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Cai F, Cheng L, Liao X, Xie Y, Wang W, Zhang H, Lu J, Chen R, Chen C, Zhou X, Mo X, Hu G, Huang L. An Integrated Clinical and Computerized Tomography-Based Radiomic Feature Model to Separate Benign from Malignant Pleural Effusion. Respiration 2024; 103:406-416. [PMID: 38422997 DOI: 10.1159/000536517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Distinguishing between malignant pleural effusion (MPE) and benign pleural effusion (BPE) poses a challenge in clinical practice. We aimed to construct and validate a combined model integrating radiomic features and clinical factors using computerized tomography (CT) images to differentiate between MPE and BPE. METHODS A retrospective inclusion of 315 patients with pleural effusion (PE) was conducted in this study (training cohort: n = 220; test cohort: n = 95). Radiomic features were extracted from CT images, and the dimensionality reduction and selection processes were carried out to obtain the optimal radiomic features. Logistic regression (LR), support vector machine (SVM), and random forest were employed to construct radiomic models. LR analyses were utilized to identify independent clinical risk factors to develop a clinical model. The combined model was created by integrating the optimal radiomic features with the independent clinical predictive factors. The discriminative ability of each model was assessed by receiver operating characteristic curves, calibration curves, and decision curve analysis (DCA). RESULTS Out of the total 1,834 radiomic features extracted, 15 optimal radiomic features explicitly related to MPE were picked to develop the radiomic model. Among the radiomic models, the SVM model demonstrated the highest predictive performance [area under the curve (AUC), training cohort: 0.876, test cohort: 0.774]. Six clinically independent predictive factors, including age, effusion laterality, procalcitonin, carcinoembryonic antigen, carbohydrate antigen 125 (CA125), and neuron-specific enolase (NSE), were selected for constructing the clinical model. The combined model (AUC: 0.932, 0.870) exhibited superior discriminative performance in the training and test cohorts compared to the clinical model (AUC: 0.850, 0.820) and the radiomic model (AUC: 0.876, 0.774). The calibration curves and DCA further confirmed the practicality of the combined model. CONCLUSION This study presented the development and validation of a combined model for distinguishing MPE and BPE. The combined model was a powerful tool for assisting in the clinical diagnosis of PE patients.
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Affiliation(s)
- Fangqi Cai
- Department of Respiratory and Critical Care Medicine, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China,
| | - Liwei Cheng
- Department of Spine Osteopathia, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiaoling Liao
- Department of Respiratory and Critical Care Medicine, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yuping Xie
- Department of Respiratory and Critical Care Medicine, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Wu Wang
- Department of Respiratory and Critical Care Medicine, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Haofeng Zhang
- Department of Respiratory and Critical Care Medicine, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jinhua Lu
- Department of Respiratory and Critical Care Medicine, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Ru Chen
- Department of Respiratory and Critical Care Medicine, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Chunxia Chen
- Department of Clinical Medicine, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Xing Zhou
- Department of Clinical Medicine, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Xiaoyun Mo
- Department of Respiratory and Critical Care Medicine, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Guoping Hu
- Department of Respiratory and Critical Care Medicine, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Luying Huang
- Department of Respiratory and Critical Care Medicine, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
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Lai CL, Karmakar R, Mukundan A, Chen WC, Wu IC, Fedorov VE, Feng SW, Choomjinda U, Huang SF, Wang HC. Lung cancer cells detection by a photoelectrochemical MoS 2 biosensing chip. BIOMEDICAL OPTICS EXPRESS 2024; 15:753-771. [PMID: 38404333 PMCID: PMC10890875 DOI: 10.1364/boe.511900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/22/2023] [Accepted: 12/22/2023] [Indexed: 02/27/2024]
Abstract
This research aims to explore the potential application of this approach in the production of biosensor chips. The biosensor chip is utilized for the identification and examination of early-stage lung cancer cells. The findings of the optical microscope were corroborated by the field emission scanning electron microscopy, which provided further evidence that the growth of MoS2 is uniform and that there is minimal disruption in the electrode, hence minimizing the likelihood of an open circuit creation. Furthermore, the bilayer structure of the produced MoS2 has been validated through the utilization of Raman spectroscopy. A research investigation was undertaken to measure the photoelectric current generated by three various types of clinical samples containing lung cancer cells, specifically the CL1, NCI-H460, and NCI-H520 cell lines. The findings from the empirical analysis indicate that the coefficient of determination (R-Square) for the linear regression model was approximately 98%. Furthermore, the integration of a double-layer MoS2 film resulted in a significant improvement of 38% in the photocurrent, as observed in the device's performance.
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Affiliation(s)
- Chun-Liang Lai
- Division of Pulmonology and Critical Care, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Road, Dalin, Chiayi 62247, Taiwan
- School of Medicine, Tzu Chi University, 701 Zhongyang Rd., Sec. 3, Hualien 97004, Taiwan
| | - Riya Karmakar
- Department of Mechanical Engineering and Center for Innovative Research on Aging Society (CIRAS), National Chung Cheng University, 168, University Road, Min Hsiung, Chiayi City 62102, Taiwan
| | - Arvind Mukundan
- Department of Mechanical Engineering and Center for Innovative Research on Aging Society (CIRAS), National Chung Cheng University, 168, University Road, Min Hsiung, Chiayi City 62102, Taiwan
| | - Wei-Chung Chen
- Ph.D. Program in Environmental and Occupational Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - I-Chen Wu
- Department of Medicine and Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung City 80756, Taiwan
| | - Vladimir E Fedorov
- Nikolaev Institute of Inorganic Chemistry, Siberian Branch of Russian Academy of Sciences, Novosibirsk 630090, Russia
- Department of Natural Sciences, Novosibirsk State University, 1, Pirogova str., Novosibirsk 630090, Russia
| | - Shih-Wei Feng
- Department of Applied Physics, National University of Kaohsiung, 700 Kaohsiung University Rd., Nanzih District, Kaohsiung 81148, Taiwan
| | - Ubol Choomjinda
- School of Nursing, Shinawatra University, 99 Moo 10, Bangtoey, Samkhok, Pathum Thani 12160, Thailand
| | - Shu-Fang Huang
- Division of Chest Medicine, Kaohsiung Armed Forces General Hospital, 2, Zhongzheng 1st. Rd., Kaohsiung City 80284, Taiwan
| | - Hsiang-Chen Wang
- Department of Mechanical Engineering and Center for Innovative Research on Aging Society (CIRAS), National Chung Cheng University, 168, University Road, Min Hsiung, Chiayi City 62102, Taiwan
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Masoudian P, Kwok C, Li P, Hosseini S, Zhang T, Amjadi K. Outcomes for Malignant Pleural Effusions Because of Melanoma Treated With Indwelling Pleural Catheters. J Bronchology Interv Pulmonol 2023; 30:244-251. [PMID: 35867004 DOI: 10.1097/lbr.0000000000000877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/09/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Indwelling pleural catheters (IPCs) reduce dyspnea and improve quality of life in patients with malignant pleural effusions (MPEs). Data on outcomes of MPEs secondary to metastatic melanoma managed with IPCs are scarce. We aimed to evaluate outcomes of patients receiving IPCs for MPEs secondary to melanoma compared with other malignancies. METHODS We identified patients from our prospectively collected database of all patients who had an IPC insertion for MPEs at our tertiary care center for melanoma between May 2006 and November 2018 and for nonmelanoma between May 2006 and June 2013. Chart reviews were conducted to obtain patient demographics, catheter complications, time of IPC removal or death, x-ray imaging, and pleural fluid characteristics. RESULTS We identified 27 MPEs because of melanoma and 1114 because of nonmelanoma malignancies treated with IPC. The most frequent complication was pleural fluid loculation requiring fibrinolytics which was significantly higher in the melanoma (14.8%) compared with the nonmelanoma group (3.8%; P =0.02). Cumulative incidence functions for catheter removal ( P =0.8) or death with catheter in situ ( P =0.3) were not significant between melanoma and nonmelanoma groups in competing risk analysis. Baseline radiographic pleural effusion scores were similar, but became significantly higher (increased pleural opacity) in the melanoma group at time points following IPC insertion ( P <0.05). CONCLUSION MPEs because of melanoma had a higher rate of loculations requiring fibrinolytics and less radiographic improvement after IPC insertion suggesting this patient subgroup has a more complicated pleural space which may be less responsive to drainage.
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Affiliation(s)
- Pourya Masoudian
- Division of Respirology, Department of Medicine, University of Ottawa
| | - Chanel Kwok
- Division of Respirology, Department of Medicine, University of Ottawa
| | - Pen Li
- Division of Respirology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sarah Hosseini
- Division of Respirology, Department of Medicine, University of Ottawa
| | - Tinghua Zhang
- Ottawa Methods Centre, The Ottawa Hospital Research Institute, Ottawa, Ontario
| | - Kayvan Amjadi
- Division of Respirology, Department of Medicine, University of Ottawa
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Luan Y, Li L, Xun X, Wang Y, Wei X, Zheng Y, Fan Z, Sun X. A Microfluidic System for Detecting Tumor Cells Based on Biomarker Hexaminolevulinate (HAL): Applications in Pleural Effusion. MICROMACHINES 2023; 14:771. [PMID: 37421004 DOI: 10.3390/mi14040771] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 07/09/2023]
Abstract
Malignant pleural effusion is a common clinical problem, which often occurs in cases of malignant tumors, especially in lung cancer. In this paper, a pleural effusion detection system based on a microfluidic chip, combined with specific tumor biomarker, hexaminolevulinate (HAL), used to concentrate and identify tumor cells in pleural effusion was reported. The lung adenocarcinoma cell line A549 and mesothelial cell line Met-5A were cultured as the tumor cells and non-tumor cells, respectively. The optimum enrichment effect was achieved in the microfluidic chip when the flow rates of cell suspension and phosphate-buffered saline achieved 2 mL/h and 4 mL/h, respectively. At the optimal flow rate, the proportion of A549 increased from 28.04% to 70.01% due to the concentration effect of the chip, indicating that tumor cells could be enriched by a factor of 2.5 times. In addition, HAL staining results revealed that HAL can be used to identify tumor cells and non-tumor cells in chip and clinical samples. Additionally, the tumor cells obtained from the patients diagnosed with lung cancer were confirmed to be captured in the microfluidic chip, proving the validity of the microfluidic detection system. This study preliminarily demonstrates the microfluidic system is a promising method with which to assist clinical detection in pleural effusion.
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Affiliation(s)
- Yiran Luan
- School of Medical Laboratory, Tianjin Medical University, Tianjin 300203, China
| | - Lei Li
- School of Medical Laboratory, Tianjin Medical University, Tianjin 300203, China
| | - Xiaoyi Xun
- School of Medical Laboratory, Tianjin Medical University, Tianjin 300203, China
| | - Yang Wang
- School of Medical Laboratory, Tianjin Medical University, Tianjin 300203, China
| | - Xinyue Wei
- School of Medical Laboratory, Tianjin Medical University, Tianjin 300203, China
| | - Yuqun Zheng
- School of Medical Laboratory, Tianjin Medical University, Tianjin 300203, China
| | - Zhijuan Fan
- Department of Laboratory, Tianjin Third Central Hospital, Tianjin 300170, China
| | - Xuguo Sun
- School of Medical Laboratory, Tianjin Medical University, Tianjin 300203, China
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Rivas F, Penin RM, Macía I, Ureña A, Déniz C, Gimeno Á, Escobar I, Ramos R. Efficacy of hyperthermia pleurodesis: A comparative experimental study on serous membrane of abdominopelvic and thoracic cavities of rats. Cir Esp 2022; 100:209-214. [PMID: 35534138 DOI: 10.1016/j.cireng.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 01/07/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Pleurodesis is a common technique for treating the accumulation of air or liquid in the pleural space caused by pneumothorax or pleural effusion, it is based on the bounding of pleural layers through induced inflammatory lesions. There are several pleurodesis procedures. OBJECTIVES To test and describe the inflammatory effect of hyperthermia on the pleural and peritoneal mesothelia of rats, with the aim of testing the effectiveness of this process for inducing pleurodesis. METHODS 35 Sprague-Dawley (male/female) rats were randomized into four treatment groups: Group A (Talc, 10 individuals); group B (control, 5 individuals); group C (hyperthermic isotonic saline, 10 individuals); and group D (filtrate air at 50°, 10 individuals). Inflammatory effect of hyperthermia was the primary outcome parameter. RESULTS In the talc group, minimal adhesions between both pleural and peritoneal layers were observed in seven rats. Talc produced peritoneal mesothelium inflammation and fibrosis associated to foreign body giant cells in 80% (8/10) of the sample. Furthermore, clear evidence of a granulomatous foreign-body reaction was detected. No macroscopic and/or microscopic damage was registered in the remaining three groups (control, hyperthermic, and filtrate air). CONCLUSIONS Talc is an excellent method for producing pleuro-peritoneal inflammatory lesions. On the contrary, hyperthermia apparently does not induce the macroscopic and microscopic damage that is required for efficient pleurodesis. Therefore, hyperthermia should not be used for pleurodesis procedures.
