title: Malignant effusions correlate with poorer prognosis in patients with diffuse large B-cell lymphoma.
abstract: OBJECTIVE
  Serous effusions are a common manifestation of diffuse large B-cell lymphoma (DLBCL). However, their prognostic significance is controversial.
  
  
  METHODS
  We searched for consecutive patients who had DLBCL with effusions from 1999 through 2007. Primary effusion lymphoma was excluded. The presence of tumor cells in effusions (malignant effusions) was determined by cytology supplemented by flow cytometry, cell blocks with special studies, polymerase chain reaction for clonality, or conventional cytogenetics.
  
  
  RESULTS
  Forty-one (18.4%) patients had effusions, with 24 (58.5%) developing at diagnosis and 17 (41.5%) during tumor course. Nineteen patients (46.0%) had malignant effusions, with six (31.6%) from local extension and 13 (68.4%) through wide dissemination. Interestingly, malignant effusion correlated with a high International Prognostic Index (IPI) score (r = 0.490, P = .002) and high tumor stage (r = 0.342, P = .031) and was a poor prognosticator (P < .001, log-rank test), even worse than stage IV disease (P = .036). In the multivariate analysis, malignant effusion (P = .056) and supportive care (P = .014) retained significance and were more powerful than IPI score and stage.
  
  
  CONCLUSIONS
  Patients who have DLBCL with lymphomatous effusions have a poor prognosis and should be treated as having stage IV disease. The analysis of effusions for tumor cells would be a useful addition to the routine workup.
authors: From the Department of Internal Medicine, Institute of Clinical Medicine.
authors: Ya-Ping
authors: YP
authors: Chen
authors: Department of Medicine.
authors: Huai-Yi
authors: HY
authors: Huang
authors: Department of Pathology, College of Medicine, National Cheng Kung University and Hospital, Tainan, Taiwan, and.
authors: Kun-Piao
authors: KP
authors: Lin
authors: Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston.
authors: L Jeffrey
authors: LJ
authors: Medeiros
authors: From the Department of Internal Medicine.
authors: Tsai-Yun
authors: TY
authors: Chen
authors: Department of Pathology, College of Medicine, National Cheng Kung University and Hospital, Tainan, Taiwan, and changkc@mail.ncku.edu.tw.
authors: Kung-Chao
authors: KC
authors: Chang
mesh_terms: D014408:Biomarkers, Tumor / Q000378:metabolism*; D020732:Cytogenetic Analysis; D004502:Education, Medical, Continuing; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D053208:Kaplan-Meier Estimate; D016403:Lymphoma, Large B-Cell, Diffuse / Q000378:metabolism / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016066:Pleural Effusion, Malignant / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D014408:Biomarkers, Tumor
keywords: Diffuse large B-cell lymphoma (DLBCL); Effusions; Fluid cytology; Prognosis; Treatment