Instituto de Biomedicina de Sevilla (IBiS), Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain.
CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
Eur J Clin Invest. 2018 Apr;48(4). doi: 10.1111/eci.12895. Epub 2018 Feb 13.
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.
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.
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.
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).
Elevated pleural fluid survivin concentrations are useful to predict failure of pleurodesis and are associated with shorter survival in patients with malignant pleural effusion.
Survivin 是凋亡抑制因子家族中众所周知的一员，与组织和胸腔积液中的肿瘤侵袭性增加有关。
在恶性胸腔积液患者中，我们研究了滑石粉胸腔内灌注引起胸腔液中 survivin 浓度的变化，并探讨了这些变化与胸膜固定术结果和患者生存的关系。
我们调查了 84 例接受滑石粉胸膜固定术的恶性胸腔积液患者，其中 32 例为乳腺癌，25 例为肺癌，27 例为间皮瘤。在胸腔镜检查前（基线）和之后 24 小时获取连续胸腔液样本。
所有胸腔液样本中均成功定量了 survivin 水平，与基线相比，胸腔镜滑石粉敷贴后胸腔液中的 survivin 水平显著升高（P<0.001）。基线时胸腔液 survivin 水平较高的患者胸膜固定术结果明显较差（P=0.004）。胸腔液 survivin 基线水平为 30 pg/mL 的截断值预测胸膜固定术失败的敏感性为 54%，特异性为 79%（P=0.009）。此外，基线 survivin 水平≥30 pg/mL 的患者术后中位生存时间为 4 个月（范围：0.1-38），而低于该截断值的患者为 13 个月（范围：0.1-259）（P<0.001）。
胸腔液中 survivin 浓度升高有助于预测胸膜固定术失败，并与恶性胸腔积液患者的生存时间较短相关。
