Cytotoxic Natural Killer Subpopulations as a Prognostic Factor of Malignant Pleural Effusion

Background Malignant pleural effusion (MPE) is a sign of advanced disease of poor prognosis. As natural killer (NK) cells are involved in the first line of tumour defence, we aimed to validate a new diagnostic and prognostic indicator for MPE based on NK subpopulations of pleural fluid (PF) and peri...

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Bibliographic Details
Published in:Lung 2019-02, Vol.197 (1), p.53-60
Main Authors: Herrera Lara, Susana, Fernández-Fabrellas, Estrella, Juan Samper, Gustavo, Marco Buades, Josefa, Andreu Lapiedra, Rafael, Pinilla Moreno, Amparo, Morales Suárez-Varela, María
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Benign
Biomarkers - blood
Care and treatment
CD16 antigen
CD56 antigen
CD56 Antigen - blood
CD57 antigen
CD57 Antigens - blood
Cytotoxicity
Decision trees
Diagnosis
Diagnostic systems
Female
GPI-Linked Proteins - blood
Humans
Immunophenotyping - methods
Killer cells
Killer Cells, Natural - immunology
Lungs
Lymphocyte Subsets - immunology
Male
Medical diagnosis
Medical prognosis
Medicine
Medicine & Public Health
Middle Aged
Natural killer cells
Patients
Peripheral blood
Phenotype
Physiological aspects
Pleural Disease
Pleural effusion
Pleural Effusion, Malignant - blood
Pleural Effusion, Malignant - diagnosis
Pleural Effusion, Malignant - immunology
Pleural Effusion, Malignant - therapy
Pleural fluid
Pneumology/Respiratory System
Predictive Value of Tests
Prognosis
Prospective Studies
Receptors, IgG - blood
Regression analysis
Subpopulations
Tumors
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Summary:Background Malignant pleural effusion (MPE) is a sign of advanced disease of poor prognosis. As natural killer (NK) cells are involved in the first line of tumour defence, we aimed to validate a new diagnostic and prognostic indicator for MPE based on NK subpopulations of pleural fluid (PF) and peripheral blood (PB). Methods NK subpopulations were determined in PF and PB in 71 patients with malignant, paramalignant or benign pleural effusion. The receiver operating characteristic (ROC) curves, Kaplan–Meier, multivariable Cox model and decision trees created with the CHAID (Chi-square automatic interaction detector) methodology were employed. Results We demonstrated that the PF/PB ratios of the CD56 bright CD16− and CD56 dim CD16− NK subpopulations were higher ( p  = 0.013 and p  = 0.003, respectively) in MPEs and paramalignant pleural effusions (PPEs) than in benign ones, with an AUC of 0.757 and 0.741, respectively. The PF/PB ratio of CD16+ NK and CD57+ NK obtained a higher hazard ratio (HR) in the crude Cox’s regression analysis. In the adjusted Cox’s regression analysis, the PF/PB ratio of CD16+ NK gave the highest HR (HR 6.1 [1.76–21.1]) ( p  = 0.004). In the decision tree created for the MPE prognosis, we observed that the main predictor variable among the studied clinical, radiological, and analytical variables was lung mass, and that 92.9% of the patients who survived had a PF/PB ratio of the CD56 dim CD16+ NK subpopulation ≤ 0.43. Conclusions Our data suggest that both the PF/PB ratios of cytotoxic subpopulations CD57+ NK and CD16+ NK are useful as a prognostic factor of MPE. Other subpopulations (CD56 bright CD16− and CD56 dim CD16− NK) could help to diagnose MPE.
ISSN:0341-2040
1432-1750
DOI:10.1007/s00408-018-0186-7