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Affiliation(s)
- Francisco Rivas
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Medical School, University of Barcelona, L'Hospitalet de Llobregat, Spain.
| | - Rosa-María Penin
- Department of Pathology, Hospital Universitari de Bellvitge, Medical School, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Iván Macía
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge and Unit of Human Anatomy and Embryology, Medical School, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Anna Ureña
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Medical School, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Carlos Déniz
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Medical School, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Álvaro Gimeno
- Animal Laboratory, Campus Ciències de la Salut de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Ignacio Escobar
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Medical School, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Ricard Ramos
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge and Unit of Human Anatomy and Embryology, Medical School, University of Barcelona, L'Hospitalet de Llobregat, Spain
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Sperandeo M, Quarato CMI, Squatrito R, Fuso P, Dimitri L, Simeone A, Notarangelo S, Lacedonia D. Effectiveness and Safety of Real-Time Transthoracic Ultrasound-Guided Thoracentesis. Diagnostics (Basel) 2022; 12:diagnostics12030725. [PMID: 35328278 PMCID: PMC8946970 DOI: 10.3390/diagnostics12030725] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/14/2022] [Indexed: 12/10/2022] Open
Abstract
Purpose: The purpose of the present study was to specifically evaluate the effectiveness and safety of real-time ultrasound-guided thoracentesis in a case series of pleural effusion. Patients and methods: An observational prospective study was conducted. From February 2018 to December 2019, a total of 361 consecutive real-time transthoracic ultrasound (TUS)-guided thoracentesis were performed in the Unit of Diagnostic and Interventional Ultrasound of the Research Hospital “Fondazione Casa Sollievo della Sofferenza” of San Giovanni Rotondo, Foggia, Italy. The primary indication for thoracentesis was therapeutic in all the cases (i.e., evacuation of persistent small/moderate pleural effusions to avoid super-infection; drainage of symptomatic moderate/massive effusions). For completeness, further diagnostic investigations (including chemical, microbiological, and cytological analysis) were conducted. All the procedures were performed by two internists with more than 30 years of experience in interventional ultrasound using a multifrequency convex probe (3–8 MHz). For pleural effusions with a depth of 2–3 cm measured at the level of the costo-phrenic sinus was employed a dedicated holed convex-array probe (5 MHz). Results: In all the cases, the attempts at thoracentesis were successful, allowing the achievement of the therapeutic purpose of the procedure (i.e., the complete drying of the pleural space or the withdrawal of fluid till a “safe” quantity [a mean of 1.5 L, max 2 L] producing relief from symptoms) regardless of the initial extent of the pleural effusion. There were only 3 cases of pneumothorax, for a prevalence rate of complications in this population of 0.83%. No statistical difference was recorded in the rate of pneumothorax according to the initial amount of pleural fluid in the effusion (p = 0.12). All the pleural effusions classified as transudates showed an anechoic TUS appearance. Only the exudative effusions showed a complex nonseptated or a hyperechoic TUS appearance. However, an anechoic TUS pattern was not unequivocally associated with transudates. Some chronic transudates have been classified as exudates by Light’s criteria, showing also a complex nonseptated TUS appearance. The cytological examination of the drained fluid allowed the detection of neoplastic cells in 15.89% cases. On the other hand, the microbiological examination of effusions yielded negative results in all the cases. Conclusions: Real-time TUS-guided thoracentesis is a therapeutically effective and safe procedure, despite the diagnostic yield of the cytological or microbiological examinations on the collected liquid being very low. Future blinded randomized studies are required to definitely clarify the actual benefit of the real-time TUS-guided procedure over percussion-guided and other ultrasound-based procedures.
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Affiliation(s)
- Marco Sperandeo
- Unit of Interventional and Diagnostic Ultrasound of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) “Fondazione Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy;
| | - Carla Maria Irene Quarato
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Universitario “Riuniti” di Foggia, University of Foggia, 71121 Foggia, Italy; (P.F.); (D.L.)
- Correspondence:
| | | | - Paolo Fuso
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Universitario “Riuniti” di Foggia, University of Foggia, 71121 Foggia, Italy; (P.F.); (D.L.)
| | - Lucia Dimitri
- Unit of Patology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) “Fondazione Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy;
| | - Anna Simeone
- Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) “Fondazione Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy;
| | | | - Donato Lacedonia
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Universitario “Riuniti” di Foggia, University of Foggia, 71121 Foggia, Italy; (P.F.); (D.L.)
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Jiang F, Xiang N. Integrated Microfluidic Handheld Cell Sorter for High-Throughput Label-Free Malignant Tumor Cell Sorting. Anal Chem 2022; 94:1859-1866. [PMID: 35020366 DOI: 10.1021/acs.analchem.1c04819] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Handheld sample preparation devices are urgently required for point-of-care diagnosis in resource-limited settings. In this paper, we develop a novel handheld sorter with a multifunction integrated microfluidic chip. The integrated microfluidic handheld sorter (μHCS) is composed of three units, including cartridges, shells, and core integrated microchip. The integrated microchip contains two flow regulators for achieving the on-chip regulation of the input flows generated by a low-cost diaphragm pump to the desired flow rates and a spiral inertial microfluidic channel for size-based cell separation. After introducing the conceptual design of our μHCS system, the performances of the separate spiral channel and flow regulator are systematically characterized and optimized, respectively. Finally, the prototype of the μHCS is successfully assembled to separate the malignant tumor cells from the clinical pleural effusions. Our μHCS is simple to use, inexpensive, portable, and compact and can be used for high-throughput label-free separation of rare cells from large volume samples in resource-limited areas.
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Affiliation(s)
- Fengtao Jiang
- School of Mechanical Engineering, and Jiangsu Key Laboratory for Design and Manufacture of Micro-Nano Biomedical Instruments, Southeast University, Nanjing 211189, China.,School of Biomedical Engineering, Faculty of Engineering, The University of Sydney, Darlington, New South Wales 2008, Australia
| | - Nan Xiang
- School of Mechanical Engineering, and Jiangsu Key Laboratory for Design and Manufacture of Micro-Nano Biomedical Instruments, Southeast University, Nanjing 211189, China
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Ali K, Habib MB, Taha NM, Abdalhadi AM, Hammamy R. Pleural Effusion Revealing a Diagnosis of Ewing Sarcoma. Cureus 2021; 13:e20439. [PMID: 35047276 PMCID: PMC8760035 DOI: 10.7759/cureus.20439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 11/14/2022] Open
Abstract
Pleural effusion can rarely present as an initial manifestation of Ewing sarcoma. We illustrate a case of a young male adult who was admitted with pleural effusion that led to the diagnosis of Ewing sarcoma.
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Niu Y, Ye L, Peng W, Wang Z, Wei X, Wang X, Li Y, Zhang S, Xiang X, Zhou Q. IL-26 promotes the pathogenesis of malignant pleural effusion by enhancing CD4 + IL-22 + T-cell differentiation and inhibiting CD8 + T-cell cytotoxicity. J Leukoc Biol 2021; 110:39-52. [PMID: 33847412 DOI: 10.1002/jlb.1ma0221-479rr] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/05/2021] [Accepted: 03/03/2021] [Indexed: 01/21/2023] Open
Abstract
IL-26 is a newly discovered IL-10 cytokine family member mainly secreted by Th17 cells. However, the relationship between IL-26 and lung cancer remains unclear. The present study reported that IL-26 is involved in the production and promotion of malignant pleural effusion (MPE) for the first time. The concentrations of IL-26 and several Th17-related cytokines in MPE and peripheral blood (PB) from MPE patients were measured. IL-26, IL-10, and IL-6 were elevated in MPE compared to PB. The cell resource of IL-26 was primary Th17 cells measured by flow cytometry, whereas Tc17 cells and macrophages could also contribute to higher concentration of IL-26 in MPE. Abundant IL-6 and IL-23 in MPE could promote the frequency of IL-26 expressed by CD4+ T cells through phosphorylating STAT3 signaling pathway and promoting the expression of a specific Th17 lineage marker RORγt subsequently. IL-26 could selectively increase Th22 proportion through up-regulating the percentage of Ki-67 expressed by CD4+ T cells and the expression of IL-22 secreted by memory CD4+ T cells. In addition, IL-26 could decrease secretion of granzyme B. The tumor-killing activity of CD8+ T cells were inhibited as well when cocultured with malignant cells. Furthermore, the accumulation of IL-26 protein in MPE predicted poor patient survival. In summary, our results indicated that IL-26 was involved in the pathogenesis of MPE by exerting its impacts on both CD4+ T cells and CD8+ T cells.
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Affiliation(s)
- Yiran Niu
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Linlin Ye
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wenbei Peng
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zihao Wang
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaoshan Wei
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xu Wang
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yu Li
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Siyu Zhang
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuan Xiang
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qiong Zhou
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Rivas F, Penin RM, Macía I, Ureña A, Déniz C, Gimeno Á, Escobar I, Ramos R. Efficacy of hyperthermia pleurodesis: A comparative experimental study on serous membrane of abdominopelvic and thoracic cavities of rats. Cir Esp 2021; 100:S0009-739X(21)00025-7. [PMID: 33608111 DOI: 10.1016/j.ciresp.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 12/01/2020] [Accepted: 01/07/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pleurodesis is a common technique for treating the accumulation of air or liquid in the pleural space caused by pneumothorax or pleural effusion, it is based on the bounding of pleural layers through induced inflammatory lesions. There are several pleurodesis procedures. OBJECTIVES To test and describe the inflammatory effect of hyperthermia on the pleural and peritoneal mesothelia of rats, with the aim of testing the effectiveness of this process for inducing pleurodesis. METHODS 35 Sprague-Dawley (male/female) rats were randomized into four treatment groups: Group A (Talc, 10 individuals); group B (control, 5 individuals); group C (hyperthermic isotonic saline, 10 individuals); and group D (filtrate air at 50°, 10 individuals). Inflammatory effect of hyperthermia was the primary outcome parameter. RESULTS In the talc group, minimal adhesions between both pleural and peritoneal layers were observed in seven rats. Talc produced peritoneal mesothelium inflammation and fibrosis associated to foreign body giant cells in 80% (8/10) of the sample. Furthermore, clear evidence of a granulomatous foreign-body reaction was detected. No macroscopic and/or microscopic damage was registered in the remaining three groups (control, hyperthermic, and filtrate air). CONCLUSIONS Talc is an excellent method for producing pleuro-peritoneal inflammatory lesions. On the contrary, hyperthermia apparently does not induce the macroscopic and microscopic damage that is required for efficient pleurodesis. Therefore, hyperthermia should not be used for pleurodesis procedures.
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Affiliation(s)
- Francisco Rivas
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Medical School, University of Barcelona, L'Hospitalet de Llobregat, Spain.
| | - Rosa-María Penin
- Department of Pathology, Hospital Universitari de Bellvitge, Medical School, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Iván Macía
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge and Unit of Human Anatomy and Embryology, Medical School, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Anna Ureña
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Medical School, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Carlos Déniz
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Medical School, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Álvaro Gimeno
- Animal Laboratory, Campus Ciències de la Salut de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Ignacio Escobar
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Medical School, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Ricard Ramos
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge and Unit of Human Anatomy and Embryology, Medical School, University of Barcelona, L'Hospitalet de Llobregat, Spain
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11
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Nauka PC, Galen BT. The Focused Assessment with Sonography in Cancer (FASC) Examination. POCUS JOURNAL 2020; 5:42-45. [PMID: 36896442 PMCID: PMC9979872 DOI: 10.24908/pocus.v5i2.14428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Malignant effusions occur frequently in patients with cancer and are important to diagnose and treat. In this report, we describe a novel point-of-care ultrasound (POCUS) protocol to rapidly identify pleural effusion, pericardial effusion, and ascites: The Focused Assessment with Sonography in Cancer (FASC). This protocol utilizes six standard sonographic positions to identify the presence of fluid in common anatomic spaces. The FASC examination is intended for widespread use by oncologists and other clinicians who treat patients with cancer.
