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Kumar A, Xu B, Srinivasan D, Potter AL, Raman V, Lanuti M, Yang CFJ, Auchincloss HG. Long-Term Survival of American Joint Committee on Cancer 8th Edition Staging Descriptors for Clinical M1a Non-Small Cell Lung Cancer. Chest 2024; 165:725-737. [PMID: 37544427 DOI: 10.1016/j.chest.2023.07.4220] [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: 04/19/2023] [Revised: 07/22/2023] [Accepted: 07/30/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND The American Joint Committee on Cancer (AJCC) 8th edition TNM staging manual for non-small cell lung cancer (NSCLC) M1a descriptors includes tumors presenting with malignant pleural or pericardial effusion (ie, M1a-Effusion), pleural or pericardial nodule(s) (ie, M1a-Pleural), or separate tumor nodule(s) in a contralateral lobe (ie, M1a-Contralateral). RESEARCH QUESTION Is M1a NSCLC presenting with malignant pleural or pericardial effusion associated with worse survival compared with other types of M1a NSCLC? STUDY DESIGN AND METHODS Patients with cT1-4, N0-3, M1a NSCLC (satisfying a single M1a descriptor of M1a-Effusion, M1a-Pleural, or M1a-Contralateral), according to AJCC eighth edition staging criteria, in the National Cancer Database from 2010 to 2015 were included. Overall survival was evaluated by using Kaplan-Meier analysis, multivariable-adjusted Cox proportional hazards modeling, and propensity score matching. RESULTS Of the 25,716 patients who met study eligibility criteria, 12,756 (49.6%) presented with M1a-Effusion tumors, 3,589 (14.0%) with M1a-Pleural tumors, and 9,371 (36.4%) with M1a-Contralateral tumors. In multivariable-adjusted analysis, compared to M1a-Effusion tumors, both M1a-Pleural tumors (hazard ratio, 0.68; 95% CI, 0.64-0.71; P < .001) and M1a-Contralateral tumors (hazard ratio, 0.66; 95% CI, 0.64-0.69; P < .001) were associated with better overall survival. No significant differences were found in overall survival between patients with M1a-Pleural tumors vs M1a-Contralateral tumors. In a propensity score-matched analysis of 5,581 patients with M1a-Effusion tumors and 5,581 patients with other M1a tumors (ie, M1a-Contralateral or M1a-Effusion), those with M1a-Effusion tumors had worse 5-year overall survival than patients with other M1a tumors (M1a-Effusion 6.4% [95% CI, 5.7-7.1] vs M1a-Other 10.6% [95% CI, 9.7-11.5]; P < .001). INTERPRETATION In this national analysis of AJCC 8th edition cT1-4, N0-3, M1a NSCLC, tumors with malignant pleural or pericardial effusion were associated with worse overall survival than tumors with either pleural or contralateral pulmonary nodules. These findings may be taken into consideration for the upcoming ninth edition of the AJCC lung cancer staging guidelines.
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Affiliation(s)
- Arvind Kumar
- Icahn School of Medicine at Mt. Sinai, New York, NY
| | - Barry Xu
- Department of Surgery, Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA
| | - Deepti Srinivasan
- Department of Surgery, Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA
| | - Alexandra L Potter
- Department of Surgery, Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA
| | - Vignesh Raman
- Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, NC
| | - Michael Lanuti
- Department of Surgery, Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA
| | - Chi-Fu Jeffrey Yang
- Department of Surgery, Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA
| | - Hugh G Auchincloss
- Department of Surgery, Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA.
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Ni C, Wu D, Chen Y, Wang S, Xiang N. Cascaded elasto-inertial separation of malignant tumor cells from untreated malignant pleural and peritoneal effusions. LAB ON A CHIP 2024; 24:697-706. [PMID: 38273802 DOI: 10.1039/d3lc00801k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Separation of malignant tumor cells (MTCs) from large background cells in untreated malignant pleural and peritoneal effusions (MPPEs) is critical for improving the sensitivity and efficiency of cytological diagnosis. Herein, we proposed a cascaded elasto-inertial cell separation (CEICS) device integrating an interfacial elasto-inertial microfluidic channel with a symmetric contraction expansion array (CEA) channel for pretreatment-free, high-recovery-ratio, and high-purity separation of MTCs from clinical MPPEs. First, the effects of flow-rate ratio, cell concentration, and cell size on separation performances in two single-stage channels were investigated. Then, the performances of the integrated CEICS device were characterized using blood cells spiked with three different tumor cells (MCF-7, MDA-MB-231, and A549 cells) at a high total throughput of 240 μL min-1. An average recovery ratio of ∼95% and an average purity of ∼61% for the three tumor cells were achieved. Finally, we successfully applied the CEICS device for the pretreatment-free separation of MTCs from clinical MPPEs of different cancers. Our CEICS device may provide a preparation tool for improving the sensitivity and efficiency of cytological examination.
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Affiliation(s)
- Chen Ni
- School of Mechanical Engineering, and Jiangsu Key Laboratory for Design and Manufacture of Micro-Nano Biomedical Instruments, Southeast University, Nanjing, 211189, China.
| | - Dan Wu
- Department of Oncology, Jiangyin People's Hospital, Jiangyin, 214400, China
| | - Yao Chen
- School of Mechanical Engineering, and Jiangsu Key Laboratory for Design and Manufacture of Micro-Nano Biomedical Instruments, Southeast University, Nanjing, 211189, China.
| | - Silin Wang
- School of Mechanical Engineering, and Jiangsu Key Laboratory for Design and Manufacture of Micro-Nano Biomedical Instruments, Southeast University, Nanjing, 211189, China.
| | - 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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Wei M, Zhang Y, Zhao L, Zhao Z. Development and validation of a radiomics nomogram for diagnosis of malignant pleural effusion. Discov Oncol 2023; 14:213. [PMID: 37999794 PMCID: PMC10673775 DOI: 10.1007/s12672-023-00835-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/21/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE We aimed to develop a radiomics nomogram based on computed tomography (CT) scan features and high-throughput radiomics features for diagnosis of malignant pleural effusion (MPE). METHODS In this study, 507 eligible patients with PE (207 malignant and 300 benign) were collected retrospectively. Patients were divided into training (n = 355) and validation cohorts (n = 152). Radiomics features were extracted from initial unenhanced CT images. CT scan features of PE were also collected. We used the variance threshold algorithm and least absolute shrinkage and selection operator (LASSO) to select optimal features to build a radiomics model for predicting the nature of PE. Univariate and multivariable logistic regression analyzes were used to identify significant independent factors associated with MPE, which were then included in the radiomics nomogram. RESULTS A total of four CT features were retained as significant independent factors, including massive PE, obstructive atelectasis or pneumonia, pleural thickening > 10 mm, and pulmonary nodules and/or masses. The radiomics nomogram constructed from 13 radiomics parameters and four CT features showed good predictive efficacy in training cohort [area under the curve (AUC) = 0.926, 95% CI 0.894, 0.951] and validation cohort (AUC = 0.916, 95% CI 0.860, 0.955). The calibration curve and decision curve analysis showed that the nomogram helped differentiate MPE from benign pleural effusion (BPE) in clinical practice. CONCLUSION This study presents a nomogram model incorporating CT scan features and radiomics features to help physicians differentiate MPE from BPE.
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Affiliation(s)
- Mingzhu Wei
- Department of Radiology, Shaoxing People's Hospital, Shaoxing, Zhejiang, People's Republic of China.
