PURPOSE: It is still difficult for clinicians to confirm malignant pleural effusions (MPE). Survivin has been shown to inhibit apoptosis, enhance proliferation and promote angiogenesis. This study aimed to investigate the effects of chemotherapy and the prognostic role of pleural survivin in lung cancer patients with MPE.
METHODS: Pleural effusion samples were collected from 67 patients with MPE (58 lung cancers; 9 extrathoracic tumors), and from 68 patients with benign conditions (31 with pneumonia; 37 with tuberculosis). Concentrations of pleural fluid survivin, Cyfra 21-1, and carcinoembryonic antigen (CEA) were measured by enzyme-linked immunosorbent assay (ELISA). The expression profile of survivin in pleural fluid, and its association with survival, were investigated.
RESULTS: Survivin levels were significantly elevated in patients with MPE, especially primary lung cancer than in those of benign origin. Survivin, Cyfra 21-1, and CEA varied in diagnostic accuracy for differentiating MPE from benign pleural effusion by 67.5%, 68.3%, and 93.4%, respectively. Lung cancer patients with MPE who were positive for survivin expression were more refractory to chemotherapy (P = 0.003). Positive for survivin expression was correlated with a reduced overall survival in univariate (P = 0.0001) and multivariate (P = 0.004) analyses.
CONCLUSIONS: Using the appropriate cut-off points, CEA in pleural fluid has a higher accuracy than other tumor markers, and that survivin has a low diagnostic accuracy for differentiating MPE from benign pleural effusion. Our findings suggest that positive survivin expression may be used as a predictor of a poor response to chemotherapy and shorter survival in lung cancer patients with MPE.
CLINICAL IMPLICATIONS: We suggest that pleural survivin may serve as a therapeutic target in lung cancer patients with MPE. Moreover, the significant correlation between positive survivin expression and poor survival in lung cancer patients with MPE indicate a possible role for survivin in influencing tumor progression and treatment response.
DISCLOSURE: The following authors have nothing to disclose: Hak-Ryul Kim, Ki-Eun Hwang, Eun-Taik Jeong
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