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Affiliation(s)
- Peter C Nauka
- Albert Einstein College of Medicine and Montefiore Medical Center, Department of Internal Medicine, Residency Training Program Bronx, NY USA
| | - Benjamin T Galen
- Albert Einstein College of Medicine and Montefiore Medical Center, Department of Internal Medicine, Division of Hospital Medicine Bronx, NY USA
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12
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Choi H, Ko Y, Lee CY. Pro-cathepsin D as a diagnostic marker in differentiating malignant from benign pleural effusion: a retrospective cohort study. BMC Cancer 2020; 20:825. [PMID: 32867726 PMCID: PMC7457471 DOI: 10.1186/s12885-020-07327-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 08/20/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Malignant pleural effusion (MPE) causes substantial symptomatic burden in advanced malignancy. Although pleural fluid cytology is a commonly accepted gold standard of diagnosis, its low diagnostic yield is a challenge for clinicians. The aim of this study was to determine whether pro-cathepsin D can serve as a novel biomarker to discriminate between MPE and benign pleural effusion (BPE). METHODS This study included 81 consecutive patients with exudative pleural effusions who had underwent thoracentesis or pleural biopsy. Pleural fluid and serum were collected as a standard procedure for all individuals at the same time. The level of pro-cathepsin D was measured by the sandwich enzyme-linked immunosorbent assay method. RESULTS Though there were no significant differences in plasma pro-cathepsin D between the two groups, the level of pleural fluid pro-cathepsin D was significantly higher in the MPE group than the BPE group (0.651 versus 0.590 pg/mL, P = 0.034). The discriminative power of pleural fluid pro-cathepsin D for diagnosing MPE was moderate, with 81% sensitivity and 53% specificity at a pro-cathepsin D cut-off ≥0.596 pg/mL (area under the curve: 0.656). Positive and negative predictive values for MPE were 38 and 89%, respectively, with pro-cathepsin D cut-off value (> 0.596 pg/mL). CONCLUSIONS The level of pleural fluid pro-cathepsin D was found to be significantly higher in MPE than in BPE. Although results of this study could not support the sole use of pleural fluid pro-cathepsin D to diagnose MPE, pleural fluid pro-cathepsin D can be added to pre-existing diagnostic methods for ruling-in or ruling-out MPE.
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Affiliation(s)
- Hayoung Choi
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.,Lung Research Institute of Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Yousang Ko
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Republic of Korea.,Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Chang Youl Lee
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Republic of Korea. .,Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea.
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13
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Fu T, Lin Y, Zeng Q, Yao W, Han L. Thoracic perfusion of recombinant mutant human tumor necrosis factor (rmhTNF) can be considered as a good adjunct in the treatment of malignant pleural effusion caused by lung cancer. BMC Pulm Med 2020; 20:175. [PMID: 32552897 PMCID: PMC7301477 DOI: 10.1186/s12890-020-01210-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tumor necrosis factor (TNF) has been investigated to be correlated with the occurrence and progression of lung cancer. This investigation was to assess the efficacy and safety of recombinant mutant human tumor necrosis factor (rmhTNF) for controlling malignant pleural effusion (MPE) through thoracic perfusion. METHODS Through searching from MEDLINE, Web of Science, EMBASE, Cochrance Library, OVID and China National Knowledge Infrastructure (CNKI), a total of 12 studies with 694 patients were included in this study. A series of meta-analysis methods were used to analyze the extracted data. RESULTS Thoracic perfusion of rmhTNF combined with cisplatin promoted the objective response rate (ORR) (P < 0.001; odds ratio = 4.49) and the quality of life (QOL) of patients with MPE (P < 0.001; odds ratio = 10.33), as compared with cisplatin alone. Although the participation of rmhTNF increased the incidence of fever (P < 0.001), it seemed to relieve the adverse reactions in the digestive tract (P = 0.017). CONCLUSIONS Thoracic perfusion of rmhTNF contributes to the treatment of MPE and improves the QOL of MPE patients.
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Affiliation(s)
- Tian Fu
- Department of Respiration, Jining NO.1 People's Hospital, Jining, 272011, Shandong Province, China
| | - Yong Lin
- Department of Respiration, Jining NO.1 People's Hospital, Jining, 272011, Shandong Province, China
| | - Qingdi Zeng
- Department of Clinical Laboratory, Jining NO.1 People's Hospital, Jining, 272011, Shandong Province, China
| | - Wei Yao
- General surgery, Zoucheng Kanzhuang Township Health Center, Zoucheng, 273502, Shandong Province, China
| | - Liping Han
- Department of Respiration, Jining NO.1 People's Hospital, Jining, 272011, Shandong Province, China.
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14
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Kim W, Park IK, Park S, Kang CH, Kim YT. Clinical course of non-small cell lung cancer patients with dry pleural dissemination: Retrospective observational study. Medicine (Baltimore) 2020; 99:e19533. [PMID: 32176106 PMCID: PMC7440317 DOI: 10.1097/md.0000000000019533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We investigated the prognosis of patients with dry pleural dissemination (DPD) of non-small cell lung cancer (NSCLC) and the risk factors of developing to malignant pleural effusion (MPE).We retrospectively reviewed 104 patients with NSCLC and DPD, confirmed surgically from 1996 to 2016. Incidence rate and risk factors of MPE were analyzed statistically. The prognosis of NSCLC patients with MPE was evaluated using the Kaplan-Meier method.The most common histologic type was adenocarcinoma in 95 (91.3%) patients. The median follow-up duration was 65.5 months and the median survival time was 37.7 months. MPE developed in 51 (49%) patients, and the median effusion-free interval was 41.9 months. The median survival time of the patients with and without MPE was not different (41.3 vs 31.7 months, P = .16). No predictive factors for the development of MPE were identified. Fifteen (14.4%) patients underwent invasive procedures for the management of MPE.Almost half of all patients with NSCLC and DPD experienced MPE, and 14.4% patients developed symptomatic MPE requiring invasive procedures. MPE in DPD did not affect the survival in NSCLC patients.
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Affiliation(s)
- Woojung Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine
- Seoul National University Cancer Research Institute, Seoul, Republic of Korea
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15
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Qaqish TR, Cox S, Carr R, Katlic M. Treatment of Pleural Effusions with Nonintubated Video-Assisted Thoracoscopic Surgery. Thorac Surg Clin 2019; 30:25-32. [PMID: 31761281 DOI: 10.1016/j.thorsurg.2019.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Video-assisted thoracic surgery has considerably improved the care of the thoracic surgical patient. Patients are able to leave the hospital sooner and experience less pain with equal oncologic outcomes when compared with open surgery. Nonintubated thoracic surgery has more recently been applied in the management of both benign and malignant pleural effusions. This article provides the general thoracic surgeon a detailed description on how to manage pleural effusions using video-assisted thoracoscopic surgery in a nonintubated patient. Surgical techniques and pearls are also presented.
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Affiliation(s)
- Thamer Robert Qaqish
- Department of Surgery, Sinai Hospital of Baltimore, 2435 West Belvedere Avenue, Suite 42, Baltimore, MD 21215, USA
| | - Solange Cox
- Department of Surgery, Sinai Hospital of Baltimore, 2435 West Belvedere Avenue, Suite 42, Baltimore, MD 21215, USA
| | - Rebecca Carr
- Department of Surgery, Sinai Hospital of Baltimore, 2435 West Belvedere Avenue, Suite 42, Baltimore, MD 21215, USA
| | - Mark Katlic
- Department of Surgery, Sinai Hospital of Baltimore, 2435 West Belvedere Avenue, Suite 42, Baltimore, MD 21215, USA.
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16
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Gu X, Chen M, Liu M, Zhang Z, Zhao W, Cheng W. Referral Characteristics of Palliative Care Service in Patients With Advanced Non-Small Cell Lung Cancer in a Tertiary Cancer Center. Am J Hosp Palliat Care 2019; 37:266-271. [PMID: 31378075 DOI: 10.1177/1049909119867281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The American Society of Clinical Oncology recently recommends patients with metastatic non-small cell lung cancer (NSCLC) should be offered palliative care services earlier. We sought to investigate the timing of palliative care referral of Chinese patients with NSCLC in our center. METHOD Retrospective medical data including demographic characteristics and referral information were collected for analysis. Overall survival (OS) was calculated as the time since cancer diagnosis till patient's death. The time interval from palliative care (PC) referral to a patient's death (PC-D) was calculated. The PC-D/OS ratio was calculated to illustrate the comparison of the duration of PC in the overall length of disease. RESULTS The mean age of 155 patients with advanced NSCLC was 62.83 years. Before referral to PC, 128 patients received anticancer treatment including surgeon (46.5%). Sixty-three (40.6%) patients died in palliative care unit. The median OS of 144 patients with end cutoff was 19 months (mean = 31.49, 95% confidence interval [CI] = 25.86-37.12). The median PC-D was 41 days (mean = 73.84, 95% CI = 60.37-87.40). The mean interval of PC-D/OS of 144 patients with definitely death time was 0.22 (SD: 0.27, 95% CI: 0.17-0.26). The median interval was 0.089. More than half of patients (n = 75, 51.8%) underwent PC less than 1% time (PC-D/OS < 0.1) of their whole disease course. Patients who were indigenous to Shanghai (P = .013) and who had brain metastasis (P = .072) had the potential longer PC-D/OS ratio. A high proportion of patients reported loss of appetite (92.8%) and fatigue (91.4%) at the initial of referral to PC. CONCLUSION This retrospective study, in a population of patients with advanced NSCLC, gave detailed information about PC services in a tertiary cancer center.
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Affiliation(s)
- Xiaoli Gu
- Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Menglei Chen
- Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Minghui Liu
- Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhe Zhang
- Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weiwei Zhao
- Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wenwu Cheng
- Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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17
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Han YQ, Yan L, Li P, Zhang L, Ouyang PH, Hu ZD. A Study Investigating Markers in PLeural Effusion (SIMPLE): a prospective and double-blind diagnostic study. BMJ Open 2019; 9:e027287. [PMID: 31375609 PMCID: PMC6688667 DOI: 10.1136/bmjopen-2018-027287] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 05/10/2019] [Accepted: 07/03/2019] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Serum and fluid laboratory markers are valuable for exploring the aetiologies of pleural effusion (PE) because of their relative non-invasiveness, low cost, objective result and short turnaround time. The diagnostic accuracy of these potential markers needs to be rigorously evaluated before their widespread application in clinical practice. Here, we plan to perform a Study Investigating Markers in PLeural Effusion (SIMPLE). METHODS AND ANALYSIS This is a prospective and double-blind clinical trial which is being performed at the Affiliated Hospital of Inner Mongolia Medical University, China. Adult patients admitted for the evaluation of aetiology of PE from September 2018 to July 2021 will be enrolled after informed consent. Pleural fluid and serum specimens will be collected and stored at -80°C for the laboratory analysis. The final diagnosis will be concurred with further imaging, microbiology, cytology and biopsy if needed. The results of investigated laboratory markers will be unknown to the clinicians who will make diagnosis and the clinical diagnoses will be unknown to the laboratory technicians who will determine markers. The diagnostic accuracy of investigated markers will be assessed using receiver operating characteristics (ROC) curve analysis, multivariable logistic regression model, decision curve analysis (DCA), net reclassification index (NRI) and integrated discriminatory index (IDI). ETHICS AND DISSEMINATION The study is approved by the Ethic Committee of the Affiliated Hospital of Inner Mongolia Medical University (NO: 2018011). The results of SIMPLE will be submitted to international scientific peer-reviewed journals or conferences in laboratory medicine or respiratory medicine, thoracic diseases. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry (ChiCTR1800017449); Pre-results.
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Affiliation(s)
- Yan-Qiu Han
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Li Yan
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Peng Li
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Lei Zhang
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Pei-Heng Ouyang
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Zhi-De Hu
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
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18
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Pleural fluid due to papillary thyroid cancer. Oncol Lett 2019; 18:962-966. [PMID: 31289575 DOI: 10.3892/ol.2019.10383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 05/14/2019] [Indexed: 11/05/2022] Open
Abstract
We report herein a rare case of massive pleural effusion caused by papillary thyroid cancer, which was accompanied by multiple pulmonary metastasis. A 91-year-old male patient presented with shortness of breath due to massive right pleural fluid. Cytological specimens, which were obtained from pleural fluid by thoracentesis, and was consistent with that observed in surgically resected thyroid cancer 6-year previously. Immunocytochemical staining of the cells was positive for cytokeratin (CK)-7, CK-19, and positive for thyroglobulin. Massive pleural fluid due to a metastatic from papillary thyroid cancer is very rare but may develop in long-term survivors with this disease as observed in this case.