- Department of Radiology, Shaoxing People's Hospital, No. 568, Zhongxing North Road, Yuecheng District, Shaoxing, 312000, Zhejiang, People's Republic of China.
| | - Yaping Zhang
- Department of Radiology, Shaoxing People's Hospital, Shaoxing, Zhejiang, People's Republic of China
| | - Li Zhao
- Department of Radiology, Shaoxing People's Hospital, Shaoxing, Zhejiang, People's Republic of China
| | - Zhenhua Zhao
- Department of Radiology, Shaoxing People's Hospital, Shaoxing, Zhejiang, People's Republic of China
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Gri N, Longhitano Y, Zanza C, Monticone V, Fuschi D, Piccioni A, Bellou A, Esposito C, Ceresa IF, Savioli G. Acute Oncologic Complications: Clinical-Therapeutic Management in Critical Care and Emergency Departments. Curr Oncol 2023; 30:7315-7334. [PMID: 37623012 PMCID: PMC10453099 DOI: 10.3390/curroncol30080531] [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: 05/07/2023] [Revised: 07/01/2023] [Accepted: 07/10/2023] [Indexed: 08/26/2023] Open
Abstract
Introduction. It is now known that cancer is a major public health problem; on the other hand, it is less known, or rather, often underestimated, that a significant percentage of cancer patients will experience a cancer-related emergency. These conditions, depending on the severity, may require treatment in intensive care or in the emergency departments. In addition, it is not uncommon for a tumor pathology to manifest itself directly, in the first instance, with a related emergency. The emergency unit proves to be a fundamental and central unit in the management of cancer patients. Many cancer cases are diagnosed in the first instance as a result of symptoms that lead the patient's admittance into the emergency room. Materials and Methods. This narrative review aims to analyze the impact of acute oncological cases in the emergency setting and the role of the emergency physician in their management. A search was conducted over the period January 1981-April 2023 using the main scientific platforms, including PubMed, Scopus, Medline, Embase and Google scholar, and 156 papers were analyzed. Results. To probe into the main oncological emergencies and their management in increasingly overcrowded emergency departments, we analyzed the following acute pathologies: neurological emergencies, metabolic and endocrinological emergencies, vascular emergencies, malignant effusions, neutropenic fever and anemia. Discussion/Conclusions. Our analysis found that a redefinition of the emergency department connected with the treatment of oncology patients is necessary, considering not only the treatment of the oncological disease in the strict sense, but also the comorbidities, the oncological emergencies and the palliative care setting. The need to redesign an emergency department that is able to manage acute oncological cases and end of life appears clear, especially when this turns out to be related to severe effects that cannot be managed at home with integrated home care. In conclusion, a redefinition of the paradigm appears mandatory, such as the integration between the various specialists belonging to oncological medicine and the emergency department. Therefore, our work aims to provide what can be a handbook to detect, diagnose and treat oncological emergencies, hoping for patient management in a multidisciplinary perspective, which could also lead to the regular presence of an oncologist in the emergency room.
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Affiliation(s)
- Nicole Gri
- Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell’Ospedale Maggiore, 3, 20162 Milano, Italy
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Christian Zanza
- Italian Society of Prehospital Emergency Medicine (SIS 118), 74121 Taranto, Italy
| | - Valentina Monticone
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, 10043 Orbassano, Italy
| | - Damiano Fuschi
- Department of Italian and Supranational Public Law, School of Law, University of Milan, 20122 Milan, Italy
| | - Andrea Piccioni
- Department of Emergency Medicine, Polyclinic Agostino Gemelli/IRCCS, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Abdelouahab Bellou
- Department of Emergency Medicine, Institute of Sciences in Emergency Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Ciro Esposito
- Unit of Nephrology and Dialysis, ICS Maugeri, University of Pavia, 27100 Pavia, Italy
| | | | - Gabriele Savioli
- Emergency Department, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
- PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
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Zhao Y, Yu L, Wang L, Wu Y, Chen H, Wang Q, Wu Y. Current status of and progress in the treatment of malignant pleural effusion of lung cancer. Front Oncol 2023; 12:961440. [PMID: 36818672 PMCID: PMC9933866 DOI: 10.3389/fonc.2022.961440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 12/30/2022] [Indexed: 01/22/2023] Open
Abstract
Malignant pleural effusion (MPE) is a common complication in the late stage of malignant tumors. The appearance of MPE indicates that the primary tumor has spread to the pleura or progressed to an advanced stage. The survival time of the patients will be significantly shortened, with a median survival of only a few months. There are a variety of traditional treatments, and their advantages and disadvantages are relatively clear. There are still many problems that cannot be solved by traditional methods in clinical work. The most common one is intrapleural perfusion therapy with chemotherapy drugs, but it has a large side effect of chemotherapy. At present, with the development of medical technology, there are a variety of treatment methods, and many innovative, significant and valuable treatment methods have emerged, which also bring hope for the treatment of refractory and recurrent MPE patients. Several clinical trials had confirmed that drug-carrying microparticles has less adverse reactions and obvious curative effect. However, there is still a long way to go to completely control and cure MPE, and the organic combination of clinical work and scientific research results is needed to bring dawn to refractory MPE patients.
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Affiliation(s)
| | | | | | | | | | | | - Yufeng Wu
- *Correspondence: Qiming Wang, ; Yufeng Wu,
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6
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Guo L, Zhang Q, Lv C, Ma X, Song X, Huang J, Chen W, Li C, Ding Q. A novel biomarker for pleural effusion diagnosis: Interleukin-36γ in pleural fluid. J Clin Lab Anal 2022; 37:e24799. [PMID: 36478612 PMCID: PMC9833963 DOI: 10.1002/jcla.24799] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Numerous studies have described the critical importance of interleukin (IL) -36γ in host defense against lung infections, but it is unknown whether it plays a role in infectious pleural effusion (IPE). This study aimed to examine the levels of IL-36γ in pleural effusions of different etiologies and evaluate the diagnostic accuracy of IL-36γ in the differential diagnosis of IPE. METHODS A total of 112 individuals was enrolled in this research. IL-36γ levels in pleural fluids of all 112 patients were measured by enzyme-linked immunosorbent assay (ELISA). We also characterized these markers' diagnostic values across various groups. RESULTS Patients with tuberculous pleural effusion (TPE) and parapneumonic effusion (PPE) had exhibited markedly higher IL-36γ levels in their pleural fluid than the malignant pleural effusion (MPE) and transudative effusion patients. Furthermore, the IL-36γ concentrations in TPE patients were evidently higher than in uncomplicated parapneumonic effusion (UPPE) patients but significantly lower than in complicated parapneumonic effusion (CPPE)/empyema patients. Pleural fluid IL-36γ is a useful marker to differentiate TPE from UPPE, at a cut-off value for 657.5 pg/ml (area under the curve = 0.904, p < 0.0001) with 70.0% sensitivity and 95.7% specificity. CONCLUSIONS The elevated IL-36γ in pleural effusion may be used as a novel biomarker for infectious pleural effusion diagnosis, particularly in patients with CPPE/empyema, and is a potentially promising biomarker to differentiate between TPE and UPPE.
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Affiliation(s)
- Lun Guo
- School of MedicineNingbo UniversityNingboChina,Department of Pulmonary and Critical Care Medicine, The Affiliated Hospital of Medical SchoolNingbo UniversityNingboChina
| | - Qipan Zhang
- School of MedicineNingbo UniversityNingboChina,Department of Pulmonary and Critical Care Medicine, The Affiliated Hospital of Medical SchoolNingbo UniversityNingboChina
| | - Chengna Lv
- Department of Pulmonary and Critical Care Medicine, The Affiliated Hospital of Medical SchoolNingbo UniversityNingboChina
| | - Xudan Ma
- School of MedicineNingbo UniversityNingboChina,Department of Pulmonary and Critical Care Medicine, The Affiliated Hospital of Medical SchoolNingbo UniversityNingboChina
| | - Xuxiang Song
- School of MedicineNingbo UniversityNingboChina,Department of Pulmonary and Critical Care Medicine, The Affiliated Hospital of Medical SchoolNingbo UniversityNingboChina
| | - Jing Huang
- Department of Pharmacy, The Affiliated Hospital of Medical CollegeNingbo UniversityNingboChina
| | - Weili Chen
- School of MedicineNingbo UniversityNingboChina,Department of Pulmonary and Critical Care Medicine, The Affiliated Hospital of Medical SchoolNingbo UniversityNingboChina
| | - Chaofen Li
- Department of laboratory medicineNingbo Ninth HospitalNingboChina
| | - Qunli Ding
- Department of Pulmonary and Critical Care Medicine, The Affiliated Hospital of Medical SchoolNingbo UniversityNingboChina
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7
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Sen M, Hausler RM, Dulmage K, Black TA, Murphy W, Pletcher Jr CH, Wang L, Chen C, Yee SS, Bornheimer SJ, Maxwell KN, Stanger BZ, Moore JS, Thompson JC, Carpenter EL. Transcriptional profiling of single tumour cells from pleural effusions reveals heterogeneity of epithelial to mesenchymal transition and extra-cellular matrix marker expression. Clin Transl Med 2022; 12:e888. [PMID: 35811459 PMCID: PMC9271990 DOI: 10.1002/ctm2.888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/29/2022] [Accepted: 05/05/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Moen Sen
- Department of Medicine, Division of Hematology and Oncology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ryan M. Hausler
- Department of Medicine, Division of Hematology and Oncology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Keely Dulmage
- Life Science InnovationBD Technologies and InnovationsDurhamNorth CarolinaUSA
| | - Taylor A. Black
- Department of Medicine, Division of Hematology and Oncology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - William Murphy
- Department of Pathology and Laboratory Medicine, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Charles H. Pletcher Jr
- Department of Pathology and Laboratory Medicine, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ling Wang
- Life Science InnovationBD Technologies and InnovationsDurhamNorth CarolinaUSA
| | - Chang Chen
- Life Science InnovationBD Technologies and InnovationsDurhamNorth CarolinaUSA
| | - Stephanie S. Yee
- Department of Medicine, Division of Hematology and Oncology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Kara N. Maxwell
- Department of Medicine, Division of Hematology and Oncology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ben Z. Stanger
- Department of Medicine, Division of Gastroenterology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jonni S. Moore
- Department of Pathology and Laboratory Medicine, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jeffrey C. Thompson
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Thoracic Oncology GroupUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Erica L. Carpenter
- Department of Medicine, Division of Hematology and Oncology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Trivedi SB, Niemeyer M. Treating Recurrent Pleural Disease: A Review of Indications and Technique for Chemical Pleurodesis for the Interventional Radiologist. Semin Intervent Radiol 2022; 39:275-284. [PMID: 36062225 PMCID: PMC9433148 DOI: 10.1055/s-0042-1754349] [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: 10/14/2022]
Abstract
Pleural space diseases such as recurrent pleural effusion and pneumothorax inflict a significant symptomatic burden on patients. Guidelines and studies are available to guide best practices in the setting of refractory effusions, mostly in the setting of malignancy, and recurrent pneumothorax. Less data is available to guide management of refractory transudative effusions. Recurrent pleural effusions can be treated with tunneled pleural catheters or catheter-based pleurodesis. While refractory transudative effusions can benefit from tunneled pleural catheter, this is an area of ongoing research. Regarding recurrent pneumothorax, video-assisted thoracoscopic surgery (VATS) pleurodesis using mechanical or laser/argon beam coagulation is the most effective means of preventing recurrence. Catheter based pleurodesis, a less invasive means of administering chemical sclerosant via percutaneous thoracostomy tube, is only used when surgery is not an option. However, both approaches induce inflammation of the pleural space, resulting in adherence of the parietal and visceral pleura to prevent fluid or air re-accumulation. This article will discuss catheter based chemical pleurodesis geared toward the interventional radiologist, including a review of disease processes and indications, technique, and strategies to mitigate complications as well as a literature review comparing percutaneous chemical pleurodesis to other therapies.
