Survivin is a negative prognostic factor in malignant pleural effusion

Background Survivin is a well‐known member of the inhibitor of apoptosis family, and has been related to increased tumour aggressivity, both in tissue and in pleural fluid. Objectives In patients with malignant pleural effusion, we sought to investigate the changes in pleural fluid survivin concentr...

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Bibliographic Details
Published in:European journal of clinical investigation 2018-04, Vol.48 (4), p.n/a
Main Authors: Arellano‐Orden, Elena, Romero‐Romero, Beatriz, Sánchez‐López, Verónica, Martín‐Juan, José, Rodríguez‐Panadero, Francisco, Otero‐Candelera, Remedios
Format: Article
Language:English
Subjects:
Aged
Apoptosis
Biomarkers - metabolism
Breast cancer
Breast Neoplasms - complications
Breast Neoplasms - mortality
Cancer
Female
Humans
Inhibitor of Apoptosis Proteins - metabolism
Interferon
Lung cancer
Lung Neoplasms - complications
Lung Neoplasms - mortality
Male
malignant pleural effusion
Mesothelioma
Mesothelioma - complications
Mesothelioma - mortality
Middle Aged
Patients
Pleural Cavity - chemistry
Pleural effusion
Pleural Effusion, Malignant - complications
Pleural Effusion, Malignant - mortality
Pleural Effusion, Malignant - therapy
Pleural fluid
pleurodesis
Pleurodesis - mortality
Prognosis
Respiratory therapy
ROC Curve
Sensitivity and Specificity
Survival
Survivin
Talc
Treatment Outcome
Tumors
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Summary:Background Survivin is a well‐known member of the inhibitor of apoptosis family, and has been related to increased tumour aggressivity, both in tissue and in pleural fluid. Objectives In patients with malignant pleural effusion, we sought to investigate the changes in pleural fluid survivin concentrations induced by talc instillation into the pleural space. Those changes were also examined in relation to pleurodesis outcome and patient survival. Methods We investigated 84 patients with malignant pleural effusion who underwent talc pleurodesis. Of them, 32 had breast cancer, 25 lung cancer and 27 had mesothelioma. Serial samples of pleural fluid were obtained before thoracoscopy (baseline) and 24 hours thereafter. Results Survivin levels were successfully quantified in all pleural fluid samples, and they were significantly higher in samples obtained after thoracoscopic talc poudrage compared with baseline (P < .001). Patients with higher pleural fluid survivin levels at baseline had a significantly poorer pleurodesis outcome (P = .004). A 30 pg/mL cut‐off for baseline survivin in pleural fluid predicted failure of pleurodesis with a 54% sensitivity and 79% specificity (P = .009). Moreover, median postpleurodesis survival of patients with baseline survivin levels ≥30 pg/mL was 4 months (range: 0.1‐38), compared with 13 months (range: 0.1‐259) in patients below that cut‐off (P < .001). Conclusion Elevated pleural fluid survivin concentrations are useful to predict failure of pleurodesis and are associated with shorter survival in patients with malignant pleural effusion.
ISSN:0014-2972
1365-2362
DOI:10.1111/eci.12895