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19
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Pei XB, Wu XZ, Yi FS, Zhai K, Shi HZ. Diagnostic value of CD206 +CD14 + macrophages in diagnosis of lung cancer originated malignant pleural effusion. J Thorac Dis 2019; 11:2730-2736. [PMID: 31463100 DOI: 10.21037/jtd.2019.06.44] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background Pleural effusions are common complications of various diseases. Patients with malignant pleural effusion (MPE) usually face poor prognosis and short life expectancy. Discriminating between MPE and benign pleural effusion remains to be difficult. The aim of our current study was to evaluate whether CD206+CD14+ macrophages could be a diagnostic biomarker for MPE. Methods The percentages of CD14+, CD86+CD14+ and CD206+CD14+ macrophages in pleural effusions were determined by flow cytometry in 34 patients with MPE and 26 with benign pleural effusion, and their diagnostic performances were evaluated by receiver operating characteristic (ROC) curves. Results The percentages of CD14+, CD86+CD14+ and CD206+CD14+ macrophages were remarkably higher in MPE than in benign pleural effusion (all P<0.05). With a cutoff value of 39.8%, a high sensitivity of 88.2% and high specificity of 100.0% were found in CD206+CD14+ macrophages to diagnose MPE. The area under the curve, positive predictive value and negative predictive value of CD206+CD14+ macrophages were 0.980 (95% CI, 0.905 to 0.999), 100.0 (88.4 to 100.0) and 86.7 (69.3 to 96.2), respectively. The diagnostic performance of CD206+CD14+ macrophages was more accurate than those of CD14+ and CD86+CD14+ macrophages. Conclusions CD206+CD14+ macrophages could be used to discriminate MPE from benign pleural effusion.
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Affiliation(s)
- Xue-Bin Pei
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Xiu-Zhi Wu
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Feng-Shuang Yi
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Kan Zhai
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Huan-Zhong Shi
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
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20
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Sarcopenia in patients with malignant pleural effusion: impact on symptoms, health status, and response to hospitalization. Support Care Cancer 2019; 27:4655-4663. [PMID: 30944992 DOI: 10.1007/s00520-019-04779-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 03/25/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Malignant pleural effusion (MPE) refers to the presence of neoplastic cells in the pleural fluid and was previously associated with lung cancer, breast cancer, and lymphoma. Patients with MPE effusion have significant symptoms, diminishing their overall quality of life but little is known about the influence sarcopenia may have on their clinical presentation. PURPOSE To examine the prevalence of sarcopenia in patients with MPE and its relationship with symptoms, health status, and the response to hospitalization. METHODS Seventy-four patients with MPE underwent measurements of symptoms, health-related quality of life, and functional status upon admission, discharge, and 3 months after hospital discharge. RESULTS Patients with MPE and sarcopenia were symptomatic during hospitalization and at discharge. Additionally, health-related quality of life and functional status were worse in patients with MPE and sarcopenia. All measures of patients with MPE and sarcopenia were significantly poorer 3 months after hospital discharge. CONCLUSIONS Sarcopenia is a clinical characteristic with substantial negative effects in patients with MPE. Specific interventions may need to be provided, designed, and offered in the clinical setting.
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21
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Wang D, Yang L, Yue D, Cao L, Li L, Wang D, Ping Y, Shen Z, Zheng Y, Wang L, Zhang Y. Macrophage-derived CCL22 promotes an immunosuppressive tumor microenvironment via IL-8 in malignant pleural effusion. Cancer Lett 2019; 452:244-253. [PMID: 30928379 DOI: 10.1016/j.canlet.2019.03.040] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/16/2019] [Accepted: 03/22/2019] [Indexed: 12/20/2022]
Abstract
Immune dysfunction often occurs in malignant pleural effusion (MPE). In our previous study, TGF-β derived predominantly from macrophages plays an important role in impairing T cell cytotoxicity in MPE. Therefore, we aimed to investigate whether other immunoregulatory cells and factors mediated TGF-β secretion from macrophages, involved in the immunosuppressive microenvironment of MPE, and to provide clues for potential immune therapy for MPE as well. We found that CCL22 level in MPE was significantly higher than that in non-malignant pleural effusion. The high level of CCL22 was closely associated with poor survival in MPE patients with lung cancer. CCL22 was dominantly produced by tumor-associated macrophages (TAMs) in MPE. Meanwhile, TAM-derived TGF-β mediated CCL22 expression in TAMs via c-Fos. CCL22 promoted the recruitment of regulatory T cells (Tregs) in MPE. Lastly, Treg-secreted high level of IL-8 further induced TGF-β production from TAMs, and promoted the immunosuppressive tumor microenvironment in MPE. Our results indicate that macrophage-derived CCL22 plays an important role in the immunosuppressive tumor microenvironment via IL-8 in MPE.
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Affiliation(s)
- Dong Wang
- Biotherapy Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China; Cancer Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China; Key Laboratory for Tumor Immunology and Biotherapy of Henan Province, Zhengzhou, Henan, 450052, PR China
| | - Li Yang
- Biotherapy Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China; Cancer Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China; Key Laboratory for Tumor Immunology and Biotherapy of Henan Province, Zhengzhou, Henan, 450052, PR China
| | - Dongli Yue
- Biotherapy Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China; Cancer Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China; Key Laboratory for Tumor Immunology and Biotherapy of Henan Province, Zhengzhou, Henan, 450052, PR China
| | - Ling Cao
- Biotherapy Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China; Cancer Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China; Key Laboratory for Tumor Immunology and Biotherapy of Henan Province, Zhengzhou, Henan, 450052, PR China
| | - Lifeng Li
- Biotherapy Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China; Cancer Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China; Key Laboratory for Tumor Immunology and Biotherapy of Henan Province, Zhengzhou, Henan, 450052, PR China
| | - Dan Wang
- Biotherapy Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China; Cancer Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China; Key Laboratory for Tumor Immunology and Biotherapy of Henan Province, Zhengzhou, Henan, 450052, PR China
| | - Yu Ping
- Biotherapy Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China; School of Life Sciences, Zhengzhou University, Zhengzhou, Henan, 450001, PR China; Key Laboratory for Tumor Immunology and Biotherapy of Henan Province, Zhengzhou, Henan, 450052, PR China
| | - Zhibo Shen
- Biotherapy Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China; Cancer Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China; Key Laboratory for Tumor Immunology and Biotherapy of Henan Province, Zhengzhou, Henan, 450052, PR China
| | - Yujia Zheng
- Biotherapy Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China; Cancer Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China; Key Laboratory for Tumor Immunology and Biotherapy of Henan Province, Zhengzhou, Henan, 450052, PR China
| | - Liping Wang
- Cancer Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China; Key Laboratory for Tumor Immunology and Biotherapy of Henan Province, Zhengzhou, Henan, 450052, PR China
| | - Yi Zhang
- Biotherapy Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China; Cancer Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China; School of Life Sciences, Zhengzhou University, Zhengzhou, Henan, 450001, PR China; Key Laboratory for Tumor Immunology and Biotherapy of Henan Province, Zhengzhou, Henan, 450052, PR China.
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Alihodzic-Pasalic A, Maric V, Hadzismailovic A, Pilav A, Grbic K. Comparison of Efficiency of Pleurodesis Between Video Assisted Thoracoscopic Surgery (VATS) and Standard Thoracostomy. Acta Inform Med 2018; 26:185-189. [PMID: 30515010 PMCID: PMC6195412 DOI: 10.5455/aim.2018.26.185-189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Chemical pleurodesis is generally accepted palliative dyspnea therapy and preventive of re-accumulation of pleural fluid in patients with malignant pleural effusions. Aim Comparative analyses of efficiency of chemical pleurodesis between Video Assisted Thoracoscopic Surgery (VATS) and standard thoracostomy. Methods From 01.01.2016-01.01.2017 at the Clinic for Thoracic Surgery of University Clinical Center (UCC) Sarajevo retrospective analysis was performed. Studied patients underwent VATS pleurodesis (G1) and standard thoracostomy pleurodesis (G2), with 60 in each group, respecting defined inclusion and exclusion criteria. Pleurodesis success was examined radiologically over the next three months. Results Average age of all patients was 63.97±8.75 years. Gender related, 45% were men and 55% were women (F/M=1.47:1). Average hospitalization was 7.22±1.37 (G1: 6.68±1.16; G2: 7.44±1.40; Mann-Whitney U-test: p=0.0016) days. Average thoracic drainage duration was 5.45±1.69, (G1: 4.28±1.15,G2: 6.05±1.58; Mann-Whitney U-test p<0.0001) days. Pleurodesis success after first month was 98.30% in G1, 91.60% in G2 (G1 vs. G2; p=0.2089); after second month was 98.30% in G1, 78.30% in G2 (G1 vs. G2; p=0.0011) and after three months was 91.60% in G1, 63.30% in G2(G1 vs. G2; p=0.0006). Average dyspnea degree (0-5) after the pleurodesis was 0.050±0.22 in G1 and 0.62±0.76 in G2 (Mann-Whitney U-test; p=0.0001). Complication were noticed in 9.2% patients, in G1 3.3%, 15.0% in G2. Conclusion Difference in pleurodesis efficiency between the G1 and G2 was established after second month and was even more evident after third month in favor of G1. Results show the significant statistical improvement of the degree of dyspnea in G1 as opposite to the G2.
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Affiliation(s)
- Alma Alihodzic-Pasalic
- Clinic for Thoracic Surgery of University Clinic Centar Sarajevo, Sarajevo Bosnia and Hercegovina
| | - Veljko Maric
- Faculty of Medicine Foca, University of East Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Ademir Hadzismailovic
- Clinic for Thoracic Surgery of University Clinic Centar Sarajevo, Sarajevo Bosnia and Hercegovina
| | - Alen Pilav
- Clinic for Thoracic Surgery of University Clinic Centar Sarajevo, Sarajevo Bosnia and Hercegovina
| | - Kemal Grbic
- Clinic for Thoracic Surgery of University Clinic Centar Sarajevo, Sarajevo Bosnia and Hercegovina
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Che N, Ma Y, Ruan H, Xu L, Wang X, Yang X, Liu X. Integrated semi-targeted metabolomics analysis reveals distinct metabolic dysregulation in pleural effusion caused by tuberculosis and malignancy. Clin Chim Acta 2017; 477:81-88. [PMID: 29208371 DOI: 10.1016/j.cca.2017.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/13/2017] [Accepted: 12/02/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE) are the 2 most frequent causes of exudative pleural effusions (PEs). However, the clinical differentiation is challenging. METHODS Metabolic signatures in pleural effusion from 156 patients were profiled. An integrated semi-targeted metabolomics platform was incorporated for high throughput metabolite identification and quantitation. In this platform, orbitrap based mass spectrometry with data dependent MS/MS acquisition was applied in the analysis. In-house database containing ~1000MS/MS spectra were established and "MetaInt" was developed for metabolite alignment. RESULTS Using this strategy, lower levels of amino acids, citric acid cycle intermediates and free fatty acids accompanied with elevated acyl-carnitines and bile acids were observed, demonstrating increased energy expenditure caused by TPE. Kynurenine pathway from tryptophan was significantly enhanced in TPE. The ratio of tryptophan/kynurenine exhibited decent performance in differentiating TPE from MPE with sensitivity of 92.7% and specificity of 86.1%. After two further independent validations, it turns out that the ratio of tryptophan/kynurenine can be applied confidently as a potential biomarker together with adenosine deaminase (ADA) for clinical diagnosis of TPE. CONCLUSIONS Conclusively, the integrated in-house platform for high throughput semi-targeted metabolomics analysis reliably identified great potential of tryptophan/kynurenine ratio as a novel diagnostic biomarker to distinguish pleural effusion caused by tuberculosis and malignancy.
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Affiliation(s)
- Nanying Che
- Department of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing, 101149, China
| | - Yan Ma
- Clinical Center, Beijing Chest Hospital, Capital Medical University, Beijing, 101149, China
| | - Huabin Ruan
- School of Life Sciences, Tsinghua University, Beijing, 100084, China
| | - Lina Xu
- School of Life Sciences, Tsinghua University, Beijing, 100084, China
| | - Xueying Wang
- School of Life Sciences, Tsinghua University, Beijing, 100084, China
| | - Xinting Yang
- Department of Tuberculosis, Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, 101149, China
| | - Xiaohui Liu
- School of Life Sciences, Tsinghua University, Beijing, 100084, China.