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Affiliation(s)
- Surbhi B. Trivedi
- Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Matthew Niemeyer
- Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
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Update on the diagnosis and management of malignant pleural effusions. Respir Med 2022; 196:106802. [DOI: 10.1016/j.rmed.2022.106802] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 12/17/2022]
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10
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Wu A, Liang Z, Yuan S, Wang S, Peng W, Mo Y, Yang J, Liu Y. Development and Validation of a Scoring System for Early Diagnosis of Malignant Pleural Effusion Based on a Nomogram. Front Oncol 2021; 11:775079. [PMID: 34950585 PMCID: PMC8688822 DOI: 10.3389/fonc.2021.775079] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/17/2021] [Indexed: 01/19/2023] Open
Abstract
Background The diagnostic value of clinical and laboratory features to differentiate between malignant pleural effusion (MPE) and benign pleural effusion (BPE) has not yet been established. Objectives The present study aimed to develop and validate the diagnostic accuracy of a scoring system based on a nomogram to distinguish MPE from BPE. Methods A total of 1,239 eligible patients with PE were recruited in this study and randomly divided into a training set and an internal validation set at a ratio of 7:3. Logistic regression analysis was performed in the training set, and a nomogram was developed using selected predictors. The diagnostic accuracy of an innovative scoring system based on the nomogram was established and validated in the training, internal validation, and external validation sets (n = 217). The discriminatory power and the calibration and clinical values of the prediction model were evaluated. Results Seven variables [effusion carcinoembryonic antigen (CEA), effusion adenosine deaminase (ADA), erythrocyte sedimentation rate (ESR), PE/serum CEA ratio (CEA ratio), effusion carbohydrate antigen 19-9 (CA19-9), effusion cytokeratin 19 fragment (CYFRA 21-1), and serum lactate dehydrogenase (LDH)/effusion ADA ratio (cancer ratio, CR)] were validated and used to develop a nomogram. The prediction model showed both good discrimination and calibration capabilities for all sets. A scoring system was established based on the nomogram scores to distinguish MPE from BPE. The scoring system showed favorable diagnostic performance in the training set [area under the curve (AUC) = 0.955, 95% confidence interval (CI) = 0.942-0.968], the internal validation set (AUC = 0.952, 95% CI = 0.932-0.973), and the external validation set (AUC = 0.973, 95% CI = 0.956-0.990). In addition, the scoring system achieved satisfactory discriminative abilities at separating lung cancer-associated MPE from tuberculous pleurisy effusion (TPE) in the combined training and validation sets. Conclusions The present study developed and validated a scoring system based on seven parameters. The scoring system exhibited a reliable diagnostic performance in distinguishing MPE from BPE and might guide clinical decision-making.
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Affiliation(s)
- Aihua Wu
- Department of Laboratory Medicine, Ningbo First Hospital, Ningbo, China
| | - Zhigang Liang
- Department of Thoracic Surgery, Ningbo First Hospital, Ningbo, China
| | - Songbo Yuan
- Department of Clinical Laboratory, The Affiliated People Hospital of Ningbo University, Ningbo, China
| | - Shanshan Wang
- Department of Laboratory Medicine, Ningbo First Hospital, Ningbo, China
| | - Weidong Peng
- Department of Respiratory and Critical Care Medicine, The Affiliated People Hospital of Ningbo University, Ningbo, China
| | - Yijun Mo
- Department of Laboratory Medicine, Ningbo First Hospital, Ningbo, China
| | - Jing Yang
- Department of Respiratory and Critical Care Medicine, Ningbo First Hospital, Ningbo, China
| | - Yanqing Liu
- Department of Laboratory Medicine, Ningbo First Hospital, Ningbo, China
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Zhang Y, Li X, Liu J, Hu X, Wan C, Zhang R, Shen Y. Diagnostic accuracy of the cancer ratio for the prediction of malignant pleural effusion: evidence from a validation study and meta-analysis. Ann Med 2021; 53:558-566. [PMID: 33818231 PMCID: PMC8023604 DOI: 10.1080/07853890.2021.1906943] [Citation(s) in RCA: 6] [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: 12/03/2020] [Accepted: 03/17/2021] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE This study aimed to assess the diagnostic accuracy of serum LDH to pleural ADA ratio (cancer ratio, CR)for malignant pleural effusion (MPE) through an original study and meta-analysis. METHODS We retrospectively collected data from 145 patients with MPE and 117 cases of benign pleural effusions (BPE). The diagnostic performance of CR and a typical biomarker of MPE, carcinoembryonic antigen (CEA), were analysed using the receiver operating characteristic (ROC) curves and the area under the curve (AUC) as a measure of accuracy. The overall diagnostic accuracy of CR was summarised by a standard diagnostic meta-analysis. RESULTS Significantly higher CR and pleural CEA values were observed in the MPE patients than in the BPE patients. At a cut-off value of 14.97, CR showed high sensitivity (0.91), low specificity (0.67), and high AUC (0.85). The combination of CEA and CR increased the AUC to 0.98. The meta-analysis included seven studies involving 2,078 patients. The pooled values for sensitivity, specificity, positive/negative likelihood ratio, and diagnostic odds ratio of CR were 0.96, 0.88, 7.70, 0.05, and 169, respectively. The AUC of the summary ROC of CR was 0.98. CONCLUSION CR has a high diagnostic accuracy for predicting MPE, especially when used in combination with pleural CEA.
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Affiliation(s)
- Ying Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
| | - Xiaoou Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
| | - Junhui Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
| | - Xueru Hu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
| | - Chun Wan
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
| | - Rui Zhang
- Department of Medical Informatics, West China Hospital, Sichuan University, Chengdu, China
| | - Yongchun Shen
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
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12
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Malterre A, Cohen-Gogo S, Kriegel I, d'Avout Fourdinier P, Bouleuc C, Lemelle L, Surun A, Cordero C, Pacquement H, Orbach D. Subcutaneous implantable pleural port catheter in the management of malignant pleural effusions in young patients with solid tumors: A new option in the armamentarium of symptomatic treatment. Pediatr Blood Cancer 2021; 68:e29109. [PMID: 34048136 DOI: 10.1002/pbc.29109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/22/2021] [Accepted: 04/27/2021] [Indexed: 11/05/2022]
Abstract
The contribution of subcutaneous implantable pleural port catheter (SIPP) for malignant pleural effusions (MPE) management in young patients with cancer, in a palliative care setting is not well explored. This monocentric series analyzed 38 patients, median age 18 years (range 3-25) with significant pleural effusion. SIPP were considered efficient for eight of 12 evaluable patients (67%) and allowed MPE outpatient management in five cases. SIPPs are safe and efficient device to manage MPE patients with solid tumors, in the palliative care setting. This original tool could help health care providers for thoracic symptom management in alternative to iterative pleural punctures.
