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Association between Tunneled Pleural Catheter Use and Infection in Patients Immunosuppressed from Antineoplastic Therapy: A Multicenter Study.
Ann Am Thorac Soc
  • Candice L Wilshire, Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, 1101 Madison Street, Suite 900, Seattle, WA, 98104, USA.
  • Shu-Ching Chang, Providence Health and Services Oregon and Southwest Washington, 360139, Portland, Oregon, United States
  • Christopher R Gilbert, Swedish Cancer Institute, 226698, Division of Thoracic Surgery and Interventional Pulmonology, Seattle, Washington, United States
  • Jason A Akulian
  • Mohammed K AlSarraj
  • Rachelle Asciak
  • Benjamin T Bevill
  • Kevin R Davidson
  • Ashley Delgado
  • Horiana B Grosu
  • Felix J F Herth
  • Hans J Lee
  • Justin E Lewis
  • Fabien Maldonado
  • David E Ost
  • Nicholas J Pastis
  • Najib M Rahman
  • Chakravarthy B Reddy
  • Lance J Roller
  • Trinidad M Sanchez
  • Samira Shojaee
  • Henry Steer
  • Jeffrey Thiboutot
  • Momen M Wahidi
  • Amber N Wright
  • Lonny B Yarmus
  • Jed A Gorden, Swedish Cancer Institute, 226698, Interventional Pulmonology, Seattle, Washington, United States
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RATIONALE: Patients with malignant/paramalignant pleural effusions (MPE/PMPEs) may have tunneled pleural catheter (TPC) management withheld due to infection concerns from immunosuppression associated with antineoplastic therapy.

OBJECTIVE: To determine the rate of infections related to TPC use and to determine the relationship to antineoplastic therapy, immune system competency and overall survival (OS)?

METHODS: We performed an international, multi-institutional study of MPE/PMPE patients undergoing TPC management from 2008-2016. Patients were stratified by whether or not they underwent antineoplastic therapy and/or were immunocompromised or not. Cumulative incidence functions and multivariable competing risk regression analyses were performed to identify independent predictors of TPC-related infection. Kaplan-Meier method and multivariable Cox proportional-hazards modeling were performed to examine for independent effects on OS.

RESULTS: A total of 1,408 TPCs were placed in 1,318 patients. Patients had a high frequency of overlap between antineoplastic therapy and an immunocompromised state (75-83%). No difference in the overall (6-7%), deep pleural (3-5%) or superficial (3-4%) TPC-related infection rates between subsets of patients stratified by antineoplastic therapy or immune status was observed. The median time to infection was 41 (interquartile range: 19-87) days following TPC insertion. Multivariable competing risk analyses demonstrated longer TPC duration was associated with a higher risk of TPC-related infection [subdistribution hazard ratio (95% CI): 1.03 (1.00-1.06), p=0.028]. Cox proportional-hazards analysis showed antineoplastic therapy was associated with better OS [hazard ratio (95% CI): 0.84 (0.73-0.97), p=0.015].

CONCLUSION: The risk of TPC-related infection does not appear to be increased by antineoplastic therapy use or an immunocompromised state. The overall rates of infection are low and comparable to immunocompetent patients with no relevant antineoplastic therapy. These results support TPC palliation for MPE/PMPE regardless of plans for antineoplastic therapy.

Clinical Institute
Swedish Thoracic Surgery
Pulmonary Medicine
Citation Information
Candice L Wilshire, Shu-Ching Chang, Christopher R Gilbert, Jason A Akulian, et al.. "Association between Tunneled Pleural Catheter Use and Infection in Patients Immunosuppressed from Antineoplastic Therapy: A Multicenter Study." Ann Am Thorac Soc (2020)
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