Bronchoscopic findings and bleeding control predict survival in patients with solid malignancies presenting with mild hemoptysis.

Abstract

BACKGROUND:

Regardless of its volume, hemoptysis is a concerning symptom. Mild hemoptysis and its significance in patients with solid malignancies has not been studied.

METHODS:

We conducted a retrospective chart review of patients with solid malignancies who presented for evaluation of mild hemoptysis. In this population, we studied the impact of bronchoscopic findings and endobronchial therapies on overall survival and bleeding recurrence. Patients were categorized into four groups on the basis of the presence or absence of active bleeding and endobronchial disease at the time of initial bronchoscopy: active bleeding with endobronchial lesion (AB/EBL), active bleeding without endobronchial lesion (AB/no-EBL), absence of active bleeding but with endobronchial lesion (no-AB/EBL), and absence of active bleeding and endobronchial lesion (no-AB/no-EBL).

MEASUREMENTS AND MAIN RESULTS:

Ninety-five of the 112 patients with solid malignancies and mild hemoptysis underwent bronchoscopies. There was a significantly lower median survival time for patients with bronchoscopic findings of active bleeding and endobronchial lesion compared with patients with no active bleeding and/or no endobronchial lesion (3.48 mo; 95% confidence interval [CI], 2.14-6.05). On a multivariate analysis, factors independently associated with improved survival were higher hemoglobin values (hazard ratio [HR], 0.78; 95% CI, 0.67-0.91) and cessation of hemoptysis without recurrence at 48 hours (HR, 0.43; 95% CI, 0.22-0.84). Variables independently associated with worse survival were disease stage (HR, 10.8; 95% CI, 2.53-46.08) and AB/EBL (HR, 3.20; 95% CI, 1.74-5.89).

CONCLUSIONS:

In patients with solid malignancies presenting with mild hemoptysis, bronchoscopic findings of AB/EBL are associated with decreased survival. Hemoptysis control without recurrence at 48 hours after endobronchial intervention may improve survival.

• Authors: Horiana B Grosu, Roberto F Casal, Rodolfo C Morice, Graciela M Nogueras-González, Georgie A Eapen, David Ost, Mona G Sarkiss, Carlos A Jimenez
• Journal: Annals of the American Thoracic Society (Ann Am Thorac Soc) Vol. 10 Issue 4 Pg. 342-9 (Aug 2013) ISSN: 2325-6621 [Electronic] United States
• PMID: 23952853 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Bronchoscopy
• Carcinoma, Non-Small-Cell Lung (complications, mortality)
• Female
• Hemoptysis (diagnosis, etiology)
• Humans
• Lung Neoplasms (complications, mortality, secondary)
• Male
• Middle Aged
• Multivariate Analysis
• Neoplasms (complications, mortality, pathology)
• Prognosis
• Proportional Hazards Models
• Retrospective Studies
• Severity of Illness Index
• Survival Rate
• Young Adult