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Affiliation(s)
- Aline Malterre
- Institut Curie, SIREDO Oncology Center Care, PSL Research University, Paris, France
| | - Sarah Cohen-Gogo
- Division of Hematology-Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Irène Kriegel
- Department of Anesthesiology, Institut Curie, Paris, France
| | | | - Carole Bouleuc
- Inter-Disciplinary Supportive Care Department for the Oncology Patient, Institut Curie, Paris, France
| | - Lauriane Lemelle
- Institut Curie, SIREDO Oncology Center Care, PSL Research University, Paris, France
| | - Aurore Surun
- Institut Curie, SIREDO Oncology Center Care, PSL Research University, Paris, France
| | - Camille Cordero
- Institut Curie, SIREDO Oncology Center Care, PSL Research University, Paris, France
| | - Hélène Pacquement
- Institut Curie, SIREDO Oncology Center Care, PSL Research University, Paris, France
| | - Daniel Orbach
- Institut Curie, SIREDO Oncology Center Care, PSL Research University, Paris, France
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13
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Cheng C, Yang Y, Yang W, Wang D, Yao C. The diagnostic value of CEA for lung cancer-related malignant pleural effusion in China: a meta-analysis. Expert Rev Respir Med 2021; 16:99-108. [PMID: 34112035 DOI: 10.1080/17476348.2021.1941885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: To accurately evaluate the diagnostic value of carcinoembryonic antigen (CEA) for malignant pleural effusion associated with lung cancer in the Chinese population.Methods: Three English databases, PubMed, Embase and Web of Science, and two Chinese databases, China National Knowledge Infrastructure (CNKI) and Wanfang Data, up to 5 November 2020, were searched. The literature on the diagnosis of lung cancer-related malignant pleural effusion by CEA in the Chinese population were collected. The data was analyzed by Stata15.0 software.Results: A total of 15 studies were included in the meta-analysis. The combined sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio were 0.80 (95% CI: 0.74-0.84), 0.92 (95% CI: 0.89-0.95), 10.46 (95% CI: 7.29-15.00), 0.22 (95% CI: 0.17-0.28), 47.26 (95% CI: 28.84-77.44), respectively . The area under the receiver operating characteristic curve was 0.93 (95% CI: 0.91-0.95). No significant publication bias was found (P > 0.05)Conclusion: CEA has anexcellent diagnostic value for patients with lung cancer-related malignant pleural effusion in the Chinese population.
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Affiliation(s)
- Chen Cheng
- Department of Oncology, Jiangdu People's Hospital Affiliated to Medical College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Yongguo Yang
- Department of Pathology, Jiangdu People's Hospital Affiliated to Medical College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Wei Yang
- Department of Oncology, Changzhi People's Hospital, Changzhi, Shanxi, China
| | - Daomeng Wang
- Department of Thoracic Surgery, Jiangdu People's Hospital Affiliated to Medical College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Chen Yao
- Department of Pathology, Jiangdu People's Hospital Affiliated to Medical College of Yangzhou University, Yangzhou, Jiangsu, China
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14
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Roh J, Ahn HY, Kim I, Son JH, Seol HY, Kim MH, Lee MK, Eom JS. Clinical course of asymptomatic malignant pleural effusion in non-small cell lung cancer patients: A multicenter retrospective study. Medicine (Baltimore) 2021; 100:e25748. [PMID: 34106603 PMCID: PMC8133234 DOI: 10.1097/md.0000000000025748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/07/2021] [Indexed: 11/26/2022] Open
Abstract
The British Thoracic Society guidelines recommend observation for patients with asymptomatic malignant pleural effusion (MPE). However, asymptomatic MPE can become symptomatic. This study examined the clinical course of asymptomatic MPE in patients with non-small cell lung cancer (NSCLC), including the incidence and timing of symptom development of asymptomatic MPE and the associated factors.Retrospective data of 4822 NSCLC patients between January 2012 and December 2017 were reviewed. Symptom development of asymptomatic MPE was defined as the development of symptoms requiring additional treatment, such as insertion of a chest tube, within 1 year in patients who lacked MPE symptoms at the time of diagnosis. Clinical information, pathological parameters, and radiological characteristics were reviewed. Patient data up to 1 year from the initial diagnosis were reviewed.Of 113 patients with asymptomatic MPE, 46 (41%) became symptomatic within 1 year despite appropriate anticancer treatment. The median time to symptom development was 4 months, and 38 patients (83%) developed symptoms within 6 months. Multivariate logistic regression showed that female sex (odds ratio [OR], 0.256; 95% confidence interval [CI], 0.101-0.649; P = .004) and the depth of pleural effusion on initial computed tomography (CT) (OR, 0.957; 95% CI, 0.932-0.982; P = .001) were independently associated with symptom development of asymptomatic MPE.A fraction of 41% of patients with asymptomatic MPE became symptomatic within 1 year. Female sex and larger MPE on initial CT were independently associated with symptom development of asymptomatic MPE.
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Affiliation(s)
- Jiyeon Roh
- Department of Internal Medicine
- Biomedical Research Institute, Pusan National University Hospital
| | - Hyo Yeong Ahn
- Biomedical Research Institute, Pusan National University Hospital
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine
| | - Insu Kim
- Department of Internal Medicine, Dong-A University Hospital, Busan
| | | | - Hee Yun Seol
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | | | | | - Jung Seop Eom
- Department of Internal Medicine
- Biomedical Research Institute, Pusan National University Hospital
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15
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Zhang M, Yan L, Lippi G, Hu ZD. Pleural biomarkers in diagnostics of malignant pleural effusion: a narrative review. Transl Lung Cancer Res 2021; 10:1557-1570. [PMID: 33889529 PMCID: PMC8044497 DOI: 10.21037/tlcr-20-1111] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Although cytology and pleural biopsy of pleural effusion (PE) are the gold standards for diagnosing malignant pleural effusion (MPE), these tools’ diagnostic accuracy is plagued by some limitations such as low sensitivity, considerable inter-observer variation and invasiveness. The assessment of PE biomarkers may hence be seen as an objective and non-invasive diagnostic alternative in MPE diagnostics. In this review, we summarize the characteristics and diagnostic accuracy of available PE biomarkers, including carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), carbohydrate antigens 125 (CA125), carbohydrate antigen 19-9 (CA19-9), carbohydrate antigen 15-3 (CA15-3), a fragment of cytokeratin 19 (CYFRA 21-1), chitinase-like proteins (CLPs), vascular endothelial growth factor (VEGF) and its soluble receptor, endostatin, calprotectin, cancer ratio, homocysteine, apolipoprotein E (Apo-E), B7 family members, matrix metalloproteinase (MMPs) and tissue-specific inhibitors of metalloproteinases (TIMPs), reactive oxygen species modulator 1 (Romo1), tumor-associated macrophages (TAMs) and monocytes, epigenetic markers (e.g., cell-free microRNA and mRNA). We summarized the evidence from systematic review and meta-analysis for traditional tumor markers’ diagnostic accuracy. According to the currently available evidence, we conclude that the traditional tumor markers have high specificity (around 0.90) but low sensitivity (around 0.50). The diagnostic accuracy of novel tumor markers needs to be validated by further studies. None of these tumor biomarkers would have sufficient diagnostic accuracy to confirm or exclude MPE when used alone. A multi-biomarker strategy, also encompassing the use of artificial intelligence algorithms, may be a valuable perspective for improving the diagnostic accuracy of MPE.
