We read with interest the study by Anevlavis et al. [ 1 ] in which they shortlisted 3 prognostic factors that determine survival in malignant pleural effusion. Certain points need discussion for better interpretation. The authors specifically enrolled patients in whom pleural effusion was the initial presentation of an underlying malignant disease. It is logical that such treatment-naive patients without any obvious primary tumor are more likely to have a better performance status, as was concluded in the study. However, an important group of patients was excluded, i.e. those who already had a histopathologically confirmed primary tumor and were secondarily found to have malignant pleural effusion. Secondly, pleural fluid in malignancy can also occur secondary to the enlargement of mediastinal lymph nodes and thoracic duct obstruction, which may not be picked up by thoracoscopy. Inclusion of these patient groups might have given different and more relevant results.
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