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Zhu J, Feng M, Liang L, Zeng N, Wan C, Yang T, Shen Y, Wen F. Is neuron-specific enolase useful for diagnosing malignant pleural effusions? evidence from a validation study and meta-analysis. BMC Cancer 2017; 17:590. [PMID: 28854885 PMCID: PMC5575856 DOI: 10.1186/s12885-017-3572-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 08/21/2017] [Indexed: 02/05/2023] Open
Abstract
Background Neuron-Specific enolase (NSE) has been used as a typical tumor marker and shows a potential to diagnose malignant pleural effusion (MPE). The ability of NSE in diagnosing MPE has been investigated in many studies, but with inconsistent conclusions. This study sought to investigate the diagnostic accuracy of NSE for MPE through a clinical study and together with a meta-analysis. Methods Pleural effusion samples from 136 patients with MPE and 102 patients with benign pleural effusion (BPE) were collected, and NSE levels were measured by electrochemiluminescence immunoassay. Receiver operating characteristic (ROC) curve analysis was performed to assess the ability of NSE to differentiate MPE from BPE. Literature search was conducted to identify suitable publications, data were extracted and diagnostic indexes including sensitivity, specificity, positive/negative likelihood ratio (PLR/NLR), and diagnostic odds ratio (DOR) were pooled. Summary ROC curve was generated to determine the overall diagnostic accuracy of NSE for MPE. Results Levels of NSE were significantly increased in pleural effusion from patients with MPE than that from BPE (18.53 ± 27.30 vs. 6.41 ± 6.95 ng/ml, p < 0.001). With a cut-off value of 8.92 ng/ml, pleural NSE had a sensitivity of 59.56% and a specificity of 83.33% in diagnosing MPE. A total of 14 studies with 1896 subjects were included for meta-analysis. The diagnostic parameters of NSE were listed as follows: sensitivity, 0.53 (95% CI: 0.38–0.67); specificity, 0.85 (95% CI: 0.75–0.91); PLR, 3.54 (95% CI: 2.33–5.39); NLR, 0.56 (95% CI: 0.42–0.73); and DOR, 6.39 (95% CI: 3.72–10.96). The area under the summary ROC curve was 0.78. Conclusions The role of pleural NSE measurement in diagnosing MPE is limited and with a low sensitivity. The clinical utility of NSE assay should be combined with the results of other tumor markers examination and the detail clinical information of patient. Further studies are needed to confirm the role of NSE in diagnosing MPE. Electronic supplementary material The online version of this article (10.1186/s12885-017-3572-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jing Zhu
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China
| | - Mei Feng
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China
| | - Liqun Liang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China
| | - Ni Zeng
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China
| | - Chun Wan
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China
| | - Ting Yang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China
| | - Yongchun Shen
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China.
| | - Fuqiang Wen
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China
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Wu XZ, Zhou Q, Lin H, Zhai K, Wang XJ, Yang WB, Shi HZ. Immune Regulation of Toll-Like Receptor 2 Engagement on CD4 + T Cells in Murine Models of Malignant Pleural Effusion. Am J Respir Cell Mol Biol 2017; 56:342-352. [PMID: 27767332 DOI: 10.1165/rcmb.2015-0396oc] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Toll-like receptor (TLR) 2 has a well-known role in sensing multiple ligands that include microbial products, endotoxin, and some extracellular matrix molecules; however, its role in the development of malignant pleural effusion (MPE) remains unknown. We performed the present study to explore the impact of TLR2 signaling on the development of MPE and to define the underlying mechanisms by which TLR2 works. Development of MPE was compared between TLR2-/- and wild-type (WT) mice. The effect of TLR2 on differentiation of T helper type 17 (Th17), Th9, and Th2 cells in MPE was explored. The mechanisms of TLR2 on survival of mice bearing MPE were also investigated. MPE volume in TLR2-/- mice was lower than that in WT mice, and the survival of TLR2-/- mice bearing MPE was longer than that of WT mice. TLR2 deficiency increased, and TLR2 activation decreased, Th17 cells in MPE, whereas TLR2 signaling showed the contrary effects on Th2 cells. Th9 cells were increased in MPE of TLR2-/- mice but were not influenced by TLR2 signaling. Intraperitoneal injection of anti-IL-17 monoclonal antibody (mAb), anti-IL-9 mAb, or recombinant mouse IL-4 accelerated the death of TLR2-/- mice bearing MPE, and intraperitoneal injection anti-IL-17 mAb in TLR2-/- mice was associated with a significantly shorter survival time than in WT mice. We have demonstrated, for the first time, that TLR2 signaling promotes the development of MPE and accelerates the death of mice bearing MPE by directly suppressing Th17 cell differentiation and directly promoting Th2 cell differentiation, and also by indirectly suppressing Th9 cell differentiation via an IL-17-dependent mechanism.
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Affiliation(s)
- Xiu-Zhi Wu
- 1 Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Qiong Zhou
- 2 Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; and
| | - Hua Lin
- 2 Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; and.,3 Department of Respiratory and Critical Care Medicine, Hebei General Hospital, Shijiazhuang, China
| | - Kan Zhai
- 1 Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiao-Juan Wang
- 1 Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wei-Bing Yang
- 2 Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; and
| | - Huan-Zhong Shi
- 1 Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Froudarakis ME, Plojoux J, Kaspi E, Anevlavis S, Laroumagne S, Karpathiou G, Roca E, Adler D, Dutau H, Astoul P. Positive pleural cytology is an indicator for visceral pleural invasion in metastatic pleural effusions. CLINICAL RESPIRATORY JOURNAL 2017; 12:1011-1016. [DOI: 10.1111/crj.12619] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 01/24/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Marios E. Froudarakis
- Department of Respiratory Medicine, Medical School; Democritus University of Thrace; Alexandroupolis Greece
| | - Jerôme Plojoux
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord; Aix-Marseille University; Marseille France
- Division of Pulmonary Medicine; University Hospitals of Geneva; Geneva Switzerland
| | - Elise Kaspi
- INSERM, GMGF UMRS 910; Aix-Marseille University; Marseille France
- Hôpital la Timone; Service de Biologie Cellulaire; Marseille France
| | - Stavros Anevlavis
- Department of Respiratory Medicine, Medical School; Democritus University of Thrace; Alexandroupolis Greece
| | - Sophie Laroumagne
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord; Aix-Marseille University; Marseille France
| | - Georgia Karpathiou
- Department of Pathology; University Hospital of Ioannina; Ioannina Greece
| | - Elisa Roca
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord; Aix-Marseille University; Marseille France
| | - Dan Adler
- Division of Pulmonary Medicine; University Hospitals of Geneva; Geneva Switzerland
| | - Hervé Dutau
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord; Aix-Marseille University; Marseille France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord; Aix-Marseille University; Marseille France
- Aix-Marseille University; Marseille France
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Bertolaccini L, Viti A, Paiano S, Pomari C, Assante LR, Terzi A. Indwelling Pleural Catheters: A Clinical Option in Trapped Lung. Thorac Surg Clin 2016; 27:47-55. [PMID: 27865327 DOI: 10.1016/j.thorsurg.2016.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Malignant pleural effusion (MPE) symptoms have a real impact on quality of life. Surgical approach through video-assisted thoracic surgery provides a first step in palliation. In patients unfit for general anesthesia, awake pleuroscopy represents an alternative. Sclerosing agents can be administered at the bedside through a chest tube. Ideal treatment of MPE should include adequate long-term symptom relief, minimize hospitalization, and reduce adverse effects. Indwelling pleural catheter (IPC) allows outpatient management of MPE through periodic ambulatory fluid drainage. IPC offers advantages over pleurodesis in patients with poor functional status who cannot tolerate pleurodesis or in patients with trapped lungs.
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Affiliation(s)
- Luca Bertolaccini
- Thoracic Surgery Unit, Sacro Cuore Don Calabria Research Hospital - Cancer Care Center, Via Don Angelo Sempreboni 5, Negrar, Verona 37024, Italy.
| | - Andrea Viti
- Thoracic Surgery Unit, Sacro Cuore Don Calabria Research Hospital - Cancer Care Center, Via Don Angelo Sempreboni 5, Negrar, Verona 37024, Italy
| | - Simona Paiano
- Thoracic Endoscopy Unit, Sacro Cuore Don Calabria Research Hospital - Cancer Care Center, Via Don Angelo Sempreboni 5, Negrar, Verona 37024, Italy
| | - Carlo Pomari
- Thoracic Endoscopy Unit, Sacro Cuore Don Calabria Research Hospital - Cancer Care Center, Via Don Angelo Sempreboni 5, Negrar, Verona 37024, Italy
| | - Luca Rosario Assante
- Thoracic Endoscopy Unit, Sacro Cuore Don Calabria Research Hospital - Cancer Care Center, Via Don Angelo Sempreboni 5, Negrar, Verona 37024, Italy
| | - Alberto Terzi
- Thoracic Surgery Unit, Sacro Cuore Don Calabria Research Hospital - Cancer Care Center, Via Don Angelo Sempreboni 5, Negrar, Verona 37024, Italy
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Liou DZ, Serna-Gallegos D, Chan JL, Borgella J, Akhmerov S, Soukiasian HJ. Survival Difference in Patients with Malignant Pleural Effusions Treated with Pleural Catheter or Talc Pleurodesis. Am Surg 2016. [DOI: 10.1177/000313481608201031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Malignant pleural effusions (MPE) are commonly managed with either pleural catheter (PC) or talc pleurodesis (TP). The aim of this study was to compare survival in MPE patients treated with either PC or TP. A retrospective review of our cancer center database was performed. Patients with metastatic cancer and MPE were analyzed. Demographic and clinical data were tabulated and compared. A total of 238 patients with MPE treated by either PC or TP were included. Of these, 79 patients comprised the PC group and 159 the TP group. PC had a higher incidence of advanced disease (stage III or IV) at initial diagnosis compared with TP (70.9% vs 57.2%, P = 0.05). TP had a longer postprocedure length of stay compared with PC (7.1 vs 5.0 days, P = 0.02); however, overall length of stay was similar (9.7 vs 11.1 days, P = 0.34). Read-missions were significantly lower in TP (11.9% vs 22.8%, P = 0.04). Mean survival was higher in TP compared with PC (18.7 vs 4.1 months, P < 0.001). Patients with metastatic cancer and MPE treated with TP had significantly higher survival compared with PC. This is likely related to a greater disease burden in PC, as 70 per cent of patients in this group had stage III or IV disease on initial presentation.
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Affiliation(s)
- Douglas Z. Liou
- From the Department of Surgery, Division of Thoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Derek Serna-Gallegos
- From the Department of Surgery, Division of Thoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Joshua L. Chan
- From the Department of Surgery, Division of Thoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jerald Borgella
- From the Department of Surgery, Division of Thoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Shah Akhmerov
- From the Department of Surgery, Division of Thoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Harmik J. Soukiasian
- From the Department of Surgery, Division of Thoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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Pan X, Zhong A, Xing Y, Shi M, Qian B, Zhou T, Chen Y, Zhang X. Increased soluble and membrane-bound PD-L1 contributes to immune regulation and disease progression in patients with tuberculous pleural effusion. Exp Ther Med 2016; 12:2161-2168. [PMID: 27698705 DOI: 10.3892/etm.2016.3611] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 04/22/2016] [Indexed: 12/11/2022] Open
Abstract
Soluble and membrane-bound programmed death ligand-1 (sPD-L1 and mPD-L1, respectively) have been demonstrated to participate in the immune suppression of non-small cell lung cancer. However, the contribution of sPD-L1 and mPD-L1 to immune regulation and disease progression in patients with pleural effusions remains unknown. The present study evaluated the levels of sPD-L1 and membrane-bound PD-1/PD-L1 in the peripheral blood and pleural effusions of patients with tuberculous pleural effusion (TPE), malignant pleural effusion (MPE) and non-tuberculous non-malignant pleural effusion (n-TB n-M). Furthermore, selected T lymphocytes and cluster of differentiation (CD)14+ monocytes were co-cultured to investigate the potential effect of the PD-1/PD-L1 pathway in TPE. Levels of sPD-L1 and PD-L1 on CD14+ monocytes were increased in the TPE group, as compared with the MPE and n-TB n-M groups. Furthermore, sPD-L1 levels and the expression levels of PD-L1 on CD14+ monocytes were demonstrated to be positively correlated with interferon (IFN)-γ concentration in pleural effusions. Therefore, IFN-γ may increase the expression of PD-L1 on CD14+ monocytes in vitro. Cell counting kit-8 analysis demonstrated that anti-PD-L1 antibody was able to partially reverse the proliferation of T lymphocytes in the co-culture system. The results of the present study indicated that sPD-L1 or mPD-L1 are associated with the immune regulation and disease progression of TPE, and may serve as possible biomarkers of TPE. Furthermore, sPD-L1 and the PD-1/PD-L1 pathway of TPE may be associated with the Th1 immune response; therefore, an anti-PD-1/PD-L1 pathway suggests a potential immune therapy strategy for the treatment of TPE.