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Affiliation(s)
- Man Zhang
- Department of Thoracic Surgery, 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
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Zhi-De Hu
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
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16
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Li Y, Tian S, Huang Y, Dong W. Driverless artificial intelligence framework for the identification of malignant pleural effusion. Transl Oncol 2021; 14:100896. [PMID: 33045678 PMCID: PMC7557891 DOI: 10.1016/j.tranon.2020.100896] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 12/16/2022] Open
Abstract
Our study aimed to explore the applicability of deep learning and machine learning techniques to distinguish MPE from BPE. We initially used a retrospective cohort with 726 PE patients to train and test the predictive performances of the driverless artificial intelligence (AI), and then stacked with a deep learning and five machine learning models, namely gradient boosting machine (GBM), extreme gradient boosting (XGBoost), extremely randomized trees (XRT), distributed random forest (DRF), and generalized linear models (GLM). Furthermore, a prospective cohort with 172 PE patients was applied to detect the external validity of the predictive models. The area under the curve (AUC) in the training, test and validation set were deep learning (0.995, 0.848, 0.917), GBM (0.981, 0.910, 0.951), XGBoost (0.933, 0.916, 0.935), XRT (0.927, 0.909, 0.963), DRF (0.906, 0.809, 0.969), and GLM (0.898, 0.866, 0.892), respectively. Although the Deep Learning model had the highest AUC in the training set (AUC = 0.995), GBM demonstrated stable and high predictive efficiency in three data sets. The final AI model by stacked ensemble yielded optimal diagnostic performance with AUC of 0.991, 0.912 and 0.953 in the training, test and validation sets, respectively. Using the driverless AI framework based on the routinely collected clinical data could significantly improve diagnostic performance in distinguishing MPE from BPE.
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Affiliation(s)
- Yuan Li
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei 430060, China
| | - Shan Tian
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei 430060, China
| | - Yajun Huang
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Weiguo Dong
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei 430060, China.
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17
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Zhang H, Li C, Hu F, Zhang X, Shen Y, Chen Y, Li F. Auxiliary diagnostic value of tumor biomarkers in pleural fluid for lung cancer-associated malignant pleural effusion. Respir Res 2020; 21:284. [PMID: 33121490 PMCID: PMC7596935 DOI: 10.1186/s12931-020-01557-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 10/22/2020] [Indexed: 12/11/2022] Open
Abstract
Background Pleural effusion (PE) can be divided into benign pleural effusion (BPE) and malignant pleural effusion (MPE). There is no consensus on the identification of lung cancer-associated MPE using the optimal cut-off levels from five common tumor biomarkers (CEA, CYFRA 21-1, CA125, SCC-Ag, and NSE). Therefore, we aimed to find indicators for the auxiliary diagnosis of lung cancer-associated MPE by analyzing and then validating the optimal threshold levels of these biomarkers in pleural fluid (PF) and serum, as well as the PF/serum ratio. Patients and method The study has two sets of patients, i.e. the training set and the test set. In the training set, 348 patients with PE, between January 1, 2016 and December 31, 2017, were divided into BPE and MPE based on the cytological diagnosis. Subsequently, the optimal cut-off levels of tumor biomarkers were analyzed. In the test set, the diagnostic compliance rate was verified with 271 patients with PE from January 1, 2018 to July 31, 2019 to evaluate the auxiliary diagnostic value of the aforementioned indicators. Result In the training set, PF CEA at the cut-off value of 5.23 ng/ml was the most effective indicator for MPE compared with other tumor biomarkers (all p < 0.001). In the test set, PF CEA at the cut-off value of 5.23 ng/ml showed the highest sensitivity, specificity and accuracy, positive and negative predictive value among other tumor biomarkers, which were 99.0%, 69.1%, 91.6%, 90.7%, and 95.9%, respectively. Conclusion PF CEA at the cut-off level of 5.23 ng/ml was the most effective indicator for identifying lung cancer-associated MPE among the five common tumor biomarkers.
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Affiliation(s)
- Hai Zhang
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, NO. 241, West Huaihai Road, Shanghai, 200030, China
| | - Changhui Li
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, NO. 241, West Huaihai Road, Shanghai, 200030, China
| | - Fang Hu
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, NO. 241, West Huaihai Road, Shanghai, 200030, China
| | - Xueyan Zhang
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, NO. 241, West Huaihai Road, Shanghai, 200030, China
| | - Yinchen Shen
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, NO. 241, West Huaihai Road, Shanghai, 200030, China
| | - Yuqing Chen
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, NO. 241, West Huaihai Road, Shanghai, 200030, China
| | - Feng Li
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, NO. 241, West Huaihai Road, Shanghai, 200030, China.
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18
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Mulet M, Zamora C, Porcel JM, Nieto JC, Pajares V, Muñoz-Fernandez AM, Calvo N, Esquerda A, Vidal S. Platelet factor 4 regulates T cell effector functions in malignant pleural effusions. Cancer Lett 2020; 491:78-86. [PMID: 32726613 DOI: 10.1016/j.canlet.2020.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 01/12/2023]
Abstract
Malignant pleural effusion (MPE) is defined as the presence of tumor cells in pleural fluid and it is a fatal complication of advanced lung adenocarcinoma (LAC). To understand the immune response to the tumor in MPE, we compared the concentration of immunomodulatory factors in MPE of LAC and pleural effusion of heart failure (HF) patients by ELISA, and the proliferation and cytotoxic phenotype of T cells stimulated in the presence of LAC and HF pleural fluids by cytometry. Platelet factor 4 (PF4), vascular endothelial growth factor (VEGF), transforming growth factor beta (TGF-β) and P-selectin levels were higher in LAC than in HF pleural fluids. However, plasmatic PF4 and P-selectin levels were similar in LAC and HF. VEGF positively correlated with TGF-β and sPD-L1 in LAC but not in HF pleural fluids. LAC pleural fluids also inhibited T lymphocyte proliferation and cytotoxicity and reduced IL-17 production. PF4 levels inversely correlated with T cell function. The high content of PF4 in MPE was associated with poor prognosis. Our findings suggest that an impaired response of T lymphocytes induced by PF4 provides a significant advantage for tumor progression.
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Affiliation(s)
- Maria Mulet
- Department Immunology, Institut Recerca Hospital de La Santa Creu i Sant Pau, Barcelona, Spain
| | - Carlos Zamora
- Department Immunology, Institut Recerca Hospital de La Santa Creu i Sant Pau, Barcelona, Spain
| | - José M Porcel
- Pleural Medicine Unit, Department of Internal Medicine, Hospital Universitari Arnau de Vilanova, IRBLleida, University of Lleida, Lleida, Spain
| | - Juan C Nieto
- Department Immunology, Institut Recerca Hospital de La Santa Creu i Sant Pau, Barcelona, Spain
| | - Virginia Pajares
- Department Pneumology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Nuria Calvo
- Department Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Aureli Esquerda
- Department of Laboratory Medicine, Hospital Universitari Arnau de Vilanova, IRBLleida, University of Lleida, Lleida, Spain
| | - Silvia Vidal
- Department Immunology, Institut Recerca Hospital de La Santa Creu i Sant Pau, Barcelona, Spain.
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19
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Laroumagne S, Guinde J, Berdah S, Dutau H, Capel J, Astoul P. A novel pleural-bladder pump for the management of recurrent malignant pleural effusions: a feasibility animal study. Respir Res 2020; 21:184. [PMID: 32669106 PMCID: PMC7364624 DOI: 10.1186/s12931-020-01447-4] [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: 02/22/2020] [Accepted: 07/08/2020] [Indexed: 12/05/2022] Open
Abstract
Background Recurrent malignant pleural effusions (MPE) are common and associated with significant morbidity in cancer patients. A new pump connecting the pleural cavity and the bladder may have application for the management of recurrent MPE. In a pre-clinical study, we investigated the utility of this pump in healthy pigs. Methods A novel pump system (Pleurapump® system) was inserted into four pigs under general anaesthesia. A tunnelled-pleural catheter was connected to a subcutaneously implanted pump while the urinary bladder was connected by percutaneous technique. Animals were ventilated mechanically and pump functioning was tested using a range of ventilation parameters and spontaneous breathing. Fluid was added to the pleural space to mimic pleural effusion and to assess the effectiveness of the pump at removing fluid to the bladder. Results The ‘pleurapump’ system successfully transported fluid from the pleural cavity to the bladder. Pressure variations caused by respiration and variations in the amount of fluid in the pleural cavity had no impact on the pumping. Pumping stopped when the pleural cavity was drained. Conclusion This pump can be implanted into pigs and successfully removed fluid from the pleural cavity to the bladder and may represent a new treatment for management of recurrent MPE. Evaluation in humans is planned.
