Original Abstract
BACKGROUND: Clinical evidence of the impact of corticosteroid use and pleurodesis outcomes in malignant pleural effusion (MPE) remains limited. This study aimed to explore the relationship between corticosteroid exposure and pleurodesis outcomes in patients with MPE. METHODS: This retrospective cohort study included 138 consecutive patients with MPE who received pleurodesis between April 2012 and September 2024. Based on pleurodesis outcomes, the 138 patients were divided into two groups as follows: success group (n = 99) and failure group (n = 39). Failure was defined as recurrent pleural effusion within 28 days after chest-tube removal, tube removal owing to intolerance, or death with chest-tube in situ; the other outcomes were defined as constituting success. Patients who received systemic corticosteroids during chest-tube usage were classified as steroid users. The cumulative corticosteroid dose was calculated as the prednisolone (PSL)-equivalent dose multiplied by the duration of steroid administration. RESULTS: Multivariate analysis of 138 patients demonstrated that poor performance status (PS), such as PS 3-4, and multi-day steroid use during chest-tube usage were associated with pleurodesis failure in patients with MPE. Furthermore, a subgroup analysis of 15 patients who received steroids during chest-tube usage showed that the cumulative steroid dosage was positively correlated with chest-tube usage duration. CONCLUSIONS: In this retrospective cohort study, multi-day corticosteroid exposure during chest-tube placement was associated with pleurodesis failure in patients with MPE. These findings should be considered hypothesis-generating and interpreted with caution because of potential confounding factors. Further prospective multicenter studies are needed to clarify this association.