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Affiliation(s)
- Xue Pan
- Department of Respiration, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Anyuan Zhong
- Department of Respiration, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Yufei Xing
- Department of Respiration, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Minhua Shi
- Department of Respiration, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Bin Qian
- Department of Respiration, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Tong Zhou
- Department of Respiration, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Yongjing Chen
- Department of Immunology, Medical College of Soochow University, Suzhou, Jiangsu 215006, P.R. China; Key Laboratory of Infection and Immunity, Soochow University, Suzhou, Jiangsu 200241, P.R. China
| | - Xueguang Zhang
- Department of Immunology, Medical College of Soochow University, Suzhou, Jiangsu 215006, P.R. China; Key Laboratory of Infection and Immunity, Soochow University, Suzhou, Jiangsu 200241, P.R. China
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Interleukin-17 inhibits development of malignant pleural effusion via interleukin-9-dependent mechanism. SCIENCE CHINA-LIFE SCIENCES 2016; 59:1297-1304. [PMID: 27535421 DOI: 10.1007/s11427-016-0097-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
Abstract
Th17 and Th9 cells have been demonstrated to possess immune regulatory functions in malignant pleural effusion (MPE). However, whether IL-17 can affect differentiation and function of Th9 cells in MPE remains unknown. The objective of the present study was to explore the impact of IL-17 on the in vivo differentiation of Th9 cells in relation to Th2 cells in a murine model of MPE, and to explore whether IL-17 inhibits MPE formation via IL-9‒dependent mechanism. It was found that Th9 and Th2 cells were decreased in MPE from IL-17 -/- mice as compared with wild type mice. IL-17 deficiency inhibited Th9 and Th2 cell differentiation via suppressing transcription factors IRF4 and GATA-3, respectively. IL-17 deficiency enhanced MPE formation by promoting angiogenesis and proliferation of pleural tumors, and thus accelerated the death of mice bearing MPE. The in vivo administration of anti-IL-9 neutralizing mAb accelerated the death of WT mice; whereas administration of exogenous IL-9 improved the survival of IL-17 -/- mice. Our data provide the first definitive evidence that IL-17 promotes the differentiation of Th9 and Th2 cells in MPE. Our findings also demonstrate that IL-17 inhibits the formation of MPE and improves the survival of mice bearing MPE via an IL-9-dependent mechanism.
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Feize W, Meng L, Yanni L, Yuan L, Liqun J, Tong L, Guowang Y, Huijuan C, Donggui W, Zhiqiang C, Lei Z. A Randomized Controlled Study to Observe the Efficacy of External Treatment With a Traditional Chinese Medicine Herbal Ointment on Malignant Plural Effusion: Outcome Report and Design Review. Integr Cancer Ther 2016; 16:473-478. [PMID: 27431570 PMCID: PMC5739134 DOI: 10.1177/1534735416660193] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background. Malignant pleural effusion (MPE) is a common complication in most malignancies. Despite its frequent occurrence, current knowledge of MPE remains limited and the effect of the management is still unsatisfying. Traditional Chinese medicine (TCM) external treatment has unique advantages, such as quicker efficacy and fewer side effects. Objective. To observe the effects and safety of Kang’ai Xiaoshui ointment (TCM herbal ointment) in MPE. Design. This was a placebo-controlled double-blinded randomized study. A total of 80 patients were enrolled, of which 72 were randomized to receive Kang’ai Xiaoshui ointment or placebo at an allocation ratio of 1:1. Kang’ai Xiaoshui ointment or placebo was applied on the thorax wall for 8 hours daily. The intervention lasted 2 weeks. Kang’ai Xiaoshui ointment consisted of Astragalus membranaces (黄芪), Semen pharbitidis (牵牛子), Cassia twig (桂枝), Pericarpium arecae (大腹皮), Curcuma zedoary (莪术), Borneol (冰片), and other substances. In both groups, diuresis and drainages were used as needed. Outcomes covered the quantity of pleural effusion evaluation, TCM Symptom Scale, Karnofsky Performance Scale, and safety indicators such as routine blood test, blood biochemistry test, and response table of skin irritation. Results. Of 72 patients randomized to receive Kang’ai Xiaoshui ointment or placebo along with symptomatic treatment, the response rate was documented as 42.4% for the treatment group and 25.0% for the placebo group (P = .138). As for the TCM symptom scale, the treatment group showed improvement in chest distress (P = .003), fullness and distention (P = .042), shortness of breath (P < .001), no statistical significance in palpitation (P = .237), and pain (P = .063), whereas the placebo group did not show statistical significance in any of the 5 symptoms. Major adverse events related to the treatment, mainly skin irritation, were distributed equally. Conclusions. Kang’ai Xiaoshui ointment showed a potential of reducing MPE, and it could alleviate symptoms of dyspnea. Thus, it may be appropriate as a supplementary intervention for MPE. There were some flaws in the study design. A larger scale and better designed trial is advocated.
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Affiliation(s)
- Wu Feize
- 1 Beijing University of Chinese Medicine, Beijing, China.,2 China-Japan Friendship Hospital, Beijing, China
| | - Liu Meng
- 2 China-Japan Friendship Hospital, Beijing, China
| | - Lou Yanni
- 2 China-Japan Friendship Hospital, Beijing, China
| | - Li Yuan
- 2 China-Japan Friendship Hospital, Beijing, China
| | - Jia Liqun
- 2 China-Japan Friendship Hospital, Beijing, China
| | - Li Tong
- 3 Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Yang Guowang
- 4 Beijing Hospital of Traditional Chinese Medicine, Beijing, China
| | - Cui Huijuan
- 2 China-Japan Friendship Hospital, Beijing, China
| | - Wan Donggui
- 2 China-Japan Friendship Hospital, Beijing, China
| | | | - Zheng Lei
- 1 Beijing University of Chinese Medicine, Beijing, China
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Akulian JA, Yarmus L. If they don't degrade can indwelling pleural catheters evolve? Respirology 2016; 21:787-8. [PMID: 27222077 DOI: 10.1111/resp.12822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 05/03/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Jason A Akulian
- Division of Pulmonary and Critical Care Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Lonny Yarmus
- Division of Pulmonary and Critical Care, Johns Hopkins Hospital, Baltimore, MD, USA
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Cho JS, Na KJ, Lee Y, Kim YD, Ahn HY, Park CR, Kim YC. Chemical Pleurodesis Using Mistletoe Extraction (ABNOVAviscum(®) Injection) for Malignant Pleural Effusion. Ann Thorac Cardiovasc Surg 2015; 22:20-6. [PMID: 26639937 DOI: 10.5761/atcs.oa.15-00230] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Malignant pleural effusion (MPE) is common in patients with advanced cancer. Chemical pleurodesis can be considered for MPE that do not respond to chemotherapy, radiotherapy, or therapeutic thoracentesis. However, it is not yet clear which agent is more effective and safer in chemical pleurodesis. METHODS This study was designed as a single arm, multicenter, and open-label phase III clinical trial to evaluate efficacy and safety of chemical pleurodesis using mistletoe extraction (ABNOVAviscum(®) Injection). References of other agents in chemical pleurodesis were investigated to compare efficacy and safety. Efficacy was evaluated by followed up chest X-ray and changes of clinical symptoms and Karnofsky performance scale. Safety was evaluated by serious adverse event (SAE) and changes of laboratory findings. A follow-up period was 4 weeks after last pleurodesis. RESULTS Of 62 patients, 49 (79.0%) had complete response, 11 (17.7%) had partial response, and two had no response. Mean response rate was significantly different in this study comparing with reference response rate which was 64% (p <0.0001). There were two SAEs, but all were recovered without sequelas. CONCLUSION The results of this study suggest that mistletoe extraction (ABNOVAviscum(®) Injection) could be an effective and safe agent of chemical pleurodesis in patients with MPE.
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Affiliation(s)
- Jeong Su Cho
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Medical Research Institution, Busan, Republic of Korea
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Moon Y, Kim KS, Park JK. Simple intrapleural hyperthermia at thoracoscopic exploration to treat malignant pleural effusion. J Cardiothorac Surg 2015; 10:136. [PMID: 26510956 PMCID: PMC4625971 DOI: 10.1186/s13019-015-0340-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 10/19/2015] [Indexed: 12/17/2022] Open
Abstract
Background Malignant pleural effusion (MPE) occurs at a terminal stage of cancer, and related symptoms may considerably reduce a patient’s respiratory function and quality of life. We assessed the benefit of simple intrapleural hyperthermia (SIH) during thoracoscopic exploration for MPE. Methods We conducted a retrospective review of 34 patients underwent thoracoscopic exploration and SIH procedures for MPE between April, 2009 and July, 2014 at our institution. One month after removal of the tube, therapeutic efficacy was evaluated, calculating response rates and recurrence rate. Results In this cohort (male, 11; female, 23; average age, 54.2 ± 12.7 years), the most frequent primary cancers were breast (n = 11, 32.4 %), lung (n = 10, 29.4 %), and ovarian (n = 6, 17.6 %). Therapeutic response (ie, presence of pleural effusion) was assessed 1 month after chest tube removal, with 19 (55.9 %) showing complete response (CR), 9 (26.5 %) showing partial response (PR), and non-response (NR) seen in 6 (17.6 %). The combined (CR + PR) response rate was 82.4 %. During follow-up, there were seven instances of recurrence, requiring repeat drainage. Three- and 7-month recurrence-free rates were 86.9 and 73.9 %, respectively. No postoperative respiratory complications or fever developed. Early death within 3 months from progression of primary cancer was identified as a risk factor in patients of NR status (HR = 18.36, p = 0.043). Conclusions If thoracoscopic exploration is indicated for MPE, SIH is a safe and effective management alternative in patients whose primary malignancy is not rapidly progressing.
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Affiliation(s)
- Youngkyu Moon
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic Medical Center School of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seoul, Seocho-gu, 06591, Republic of Korea.
| | - Kyung Soo Kim
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic Medical Center School of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seoul, Seocho-gu, 06591, Republic of Korea.
| | - Jae Kil Park
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic Medical Center School of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seoul, Seocho-gu, 06591, Republic of Korea.
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Giarnieri E, Bellipanni G, Macaluso M, Mancini R, Holstein AC, Milanese C, Giovagnoli MR, Giordano A, Russo G. Review: Cell Dynamics in Malignant Pleural Effusions. J Cell Physiol 2015; 230:272-7. [PMID: 25205557 DOI: 10.1002/jcp.24806] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 09/05/2014] [Indexed: 12/29/2022]
Abstract
Malignant pleural effusions (MPEs) are a common manifestation found in patients with lung cancer. After cytological and histological confirmation of malignancy, talc pleurodesis still remains the treatment of choice in patients with MPEs resistant to chemotherapy. Despite this, primary challenges include reduced quality of life and life expectancy in general. Therefore, a better understanding of the cell biology of MPEs, along with improvements in treatment is greatly needed. It has recently been demonstrated that MPEs may represent an excellent source for identification of molecular mechanisms within the tumor and its environment. The present review summarizes the current understanding of MPEs cells and tumor microenvironment, and particularly focuses on dissecting the cross-talk between MPEs and epithelial to mesenchymal transition (EMT), inflammation and cancer stem cells.
