleurodesis Success in Malignant Pleural Effusion in Patients With Indwelling Pleural Catheter

Our plain-English summary of Clinical Factors Influencing Spontaneous Pleurodesis Success in Malignant Pleural Effusion in Patients With Indwelling Pleural Catheter, by H.G. Kamil, A. AbiMusaAsa'ari, M. Asaduzzaman, et al (Curēus, 2026).

The study

• Authors: H.G. Kamil, A. AbiMusaAsa'ari, M. Asaduzzaman, J. Su, M. Haris
• Journal: Curēus
• Published: 2026;18(1):e100854
• Read it: PubMed · Publisher · Free full text

Abstract

Background Indwelling pleural catheters (IPCs) provide effective palliation for malignant pleural effusion (MPE) and may induce spontaneous pleurodesis (SP). However, risk factors causing transudative effusion, such as hypoalbuminemia, congestive cardiac failure (CCF), and renal failure (RF), may reduce pleurodesis success. Evidence on the impact of these comorbidities in MPE patients undergoing IPC placement remains limited. Objective To evaluate the impact of hypoalbuminemia, CCF and RF on successful SP in MPE. Methods A retrospective single-centre study was conducted in a tertiary care hospital on all patients with cytologically or radiologically confirmed MPE who underwent IPC placement between January 2020 and December 2024. SP was defined as catheter removal and no fluid recurrence up to 90 days. Demographic data, albumin levels, comorbidities, cancer type, and active anti-cancer therapy were compared between the SP and non-pleurodesis (NP) group. Results Among 110 patients (mean age 70 years; 54/110, 49% male), SP occurred in 30/110 (27%). Mean serum albumin was higher in the SP group (25.2 vs 20.4 g/L, p=0.001). CCF was present in 3/30 (10%) SP group compared with 15/80 (19%) NP group (p=0.005), while RF occurred only in the NP group, 4/80 (5%). Systemic anti-cancer therapy was associated with higher SP rates (26/30, 87% vs 32/80, 40%; p<0.001). SP varied by cancer type, highest in mesothelioma (6/12, 50%) and absent in small cell lung cancer (0/3, 0%). Conclusions Higher albumin, active anti-cancer therapy, and absence of multiple comorbidities causing transudative effusion predict successful SP. Identifying these factors may improve patient selection and procedural outcomes.

Copyright © 2026, Kamil et al.

In plain English

This retrospective cohort study at one NHS hospital in the United Kingdom reviewed 110 consecutive patients with malignant pleural effusion (cancer-related fluid around the lung). Each had a drainage tube called an indwelling pleural catheter placed between January 2020 and December 2024. Asbestos exposure was not studied; mesothelioma was one of the cancer types included. Spontaneous pleurodesis (catheter removed, no fluid return up to 90 days) occurred in 30 of 110 patients (27%). Their mean blood albumin was higher than in the 80 without pleurodesis (25.2 vs 20.4 g/L, p = 0.001). Congestive cardiac failure affected 3 of 30 with pleurodesis and 15 of 80 without. Renal failure occurred only in patients without pleurodesis (4 of 80). Systemic anti-cancer therapy was received by 26 of 30 with pleurodesis and 32 of 80 without. Pleurodesis occurred in 6 of 12 mesothelioma patients and 0 of 3 with small cell lung cancer. The authors concluded that higher albumin, fewer of these conditions and ongoing anti-cancer therapy were associated with a potentially increased likelihood of pleurodesis. They noted the retrospective design, modest size and lack of multivariate analysis.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective cohort study at a single centre
• Who was studied: 110 consecutive patients with cytologically or radiologically confirmed malignant pleural effusion who had an indwelling pleural catheter placed at one NHS tertiary centre in the United Kingdom, January 2020 to December 2024. 30 achieved spontaneous pleurodesis and 80 did not. Cancer types were non-small cell lung cancer (37), small cell lung cancer (3), mesothelioma (12) and extra-thoracic cancers (58).
• Exposure: No asbestos or fiber exposure was studied. The factors examined were serum albumin and hypoalbuminemia, congestive cardiac failure (pro-BNP >1500 or EF <35%), renal failure (eGFR <27 mL/min/1.73 m² with proteinuria), cancer type, and receipt of systemic anti-cancer therapy.
• Main results:
  • Spontaneous pleurodesis occurred in 30/110 patients (27%); 80/110 (73%) did not achieve pleurodesis.
  • Mean serum albumin was 25.2 g/L (SD 6.66, range 11-42) in the spontaneous pleurodesis group and 20.4 g/L (SD 5.26, range 8-31) in the non-pleurodesis group, p = 0.001.
  • Hypoalbuminemia was present in 27/30 (90%) of the spontaneous pleurodesis group and 77/80 (96%) of the non-pleurodesis group (p less than 0.001).
  • Congestive cardiac failure was present in 3/30 (10%) of the spontaneous pleurodesis group and 15/80 (19%) of the non-pleurodesis group (p = 0.005).
  • Renal failure occurred only in the non-pleurodesis group (4/80, 5%); the numbers were too small to calculate a p-value.
  • A lower burden of risk factors causing transudative effusion was associated with spontaneous pleurodesis (p = 0.032 in the text; Table 1 gives p = 0.021).
  • 26/30 (87%) of the spontaneous pleurodesis group were receiving systemic anti-cancer therapy, compared with 32/80 (40%) of the non-pleurodesis group (p less than 0.001).
  • Spontaneous pleurodesis rates by cancer type were: mesothelioma 6/12 (50%), non-small cell lung cancer 10/37 (27%), extra-thoracic cancers 14/58 (24%) and small cell lung cancer 0/3 (0%).
• The authors' conclusion: The authors concluded that higher serum albumin, absence of multiple risk factors causing transudative effusion, and ongoing systemic anti-cancer therapy are associated with a potentially increased likelihood of spontaneous pleurodesis in these patients.
• Limitations the authors state:
  • Retrospective design, modest sample size, early mortality and no multivariate analysis
  • Larger prospective studies are needed to avoid selection bias
  • Too few renal failure cases for meaningful statistical analysis

Topics

Medical terms in this study, explained in our Lexicon: Pleurodesis, Pleural Effusion, Indwelling Pleural Catheter, Mesothelioma, Small Cell Lung Cancer.

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