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Survivin is a negative prognostic factor in malignant pleural effusion
Author(s) -
ArellanoOrden Elena,
RomeroRomero Beatriz,
SánchezLópez Verónica,
MartínJuan José,
RodríguezPanadero Francisco,
OteroCandelera Remedios
Publication year - 2018
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.12895
Subject(s) - pleurodesis , medicine , survivin , thoracoscopy , mesothelioma , malignant pleural effusion , pleural disease , pleural effusion , pleural fluid , respiratory disease , gastroenterology , surgery , cancer , lung , pathology
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.