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Affiliation(s)
- Enrico Giarnieri
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University La Sapienza, Rome, Italy
| | - Gianfranco Bellipanni
- Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, BioLife Science Bldg., Philadelphia, Pennsylvania
| | - Marcella Macaluso
- Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, BioLife Science Bldg., Philadelphia, Pennsylvania
| | - Rita Mancini
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University La Sapienza, Rome, Italy
| | - Adam Carl Holstein
- Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, BioLife Science Bldg., Philadelphia, Pennsylvania
| | - Carla Milanese
- Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, BioLife Science Bldg., Philadelphia, Pennsylvania
| | - Maria Rosaria Giovagnoli
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University La Sapienza, Rome, Italy
| | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, BioLife Science Bldg., Philadelphia, Pennsylvania.,INT-CROM, "Pascale Foundation" National Cancer Institute-Cancer Research Center, Mercogliano (AV), Italy.,Department of Medical and Surgical Sciences and Neurosciences, University of Siena, Siena, Italy
| | - Giuseppe Russo
- Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, BioLife Science Bldg., Philadelphia, Pennsylvania
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Li Q, Sun W, Yuan D, Lv T, Yin J, Cao E, Xiao X, Song Y. Efficacy and safety of recombinant human tumor necrosis factor application for the treatment of malignant pleural effusion caused by lung cancer. Thorac Cancer 2015; 7:136-9. [PMID: 26816548 PMCID: PMC4718129 DOI: 10.1111/1759-7714.12296] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 06/21/2015] [Indexed: 12/13/2022] Open
Abstract
Malignant pleural effusion (MPE) signifies a poor prognosis for patients with lung cancer. For treating physicians, the primary goals are to achieve sufficient control of MPE and minimize invasive intervention. Recombinant human mutant tumor necrosis factor‐alpha (rhu‐TNF) has been used in the treatment of MPE. The aim of our research was to evaluate the efficacy and safety of rhu‐TNF application via ultrasound‐guided chest tube for the treatment of MPE. rhu‐TNF was administered as a single dose to 102 patients with MPE caused by lung cancer, and dexamethasone (Dxm, 5 mg) was administered 30 minutes before rhu‐TNF in 35 randomly selected patients in order test its ability to prevent side effects. The primary endpoint was the efficacy of the rhu‐TNF treatment (disease response rate) and side effects (pain, fever, and flu‐like symptoms), evaluated four weeks after instillation. The disease response rate of rhu‐TNF treatment was 81.37%. Side effects included 13 (12.75%) patients complaining of flu‐like symptoms, 15 (14.71%) with fever/chill, and 14 (13.73%) with chest pain. A significantly higher efficacy was observed for treatment with 3 MU versus 2 MU of rhu‐TNF (P = 0.036), while the adverse effects were similar. There was no significant association between the dose of rhu‐TNF and progression‐free survival (P = 0.752). In conclusion, our study shows that intra‐pleural instillation of rhu‐TNF achieves sufficient control of MPE and minimizes invasive intervention.
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Affiliation(s)
- Qian Li
- Department of Respiratory and Critical Care Medicine Jinling Hospital School of Medicine Nanjing University Nanjing China
| | - Wenkui Sun
- Department of Respiratory and Critical Care Medicine Jinling Hospital School of Medicine Nanjing University Nanjing China
| | - Dongmei Yuan
- Department of Respiratory and Critical Care Medicine Jinling Hospital School of Medicine Nanjing University Nanjing China
| | - Tangfeng Lv
- Department of Respiratory and Critical Care Medicine Jinling Hospital School of Medicine Nanjing University Nanjing China
| | - Jie Yin
- Department of Respiratory and Critical Care Medicine Jinling Hospital School of Medicine Nanjing University Nanjing China
| | - Ehong Cao
- Department of Respiratory and Critical Care Medicine Jinling Hospital School of Medicine Nanjing University Nanjing China
| | - Xinwu Xiao
- Department of Respiratory and Critical Care Medicine Jinling Hospital School of Medicine Nanjing University Nanjing China
| | - Yong Song
- Department of Respiratory and Critical Care Medicine Jinling Hospital School of Medicine Nanjing University Nanjing China
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Diagnostic accuracy of calretinin for malignant mesothelioma in serous effusions: a meta-analysis. Sci Rep 2015; 5:9507. [PMID: 25821016 PMCID: PMC4377575 DOI: 10.1038/srep09507] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 03/04/2015] [Indexed: 02/05/2023] Open
Abstract
Numerous studies have investigated the utility of calretinin in differentiating malignant mesothelioma (MM) from metastatic carcinoma (MC) in serous effusions. However, the results remain controversial. The aim of this study is to determine the overall accuracy of calretinin in serous effusions for MM through a meta-analysis of published studies. Publications addressing the accuracy of calretinin in the diagnosis of MM were selected from the Medline (Ovid), PubMed, the Cochrane Library Database and the Web of Science. Data from selected studies were pooled to yield summary sensitivity, specificity, positive and negative likelihood ratio (LR), diagnostic odds ratio (DOR), and receiver operating characteristic (SROC) curve. Statistical analysis was performed by Meta-Disc 1.4 and STATA 12.0 softwares. 18 studies met the inclusion criteria and the summary estimating for calretinin in the diagnosis of MM were: sensitivity 0.91 (95%CI: 0.87–0.94), specificity 0.96 (95%CI: 0.95–0.96), positive likelihood ratio (PLR) 14.42 (95%CI: 7.92–26.26), negative likelihood ratio (NLR) 0.1 (95%CI: 0.05–0.2) and diagnostic odds ratio 163.03 (95%CI: 54.62–486.63). The SROC curve indicated that the maximum joint sensitivity and specificity (Q-value) was 0.92; the area under the curve was 0.97. Our findings suggest that calretinin may be a useful diagnostic tool for confirming MM in serous effusions.
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Keeratichananont W, Limthon T, Keeratichananont S. Efficacy and safety profile of autologous blood versus tetracycline pleurodesis for malignant pleural effusion. Ther Adv Respir Dis 2015; 9:42-8. [PMID: 25663279 DOI: 10.1177/1753465815570307] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Autologous blood pleurodesis (ABP) is used for the treatment of pneumothorax with a good efficacy. The aim of this study is to determine the efficacy and safety of ABP in the treatment of malignant pleural effusion (MPE). METHODS A prospective study was conducted at Songklanagarind Hospital, Thailand. Symptomatic MPE patients were randomized to receive pleurodesis with either autologous blood or tetracycline. In the ABP group, 100 ml of autologous venous blood was instilled via chest tube followed by 50 ml of sterile normal saline (NSS). In the tetracycline group, 20 ml of 1% lidocaine diluted in 30 ml NSS was instilled followed by 1 g of tetracycline diluted in 100 ml of NSS. The chest tube was clamped for 2 hours, then reconnected to suction and removed. Pleurodesis effectiveness was evaluated according to Paladine's criteria and adverse events were recorded. RESULTS A total of 48 symptomatic MPE patients were recruited. Of these, 24 cases were randomized to receive ABP and 24 cases received tetracycline. There was no difference between the two groups in baseline characteristics. The overall success rate of pleurodesis was the same in both the autologous blood group and the tetracycline group (83.4% versus 87.5%, p = 0.36). In the ABP group, the pain score and fever were significantly lower (8.3% versus 29.1%, p = 0.003) and there was a small percentage of cases that needed analgesia (4.2% versus 75%, p < 0.001); no serious events occurred. CONCLUSIONS ABP was as effective as tetracycline in the treatment of MPE. ABP produced less pain and fever, and could shorten the hospital stay.
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Affiliation(s)
- Warangkana Keeratichananont
- Assistant Professor, Division of Respiratory and Respiratory Critical Care Medicine, Department of Medicine, Faculty of Medicine, Prince of Songkhla University, Hatyai, Songkhla 90110, Thailand
| | - Theeranan Limthon
- Division of Respiratory and Respiratory Critical Care Medicine, Department of Medicine, Songklanagarind Hospital, Songkhla, Thailand
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Zhu H, Booth CN, Reynolds JP. Clinical presentation and cytopathologic features of malignant pericardial cytology: a single institution analysis spanning a 29-year period. J Am Soc Cytopathol 2015; 4:203-209. [PMID: 31051755 DOI: 10.1016/j.jasc.2015.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/21/2015] [Accepted: 01/21/2015] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Pericardial effusion can be a consequence of various diseased states, including infection, autoimmune disease, renal failure, myocardial disease, and neoplasms. Although multiple case reports of malignancy-associated pericardial effusion have been published, few database analyses are available in these published reports. In this study, we retrospectively reviewed 1022 cytology cases and assessed malignancy-associated pericardial effusion. MATERIALS AND METHODS We reviewed our cytology reports for pericardial effusion cases from January 1, 1983 to July 31, 2013. These cases were classified as benign, atypical, malignant, and nondiagnostic. The malignant cases were further characterized based on either immunohistochemical staining results or patients' history. RESULTS We identified 1022 cases and grouped them as follows: 824 benign (80.6%), 38 atypical (3.7%), 158 malignant (15.4%), and 2 unsatisfactory (0.1%). Malignant cases included 131 adenocarcinoma (82.9%), 12 lymphoma (7.9%), 6 poorly differentiated carcinoma (3.8%), 4 mesothelioma (2.5%), 2 squamous cell carcinoma (1.3%), 1 melanoma (0.6%), 1 sarcoma (0.6%), and 1 small cell carcinoma (0.6%). Of these 131 adenocarcinomas, 83 cases had clinical history and/or immunohistochemical study available for further classification, which included 44 lung, 18 breast, 7 esophagogastric adenocarcinomas, 6 adenocarcinomas of unknown primary sites, 5 ovarian, and 2 rectal adenocarcinomas. The clinical presentation, prognosis, and cytopathologic features for malignant pericardial effusions are summarized. CONCLUSIONS In this study, 15.4% of pericardial effusion cases were caused by metastatic malignancy, with lung adenocarcinoma being the most common primary site, followed by breast and lymphoma. Relatively young patients are affected, with average age being 56 years. Prognosis is poor for patients with malignant pericardial effusion. However, targeted therapy showed improved survival.
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Affiliation(s)
- Hui Zhu
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio
| | - Christine N Booth
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio
| | - Jordan P Reynolds
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio.
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Diagnostic accuracy of Ber-EP4 for metastatic adenocarcinoma in serous effusions: a meta-analysis. PLoS One 2014; 9:e107741. [PMID: 25229691 PMCID: PMC4168227 DOI: 10.1371/journal.pone.0107741] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 08/14/2014] [Indexed: 02/05/2023] Open
Abstract
Numerous studies have investigated the utility of Ber-EP4 in differentiating metastatic adenocarcinoma (MAC) from malignant epithelial mesothelioma (MM) and/or reactive mesothelial cells (RM) in serous effusions. However, the results remain controversial. The aim of this study is to determine the overall accuracy of Ber-EP4 in serous effusions for MAC through a meta-analysis of published studies. Publications addressing the accuracy of Ber-EP4 in the diagnosis of MAC were selected from the Pubmed, Embase and Cochrane Library. Data from selected studies were pooled to yield summary sensitivity, specificity, positive and negative likelihood ratio (LR), diagnostic odds ratio (DOR), and receiver operating characteristic (SROC) curve. Statistical analysis was performed by Meta-Disc 1.4 and STATA 12.0 softwares. 29 studies, based on 2646 patients, met the inclusion criteria and the summary estimating for Ber-EP4 in the diagnosis of MAC were: sensitivity 0.8 (95% CI: 0.78-0.82), specificity 0.94 (95% CI: 0.93-0.96), positive likelihood ratio (PLR) 12.72 (95% CI: 8.66-18.7), negative likelihood ratio (NLR) 0.18 (95% CI: 0.12-0.26) and diagnostic odds ratio 95.05 (95% CI: 57.26-157.77). The SROC curve indicated that the maximum joint sensitivity and specificity (Q-value) was 0.91; the area under the curve was 0.96. Our findings suggest that BER-EP4 may be a useful diagnostic adjunctive tool for confirming MAC in serous effusions.
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Yoon SY, Kim JH, Kim WS, Chung HW, Lee MH, Kim SY, Cho YH. Pleural Metastasis as Initial Presentation of Occult Gastric Cardia Cancer: A Possible Role of PET-CT in Diagnosis. Cancer Res Treat 2014; 46:415-8. [PMID: 25036578 PMCID: PMC4206069 DOI: 10.4143/crt.2013.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 06/20/2013] [Indexed: 11/21/2022] Open
Abstract
We report on a case of malignant pleural effusion as initial metastatic presentation of occult gastric cardia cancer in a young woman. To the best of our knowledge, this is the first report of gastric adenocarcinoma metastasized to pleura as an initial presentation. Location of cardia and signet ring cell histology may contribute to the manifestation. Utilization of positron emission tomography-computed tomography was helpful for proper diagnosis. For patients with such distinct clinical presentations, it would be appropriate to consider gastric cancer as one of the possible primary sites.