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Affiliation(s)
- S Laroumagne
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology - Hôpital Nord, Marseille, France
| | - J Guinde
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology - Hôpital Nord, Marseille, France
| | - S Berdah
- LBA-UMRT24, Aix-Marseille Université, Marseille, France
| | - H Dutau
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology - Hôpital Nord, Marseille, France
| | - J Capel
- Sequana Medical AG, Zurich, Switzerland
| | - P Astoul
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology - Hôpital Nord, Marseille, France. .,Aix-Marseille University, Marseille, France.
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20
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Abstract
Malignant pleural effusion frequently complicates both solid and hematologic malignancies and is associated with high morbidity, mortality, and health care costs. Although no pleura-specific therapy is known to impact survival, both pleurodesis and indwelling pleural catheter (IPC) placement can significantly alleviate symptoms and improve quality of life. The optimal choice of therapy in terms of efficacy and particularly cost-effectiveness depends on patient preferences and individual characteristics, including lung expansion and life expectancy. Attempting chemical pleurodesis through an IPC in the outpatient setting appears to be a particularly promising approach in the absence of a nonexpandable lung.
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Affiliation(s)
- Majid Shafiq
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - David Feller-Kopman
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1800 Orleans Street, Suite 7-125, Baltimore, MD 21287, USA.
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21
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Wu CG, Chiovaro F, Curioni-Fontecedro A, Casanova R, Soltermann A. In vitro cell culture of patient derived malignant pleural and peritoneal effusions for personalised drug screening. J Transl Med 2020; 18:163. [PMID: 32276643 PMCID: PMC7149866 DOI: 10.1186/s12967-020-02331-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/04/2020] [Indexed: 12/29/2022] Open
Abstract
Background Malignant serous effusion (MSE) denotes a manifestation of metastatic disease with typical high concentrations of both cancer and immune cells, making them an ideal resource for in vitro cytologic studies. Hence, the aim of the study was to investigate the features of 2D and 3D MSE culture systems as well as their feasibilities for in vitro drug screening. Methods Pleural and peritoneal effusions from 8 patients were collected and processed for 2D monolayer and 3D hanging drop cell culture into GravityPLUS™ plates. Representative markers for cell components, proliferation rate and tumour classification were investigated by immunohistochemistry, followed by absolute quantification using a digitalised image analysis approach. Further, we implemented another 3D cell culture model based on a low attachment method for in vitro drug sensitivity testing of carboplatin, pemetrexed and pembrolizumab for 5 patients. Results Monolayer cell culture was favourable for the growth of mesothelial cells, while hanging drop culture in GravityPLUS™ plates showed better ability for preserving cancer cells, inducing positive diagnostic markers expression and restraining the growth of mesothelial cells. For in vitro drug testing, MSE from five patients presented various drug sensitivities, and one case showed strong response to PD-1 checkpoint inhibition (pembrolizumab). For some patients, the application of combinatorial drugs had better therapeutic responses compared to monotherapy. Conclusions Digitalised quantification of data offers a better understanding of different MSE culture models. More importantly, the proposed platforms are practical and amenable for performing in vitro chemo-/immunotherapeutic drug testing by using routine cytologic MSE in a personalised manner. Next to cell blocks, our work demonstrates the prognostic and predictive value of cytologic effusion samples.
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Affiliation(s)
- Cheng-Guang Wu
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091, Zurich, Switzerland. .,University of Zurich, Rämistrasse 71, 8006, Zurich, Switzerland.
| | | | - Alessandra Curioni-Fontecedro
- Department of Medical Oncology and Haematology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Ruben Casanova
- University of Zurich, Rämistrasse 71, 8006, Zurich, Switzerland
| | - Alex Soltermann
- ADMED Pathology, Rue de la Maladière 45, 2000, Neuchâtel, Switzerland
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22
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Validation of Calprotectin As a Novel Biomarker For The Diagnosis of Pleural Effusion: a Multicentre Trial. Sci Rep 2020; 10:5679. [PMID: 32231227 PMCID: PMC7105479 DOI: 10.1038/s41598-020-62388-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/08/2020] [Indexed: 11/09/2022] Open
Abstract
Discriminating between malignant pleural effusion (MPE) and benign pleural effusion (BPE) remains difficult. Thus, novel and efficient biomarkers are required for the diagnosis of pleural effusion (PE). The aim of this study was to validate calprotectin as a diagnostic biomarker of PE in clinical settings. A total of 425 patients were recruited, and the pleural fluid samples collected had BPE in 223 cases (53.7%) or MPE in 137 patients (33%). The samples were all analysed following the same previously validated clinical laboratory protocols and methodology. Calprotectin levels ranged from 772.48 to 3,163.8 ng/mL (median: 1,939 ng/mL) in MPE, and 3,216-24,000 ng/mL in BPE (median: 9,209 ng/mL; p < 0.01), with an area under the curve of 0.848 [95% CI: 0.810-0.886]. For a cut-off value of ≤ 6,233.2 ng/mL, we found 96% sensitivity and 60% specificity, with a negative and positive predictive value, and negative and positive likelihood ratios of 96%, 57%, 0.06, and 2.4, respectively. Multivariate analysis showed that low calprotectin levels was a better discriminator of PE than any other variable [OR 28.76 (p < 0.0001)]. Our results confirm that calprotectin is a new and useful diagnostic biomarker in patients with PE of uncertain aetiology which has potential applications in clinical practice because it may be a good complement to cytological methods.
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23
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Santotoribio JD, del Valle-Vazquez L, García-de la Torre A, del Castillo-Otero D, Lopez-Saez JB, Sanchez del Pino MJ. The diagnostic value of pleural fluid homocysteine in malignant pleural effusion. PLoS One 2019; 14:e0222616. [PMID: 31550262 PMCID: PMC6759144 DOI: 10.1371/journal.pone.0222616] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/03/2019] [Indexed: 01/10/2023] Open
Abstract
Background Pleural fluid homocysteine (HCY) can be useful for diagnosis of malignant pleural effusion (MPE). There are no published studies comparing the diagnostic accuracy of HCY with other tumour markers in pleural fluid for diagnosis of MPE. The aim was to compare the accuracy of HCY with that of carcinoembryonic antigen (CEA), cancer antigen (CA) 15.3, CA19.9 and CA125 in pleural fluid and to develop a probabilistic model using these biomarkers to differentiate benign (BPE) from MPE. Methods Patients with pleural effusion were randomly included. HCY, CEA, CA15.3, CEA19.9 and CA125 were quantified in pleural fluid. Patients were classified into two groups: MPE or BPE. By applying logistic regression analysis, a multivariate probabilistic model was developed using pleural fluid biomarkers. The diagnostic accuracy was determined by receiver operating characteristic (ROC) curves and calculating the area under the curve (AUC). Results Population of study comprised 133 patients (72 males and 61 females) aged between 1 and 96 years (median = 70 years), 81 BPE and 52 MPE. The logistic regression analysis included HCY (p<0.0001) and CEA (p = 0.0022) in the probabilistic model and excluded the other tumour markers. The probabilistic model was: HCY+CEA = Probability(%) = 100×(1+e-z)-1, where Z = 0.5471×[HCY]+0.3846×[CEA]–8.2671. The AUCs were 0.606, 0.703, 0.778, 0.800, 0.846 and 0.948 for CA125, CA19.9, CEA, CA15.3, HCY and HCY+CEA, respectively. Conclusions Pleural fluid HCY has higher accuracy for diagnosis of MPE than CEA, CA15.3, CA19.9 and CA125. The combination of HCY and CEA concentrations in pleural fluid significantly improves the diagnostic accuracy of the test.
