title: 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).
  
  
  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: Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
authors: Horiana B
authors: HB
authors: Grosu
authors: Roberto F
authors: RF
authors: Casal
authors: Rodolfo C
authors: RC
authors: Morice
authors: Graciela M
authors: GM
authors: Nogueras-González
authors: Georgie A
authors: GA
authors: Eapen
authors: David
authors: D
authors: Ost
authors: Mona G
authors: MG
authors: Sarkiss
authors: Carlos A
authors: CA
authors: Jimenez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000401:mortality*; D005260:Female; D006469:Hemoptysis / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000401:mortality* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications / Q000401:mortality* / Q000473:pathology; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D055815:Young Adult
references: Chest. 2003 Jan;123(1 Suppl):284S-311S
references: 12527586
references: Arch Intern Med. 1991 Dec;151(12):2449-51
references: 1747002
references: Eur Respir J. 2008 Oct;32(4):1131-2
references: 18827169
references: Am Rev Respir Dis. 1981 Sep;124(3):221-5
references: 7283254
references: Chest. 1994 Apr;105(4):1155-62
references: 8162743
references: Tuberk Toraks. 2006;54(1):34-42
references: 16615016
references: Chest. 1997 Aug;112(2):440-4
references: 9266882
references: Am Rev Respir Dis. 1968 Feb;97(2):187-92
references: 5637935
references: Respiration. 2006;73(6):808-14
references: 16446530
references: Clin Chest Med. 1992 Mar;13(1):69-82
references: 1582150
references: Chest. 2001 Mar;119(3):781-7
references: 11243957
references: Chest. 1985 Feb;87(2):142-4
references: 3967521
references: Arch Intern Med. 1989 Jul;149(7):1666-8
references: 2742442
references: Ann Thorac Surg. 2009 Mar;87(3):849-53
references: 19231404