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Affiliation(s)
- So Young Yoon
- Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Jeong Hwan Kim
- Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Wan Seop Kim
- Department of Pathology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Hyun Woo Chung
- Department of Nuclear Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Mark Hong Lee
- Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Sung Yong Kim
- Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Yo Han Cho
- Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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Patterson MJ, Sutton RE, Forrest I, Sharrock R, Lane M, Kaufmann A, O'Donnell R, Edmondson RJ, Wilson BT, Curtin NJ. Assessing the function of homologous recombination DNA repair in malignant pleural effusion (MPE) samples. Br J Cancer 2014; 111:94-100. [PMID: 24867690 PMCID: PMC4090730 DOI: 10.1038/bjc.2014.261] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/20/2014] [Accepted: 04/23/2014] [Indexed: 12/02/2022] Open
Abstract
Background: Patients with malignant pleural effusions (MPEs) generally have advanced disease with poor survival and few therapeutic options. Cells within MPEs may be used to stratify patients for targeted therapy. Targeted therapy with poly(ADP ribose) polymerase inhibitors (PARPi) depends on identifying homologous recombination DNA repair (HRR)-defective cancer cells. We aimed to determine the feasibility of assaying HRR status in MPE cells. Methods: A total of 15 MPE samples were collected from consenting patients with non-small-cell lung cancer (NSCLC), mesothelioma and ovarian and breast cancer. Primary cultures were confirmed as epithelial by pancytokeratin, and HRR status was determined by the detection of γH2AX and RAD51 foci following a 24-h exposure to rucaparib, by immunofluorescence microscopy. Massively parallel next-generation sequencing of DNA repair genes was performed on cultured MPE cells. Results: From 15 MPE samples, 13 cultures were successfully established, with HRR function successfully determined in 12 cultures. Four samples – three NSCLC and one mesothelioma – were HRR defective and eight samples – one NSCLC, one mesothelioma, one sarcomatoid, one breast and four ovarian cancers – were HRR functional. No mutations in DNA repair genes were associated with HRR status, but there was probable loss of heterozygosity of FANCG, RPA1 and PARP1. Conclusions: HRR function can be successfully detected in MPE cells demonstrating the potential to stratify patients for targeted therapy with PARPi.
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Affiliation(s)
- M J Patterson
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - R E Sutton
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne NE1 3BZ, UK
| | - I Forrest
- Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
| | - R Sharrock
- Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
| | - M Lane
- Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
| | - A Kaufmann
- 1] Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne NE2 4HH, UK [2] The Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead Foundation Trust, Gateshead NE9 6SX, UK
| | - R O'Donnell
- 1] Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne NE2 4HH, UK [2] The Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead Foundation Trust, Gateshead NE9 6SX, UK
| | - R J Edmondson
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - B T Wilson
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne NE1 3BZ, UK
| | - N J Curtin
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
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Gao BA, Zhou G, Guan L, Zhang LY, Xiang GM. Effectiveness and safety of diagnostic flexi-rigid thoracoscopy in differentiating exudative pleural effusion of unknown etiology: a retrospective study of 215 patients. J Thorac Dis 2014; 6:438-43. [PMID: 24822100 DOI: 10.3978/j.issn.2072-1439.2014.02.09] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 02/19/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the effectiveness and safety of diagnostic flexi-rigid thoracoscopy in differentiating exudative pleural effusion of unknown etiology. METHODS A total of 215 patients with undiagnosed exudative pleural effusion were consecutively recruited between January 2011 and February 2013. Thoracoscopy was carried out under local anesthesia, and multisite pleural biopsies were performed using a flexi-rigid thoracoscope. The tolerance of the patients, surgical complications and postoperative pathological diagnosis rate were used to evaluate the effectiveness and safety of the thoracoscopy procedures. RESULTS All patients, Karnofsky performance status (KPS) >70, could tolerate both the thoracoscopic surgery and pleural biopsy; there were no severe complications. Thoracoscopic findings included pleural hyperaemia, fibrinous adhesion, nodular bulge and fester. The pathological biopsy confirmed diagnoses of malignant tumor (97 cases), tuberculous pleuritis (91 cases), tuberculous empyema (one case), pulmonary schistosomiasis (one case) and unknown etiology (25 cases). The total diagnosis rate was 88.4%. Subcutaneous emphysema occurred in ten cases and fever in six cases, all of which recovered completely with conservative treatment. CONCLUSIONS Flexi-rigid thoracoscopy had a high diagnosis rate, differentiating exudative pleural effusion of unknown etiology with satisfactory effectiveness and safety. There was high degree of relationship between thoracoscopic appearance and primary disease or tumor classification.
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Affiliation(s)
- Bao-An Gao
- 1 Department of Respiratory Medicine, 2 RICU, The First College of Clinical Medical Science of China Three Gorges University & Yichang Central People's Hospital, Yichang 443003, China
| | - Gang Zhou
- 1 Department of Respiratory Medicine, 2 RICU, The First College of Clinical Medical Science of China Three Gorges University & Yichang Central People's Hospital, Yichang 443003, China
| | - Li Guan
- 1 Department of Respiratory Medicine, 2 RICU, The First College of Clinical Medical Science of China Three Gorges University & Yichang Central People's Hospital, Yichang 443003, China
| | - Ling-Yun Zhang
- 1 Department of Respiratory Medicine, 2 RICU, The First College of Clinical Medical Science of China Three Gorges University & Yichang Central People's Hospital, Yichang 443003, China
| | - Guang-Ming Xiang
- 1 Department of Respiratory Medicine, 2 RICU, The First College of Clinical Medical Science of China Three Gorges University & Yichang Central People's Hospital, Yichang 443003, China
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Li D, Wang B, Hu Q, Shen Y, Xu D, Wang T, Wen F. Diagnostic accuracy of MOC-31 for malignant effusions: a meta-analysis. Tumour Biol 2014; 35:6003-9. [DOI: 10.1007/s13277-014-1795-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 02/25/2014] [Indexed: 01/06/2023] Open
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Abstract
Malignant pleural effusion (MPE) refers to the presence of neoplastic cells in the pleural fluid. Approximately 40 000 people per year in the UK are affected by MPE and it is associated with significant morbidity and an overall poor prognosis. Management should be prompt and care plans should be individualized and involve a multidisciplinary team of healthcare professionals. This article reviews the pathophysiology of MPE along with available investigations and management strategies for these patients.
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Affiliation(s)
- A M Egan
- Interventional Respiratory Unit, Galway University Hospital, Newcastle Road, Galway, Ireland.
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Xia H, Wang XJ, Zhou Q, Shi HZ, Tong ZH. Efficacy and safety of talc pleurodesis for malignant pleural effusion: a meta-analysis. PLoS One 2014; 9:e87060. [PMID: 24475222 PMCID: PMC3903610 DOI: 10.1371/journal.pone.0087060] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 12/17/2013] [Indexed: 11/18/2022] Open
Abstract
Background Talc pleurodesis has been widely used to control malignant pleural effusion; however, it is still not clear whether talc pleurodesis is more effective than other local therapies. We performed a meta-analysis to evaluate the efficacy and safety of talc pleurodesis in the management of malignant pleural effusion. Methods PubMed, Embase, and Web of Science were searched for English-language studies of clinical controlled trials comparing talc pleurodesis with control therapies until August 8, 2013. Success rate and incidence of adverse events were evaluated. Relative risks were estimated using random- or fixed- effects model and statistical heterogeneity was assessed using I2 test. Results Twenty trials involving 1,525 patients with malignant pleural effusion were included. The success rate of talc pleurodesis was significantly higher than that of control therapies (relative risk, 1.21; 95% confidence interval, 1.01–1.45; p = 0.035) with similar adverse events. In addition, thoracoscopic talc poudrage was more effective than bedside talc slurry (relative risk, 1.12; 95% confidence interval, 1.01–1.23; p = 0.026). Conclusions The current evidences suggested the benefit for talc pleurodesis in the treatment of malignant pleural effusion. Talc pleurodesis, especially thoracoscopic talc poudrage pleurodesis, should be performed in patients with malignant pleural effusion, especially those with life-expectancy longer than one month.
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Affiliation(s)
- Huan Xia
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Xiao-Juan Wang
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Qiong Zhou
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huan-Zhong Shi
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
- Center of Medical Research, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zhao-Hui Tong
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
- * E-mail:
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Ercan S, Davutoglu V, Altunbas G, Inanc IH, Kaplan M, Oylumlu M, Koç I, Yuce M, Ozer O, Soydinc S. Prognostic role of incidental pleural effusion diagnosed during echocardiographic evaluation. Clin Cardiol 2014; 37:115-8. [PMID: 24399802 DOI: 10.1002/clc.22239] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 11/27/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine the long-term prognostic implications of incidental pleural effusion (PE) detected during echocardiographic examination and its relationship with concomitant diseases. HYPOTHESIS The study hypothesis is to test whether incidental pleural PE detected during echocardiographic examination be used as a prognostic marker. METHODS The study was performed by evaluating patient records (N = 251) in whom PE was incidentally detected during echocardiographic examination in a tertiary hospital between 1999 and 2012. The patients were classified into 4 major groups according to the concomitant primary disease: malignancy, and cardiovascular, renal, and pulmonary diseases. The total survival time was obtained from hospital records for patients who died during the hospital stay and social security institution records for patients with out-of-hospital death. RESULTS One-year and 5-year life expectancies of PE cases concomitant with different disorders were as follows; heart failure (n = 151), 81% and 70%; malignancies (n = 45), 53% and 44%; pulmonary diseases (n = 37), 89% and 78%; renal diseases (n = 18), 100% and 83%; respectively. PE associated with heart failure, renal disease, and pulmonary disease had similar (P > 0.05 for all) and favorable outcomes compared to PE associated with malignancies (P < 0.001). CONCLUSIONS The prognosis of incidental PE was the worst in patients with concomitant malignancies; however, PE associated with nonmalignant diseases including heart failure, pulmonary disease, and renal disease have similar and favorable outcomes.
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Affiliation(s)
- Suleyman Ercan
- Department of Cardiology, University of Gaziantep, Gaziantep, Turkey
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Tang Y, Xu L. Superiority and clinical significance of Lunx mRNA in the diagnosis of malignant pleural effusion caused by pulmonary carcinoma. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2013; 32:37. [PMID: 23759037 PMCID: PMC3681715 DOI: 10.1186/1756-9966-32-37] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 05/25/2013] [Indexed: 12/18/2022]
Abstract
Background Pulmonary carcinoma is the main cause of malignant pleural effusions (MPEs). However, there is no satisfactory marker for diagnosing MPEs caused by pulmonary carcinoma. The purpose of this study is to assess the clinical significance of Lunx mRNA detection in diagnosing MPEs caused by pulmonary carcinoma. Methods A total of 209 patients with pleural effusions were recruited. The patients were diagnosed by cast-off cells, bronchoscopy, and pleural biopsy. The levels of Lunx mRNA in the pleural effusions were determined by real-time PCR. The levels of PH, LDH, glucose, albumin, and CEA were also determined. Patients who accepted chemotherapy underwent Lunx mRNA detection before and after the first chemotherapy session. The patients were divided into four groups according the effect of chemotherapy: complete remission (CR), partial remission (PR), no change (NC), and progressive disease (PD). The patients were also divided into two groups according the change in direction of Lunx mRNA expression after chemotherapy: increased group and decreased group. The patients were followed up to determine survival. Results Lunx mRNA was positive in 89 of 106 patients with pleural effusions caused by pulmonary carcinoma. The specificity and sensitivity were 95.9% and 84.9%. The area under the ROC curve was 0.922. Lunx mRNA detection was better than detection using cast-off cells and CEA. All of the Lunx-positive patients with MPEs were diagnosed with pulmonary carcinoma, and all extrapulmonary carcinoma patients were Lunx-negative. The positive predictive value of Lunx mRNA for the source of tumor cells was 100%. Lunx mRNA expression decreased after the first session of chemotherapy in the CR and PR groups, increased in the PD group, there was no change in the NC group. Further analysis indicated the change in direction of Lunx mRNA expression was associated with the overall survival of patients. The patients in the increased group had longer overall survival times than those in the decreased group. Conclusion Lunx mRNA is a specific tumor gene that is highly expressed in MPEs caused by pulmonary carcinoma. The changes in Lunx mRNA levels after chemotherapy can predict the prognosis of patients with MPEs caused by pulmonary carcinoma.
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Affiliation(s)
- Ying Tang
- Department of Respiratory Medicine, the First Hospital of Jilin University, Changchun; 130021, China
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