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Affiliation(s)
- Jose D. Santotoribio
- Department of Laboratory Medicine, Puerto Real University Hospital, Cadiz, Spain
- Department of Biomedicine, Biotechnology and Public Health, Cadiz University School of Medicine, Cadiz, Spain
- * E-mail:
| | | | - Angela García-de la Torre
- Department of Laboratory Medicine, Virgen de la Victoria University Hospital, Malaga, Spain
- Instituto de Investigacion Biomédica de Malaga (IBIMA), Malaga, Spain
| | - Daniel del Castillo-Otero
- Department of Pneumology, Puerto Real University Hospital, Cadiz, Spain
- Department of Medicine, Cadiz University School of Medicine, Cadiz, Spain
| | - Juan-Bosco Lopez-Saez
- Department of Medicine, Cadiz University School of Medicine, Cadiz, Spain
- Department of Internal Medicine, Puerto Real University Hospital, Cadiz, Spain
| | - Maria J. Sanchez del Pino
- Department of Biomedicine, Biotechnology and Public Health, Cadiz University School of Medicine, Cadiz, Spain
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Wang W, Jiang X, Zhang Y, Song Y, Song Z. Intracavitary chemotherapy with epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) is not superior to TKI monotherapy in controlling malignant pleural effusion recurrence in EGFR-mutated lung cancer patients. J Thorac Dis 2019; 11:3712-3720. [PMID: 31656643 PMCID: PMC6790470 DOI: 10.21037/jtd.2019.09.36] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 09/03/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR) mutated non-small cell lung cancer (NSCLC) patients benefit from EGFR-tyrosine kinase inhibitors (TKIs) therapy. There are few studies comparing the efficacy between intrapleural chemotherapy combination with TKIs and TKIs alone in controlling re-accumulation of malignant pleural effusions (MPEs). The purpose of the study was to determine if patients with EGFR-mutated NSCLC and MPEs would benefit from intrapleural chemotherapeutics with an oral EGFR-TKI than EGFR-TKI alone. METHODS We evaluated EGFR-mutated lung cancer patients with MPEs in Zhejiang Cancer Hospital. We evaluated the efficacy. Progression-free survival (PFS) and overall survival (OS) was evaluated by Kaplan-Meier method. RESULTS One hundred one NSCLC patients with MPEs at the time of diagnosis were included. We divided the patients into two groups. The overall response rate (ORR) with respect to MPE recurrence between the TKI alone and combination therapy groups was 65.5% (38/58) and 58.1% (25/43) (P=0.449). The disease control rate was 89.7% (52/58) and 86.0% (37/43) (P=0.579), respectively. The PFS in the TKI alone and TKI plus intrapleural drugs was 10.3 and 9.9 months, respectively (P=0.746). The intrapleural PFS was 11.4 and 11.0 months for the TKI alone and combination groups, respectively (P=0.188). The OS was 24.9 and 22.6 months (P=0.543), respectively. Hematologic toxicity and chest pain were more frequent in the combination therapy than TKI alone groups. CONCLUSIONS Intrapleural chemotherapy with TKI did not improve the efficacy of controlling MPEs in patients with EGFR-mutated NSCLC, but may increase adverse events, which are typical side effects of chemotherapy. We could treat these patients with TKI drugs alone combined with pleural effusion drainage.
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Affiliation(s)
- Wenxian Wang
- Department of Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences, Hangzhou 310022, China
- Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Xiaowen Jiang
- Department of Medical Oncology, Zhejiang Medical and Health Group Hangzhou Hospital/Hangzhou Hanggang Hospital, Hangzhou 310000, China
| | - Yiping Zhang
- Department of Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences, Hangzhou 310022, China
- Zhejiang Cancer Hospital, Hangzhou 310022, China
- Department of Medical Oncology, Zhejiang Medical and Health Group Hangzhou Hospital/Hangzhou Hanggang Hospital, Hangzhou 310000, China
- Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology, Hangzhou 310000, China
| | - Yong Song
- Department of Respiratory Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - Zhengbo Song
- Department of Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences, Hangzhou 310022, China
- Zhejiang Cancer Hospital, Hangzhou 310022, China
- Department of Medical Oncology, Zhejiang Medical and Health Group Hangzhou Hospital/Hangzhou Hanggang Hospital, Hangzhou 310000, China
- Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology, Hangzhou 310000, China
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25
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Choi MG, Park S, Oh DK, Kim HR, Lee GD, Lee JC, Choi CM, Ji W. Effect of medical thoracoscopy-guided intrapleural docetaxel therapy to manage malignant pleural effusion in patients with non-small cell lung cancer: A pilot study. Thorac Cancer 2019; 10:1885-1892. [PMID: 31389192 PMCID: PMC6775018 DOI: 10.1111/1759-7714.13158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/09/2019] [Accepted: 07/13/2019] [Indexed: 12/14/2022] Open
Abstract
Background Although chemical pleurodesis is a useful treatment option for malignant pleural effusion, little is known about the effects of intrapleural docetaxel therapy. Objectives This study aimed to evaluate the effects of medical thoracoscopy‐guided intrapleural docetaxel therapy in patients with lung cancer. Methods Patients with lung cancer who diagnosed malignant pleural effusion were enrolled in this single‐center prospective pilot study. The clinical response and toxicity were evaluated at two, six and 12 weeks post‐treatment. Results Medical thoracoscopy‐guided intrapleural docetaxel therapy was conducted in four patients between June 2016 and August 2017. The control rate of malignant pleural effusion was 100% (4/4), and the progression‐free duration of effusion was 527 ± 109 days. No serious adverse events were observed, but only mild‐to‐moderate adverse events were observed and well controlled by conservative management. Although the overall quality of life assessed using questionnaires did not show significant improvement, symptom burden due to dyspnea was significantly improved. Conclusions Intrapleural docetaxel therapy with medical thoracoscopy showed good clinical responses, relieving dyspnea symptoms and providing tolerable safety profiles in patients with non‐small cell lung cancer (NSCLC) with malignant pleural effusion. A further prospective trial is warranted to evaluate the clinical effects of intrapleural docetaxel therapy in order to compare it with other treatment modalities.
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Affiliation(s)
- Myeong Geun Choi
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sojung Park
- Division of Pulmonary and Critical care medicine, Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Dong Kyu Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Seoul, South Korea
| | - Geun Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Seoul, South Korea
| | - Jae Cheol Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chang-Min Choi
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.,Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Wonjun Ji
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Radiofrequency deep hyperthermia combined with chemotherapy in the treatment of advanced non-small cell lung cancer. Chin Med J (Engl) 2019; 132:922-927. [PMID: 30958433 PMCID: PMC6595762 DOI: 10.1097/cm9.0000000000000156] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background In the era of precision medicine, chemotherapy is still considered the cornerstone of treatment for lung cancer patients without gene mutations. How to reduce the toxicity and increase the efficiency of chemotherapy is worth exploring. This study aimed to investigate the curative effects and safety of hyperthermia combined with chemotherapy (HCT) for advanced patients with non-small cell lung cancer (NSCLC), especially those with malignant pleural effusion. Methods We retrospectively evaluated medical records of 93 patients with advanced NSCLC (stage IIIB-IV) from March 2011 to January 2014. The patients were divided into HCT and chemotherapy (CT) groups. The HCT group was treated with gemcitabine and cisplatin (GP) regimen combined with regional radiofrequency deep hyperthermia, while the CT group was treated with GP regimen only. Those with malignant pleural effusion extra underwent thoracentesis and intrapleural injection chemotherapy combined with hyperthermic or not. Clinical treatment results and adverse reactions were compared and analyzed after treatment. SPSS 19.0 software (SPSS Inc., USA) was used for statistical data processing. P values less than 0.05 were accepted to be statistically significant. Results Among the 93 patients, HCT group included 48 patients (16 patients with malignant pleural effusion), CT group included 45 patients (10 patients with malignant pleural effusion). There was no significant difference between the two groups in patient characteristics. The overall response rate (ORR) of pleural effusions was much better in HCT group than that in CT group (81.2% vs. 40.0%, P = 0.046). The patients in HCT group had lower incidence rate of weakness (12.5% vs. 46.7%, χ2 = 13.16, P < 0.001) and gastrointestinal (25.0% vs. 77.8%, χ2 = 25.88, P < 0.001) adverse reactions than that in CT group. The objective tumor response and survival showed no significant differences. Conclusions Hyperthermia combined with chemotherapy might lead to the development of better therapeutic strategy for advanced NSCLC with malignant pleural effusion patients. Also, it could greatly reduce the chemotherapy toxic effects in the incidence of weakness and gastrointestinal adverse reactions in advanced NSCLC patients.
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27
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Javed IN, Abdo T, Ahmad N, Jones KR. Metastatic Pleural Effusion: An Unusual Presentation of Urothelial Bladder Carcinoma. Cureus 2019; 11:e4619. [PMID: 31312546 PMCID: PMC6615589 DOI: 10.7759/cureus.4619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Pleural effusions are frequently encountered in clinical practice. In the United States, malignancy is the third leading cause of pleural effusion after heart failure and pneumonia. The most common cause of malignant pleural effusion (MPE) is lung cancer, followed by breast cancer, lymphoma, and mesothelioma. Genitourinary cancers rarely metastasize to the pleura. Although several atypical patterns of thoracic metastasis from genitourinary cancers have been described in the literature, genitourinary cancers rarely give rise to MPEs. We describe a case where the workup of a unilateral pleural effusion led to the diagnosis of high-grade urothelial bladder carcinoma.
