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June 18, 1973

Empyema in Lung Cancer— The Cloud With a Silver Lining

JAMA. 1973;224(12):1644. doi:10.1001/jama.1973.03220260058017

Some of the most enlightening lessons from nature derive from observations of diseases that prevent or benefit other more serious diseases. One such natural "experiment," the protection from malaria by the sickle cell trait, has provided valuable insights into the interactions of heredity, global epidemiology, and survival. Another, the amelioration of rheumatoid arthritis by concurrent viral hepatitis, has contributed to the appreciation of the role of steroid hormones in nonspecific responses to stress. On a much more modest scale, important clues to links between cancer and immunity may be furnished by the observed beneficial effect of postresection empyema on survival in lung cancer.

The observation that empyema benefits lung cancer is not new. Reported in The Journal1 forty years ago, the first successful pneumonectomy was complicated by empyema. Surprisingly, the patient survived for more than 30 years. A number of more recent reports have since appeared describing improved prognosis