Development and validation of a predictive model for pleural effusion control following talc pleurodesis in malignant pleural effusion.

Abstract

Background: Talc slurry pleurodesis is widely used for malignant pleural effusion (MPE); however, its success rate ranges from 50 to 75%, and reliable predictors are lacking. This study aimed to identify predictors of pleural effusion control failure following pleurodesis and develop a short-term predictive scoring system.

Methods: We retrospectively analyzed 170 patients with MPE who underwent talc pleurodesis at a single center between 2014 and 2024. The cohort was divided into training (n = 136) and validation (n = 34) cohorts. Logistic regression was used to identify independent predictors of pleural effusion control failure within 30-90 days.

Results: The most common primary tumors were lung, breast, and ovarian cancers. Pleural effusion was controlled in 70.6% of cases. Univariate analysis identified low body mass index, supportive care alone, Grade 2 collapse of the lower lung field post-drainage, extensive pulmonary consolidation, large tumor (≥ 7 cm), hypoalbuminemia, and positive pleural fluid cytology (Class III or higher) to be associated with pleural effusion control failure. Multivariate analysis revealed that massive pleural effusion (P = 0.048), supportive care alone (P < 0.001), and Grade 2 lung collapse (P = 0.003) were independent predictors of pleural effusion control failure. A scoring system incorporating these factors was validated in a validation cohort, demonstrating a control rate of approximately 90%, 60% and 30% in patients scoring ≤ 1, 2 and ≥ 3 points, respectively.

Conclusions: The scoring system may support early decision-making regarding talc pleurodesis and palliative strategies, potentially improving quality of life in patients with MPE.