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Affiliation(s)
- Isma N Javed
- Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma, USA
| | - Tony Abdo
- Pulmonology, University of Oklahoma Health Sciences Center, Oklahoma, USA
| | - Nazir Ahmad
- Internal Medicine, Saint Anthony Hospital, Oklahoma, USA
| | - Kellie R Jones
- Pulmonology, University of Oklahoma Health Sciences Center, Oklahoma, USA
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28
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Mesothelium and Malignant Mesothelioma. J Dev Biol 2019; 7:jdb7020007. [PMID: 30965570 PMCID: PMC6630312 DOI: 10.3390/jdb7020007] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/02/2019] [Accepted: 04/05/2019] [Indexed: 02/06/2023] Open
Abstract
The mesothelium is an epithelial structure derived from the embryonic mesoderm. It plays an important role in the development of a number of different organs, including the heart, lungs, and intestines. In this publication, we discuss aspects of the development of the mesothelium, where mesothelial structures can be found, and review molecular and cellular characteristics associated with the mesothelium. Furthermore, we discuss the involvement of the mesothelium in a number of disease conditions, in particular in the pathogenesis of mesotheliomas with an emphasis on malignant pleural mesothelioma (MPM)—a primary cancer developing in the pleural cavity.
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Arrieta O, Escamilla-López I, Lyra-González I, Barrón F, Ramírez-Tirado LA, Vergara E, Corona-Cruz JF, Maldonado F, Jiménez-Fuentes E. Radical aggressive treatment among non-small cell lung cancer patients with malignant pleural effusion without extra-thoracic disease. J Thorac Dis 2019; 11:595-601. [PMID: 30963004 DOI: 10.21037/jtd.2019.01.36] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Malignant pleural effusion (MPE) is an indicator of advanced disease (stage M1a) in patients with non-small cell lung cancer (NSCLC). Typically, these patients are candidates for palliative treatment. There is a lack of evidence about the radical surgical treatment in carcinomatous pleuritis with massive effusion. Here, we present data from a specific subset of patients with MPE treated with systemic therapy and aggressive surgical therapy. M1a NSCLC adenocarcinoma patients with MPE and without extra-thoracic disease were included. After receiving systemic therapy, all patients underwent surgical treatment, which included pneumonectomy or lobectomy, plus mediastinal dissection. Following surgery, patients received radiotherapy to thoracic wall and mediastinum. A total of six patients were analyzed. All patients had an Eastern Cooperative Oncology Group (ECOG) performance status ≤1, two patients harbored EGFR mutation and were treated with tyrosine kinase inhibitors (TKIs), the other four patients were treated with pemetrexed and platin as first-line treatment. Following systemic therapy, two patients had a pneumonectomy, four patients had a lobectomy plus pleurectomy performed. All patients continued with maintenance systemic therapy, and achieved complete responses, according to RECIST 1.1 criteria. The media progression-free survival (PFS) time was 15.9 months (95% CI: 15.6-55.5 months). At the last follow-up, all patients were still alive, with 4 of them without signs of macroscopic tumoral activity. The median overall survival (OS) was not reached. NSCLC patients with MPE without extra-thoracic disease could benefit from an aggressive surgical approach following standard of care systemic therapy. However, considering the low sample size of this study and the relatively low incidence of MPE without extra-thoracic disease, further prospective multi-center studies are necessary to evaluate aggressive surgery as a therapeutic option.
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Affiliation(s)
- Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | - Iván Lyra-González
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Feliciano Barrón
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | - Edgar Vergara
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | - Federico Maldonado
- Radio-Oncology Department, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Edgardo Jiménez-Fuentes
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico.,Thoracic Surgery Department, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
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30
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Thompson JC, Fan R, Black T, Yu GH, Savitch SL, Chien A, Yee SS, Sen M, Hwang WT, Katz SI, Feldman M, Vachani A, Carpenter EL. Measurement and immunophenotyping of pleural fluid EpCAM-positive cells and clusters for the management of non-small cell lung cancer patients. Lung Cancer 2018; 127:25-33. [PMID: 30642547 DOI: 10.1016/j.lungcan.2018.11.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/14/2018] [Accepted: 11/16/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES A malignant pleural effusion (MPE) is a common complication in non-small cell lung cancer (NSCLC) with important staging and prognostic information. Patients with MPEs are often candidates for advanced therapies, however, the current gold standard, cytological analysis of pleural fluid samples, has limited sensitivity. We aimed to demonstrate the feasibility of non-invasive enumeration and immunophenotyping of EpCAM-positive cells in pleural fluid samples for the diagnosis of a MPE in NSCLC patients. MATERIALS AND METHODS Pleural fluid specimens were prospectively collected from patients with NSCLC and the CellSearch® technology was utilized for the enumeration of pleural EpCAM-positive cells (PECs) and determination of PD-L1 expression on PECs from pleural fluid samples. The diagnostic performance of the enumeration of single PECs and PEC clusters was assessed using receiver operating characteristic (ROC) curves. The Kaplan-Meier method and Cox proportional hazards model was used to assess the impact of PECs and PEC clusters on overall survival (OS). RESULTS 101 NSCLC patients were enrolled. The median number of PECs was significantly greater in the malignant (n = 84) versus non-malignant group (n = 17) (730 PECs/mL vs 1.0 PEC/mL, p < 0.001). The area under the ROC curve was 0.91. A cutoff value of 105 PECs/mL had a sensitivity and specificity of 73% and 100% for the diagnosis of a MPE, respectively. Among 69 patients with a pathology-confirmed MPE and tissue immunohistochemistry (IHC) results, 15 (22%) had greater than 50% PD-L1+ PECs. Overall concordance between tissue and PEC PD-L1 expression was 76%. Higher numbers of pleural effusion single PECs were associated with inferior overall survival (Cox adjusted HR 1.8, 95% CI: 1.02-3.05 p = 0.043). CONCLUSION Non-invasive measurement of PECs in NSCLC patients, using an automated, clinically available approach, may improve the diagnostic accuracy of a MPE, allow for immunophenotyping of PECs, and provide prognostic information.
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Affiliation(s)
- Jeffrey C Thompson
- Division of Pulmonary, Allergy and Critical Care Medicine, Thoracic Oncology Group, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.
| | - Ryan Fan
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Taylor Black
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Gordon H Yu
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine Philadelphia, PA, United States
| | - Samantha L Savitch
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Austin Chien
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Stephanie S Yee
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Moen Sen
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Wei-Ting Hwang
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, United States; Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Sharyn I Katz
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States; Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Michael Feldman
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine Philadelphia, PA, United States; Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Anil Vachani
- Division of Pulmonary, Allergy and Critical Care Medicine, Thoracic Oncology Group, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States; Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Erica L Carpenter
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States; Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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Jeon J, Kim TJ, Park HS, Lee KY. Malignant Pleural Effusion from Metastatic Prostate Cancer: A Case Report with Unusual Cytologic Findings. J Pathol Transl Med 2018; 52:257-261. [PMID: 29874900 PMCID: PMC6056359 DOI: 10.4132/jptm.2018.05.08] [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] [Received: 02/20/2018] [Accepted: 05/08/2018] [Indexed: 11/17/2022] Open
Abstract
We present a case of 55-year-old man who complained of dyspnea and sputum for a month. He was an ex-smoker with a history of prostate cancer and pulmonary tuberculosis. Chest radiographs revealed bilateral pleural effusions of a small to moderate amount. Pigtail catheters were inserted for drainage. The pleural fluid consisted of large clusters and tightly cohesive groups of malignant cells, which however could not be ascribed to prostate cancer with certainty. We performed immunocytochemical panel studies to determine the origin of cancer metastasis. The immunostaining results were positive for prostate-specific antigen, alpha-methylacyl-coenzyme A racemase, and Nkx 3.1, consistent with prostate cancer. Pleural effusion associated with prostate cancer is rare. To our knowledge, this is the first case report in Korea to describe cytologic features of malignant pleural effusion associated with prostate cancer.
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Affiliation(s)
- Jinyoung Jeon
- Department of Hospital Pathology, Seoul St. Mary's Hospital, Seoul, Korea
| | - Tae-Jung Kim
- Department of Hospital Pathology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hong Sik Park
- Department of Hospital Pathology, Seoul St. Mary's Hospital, Seoul, Korea
| | - Kyo-Young Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, Seoul, Korea
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Jiang T, Li A, Su C, Li X, Zhao C, Ren S, Zhou C, Zhang J. Addition of bevacizumab for malignant pleural effusion as the manifestation of acquired EGFR-TKI resistance in NSCLC patients. Oncotarget 2017; 8:62648-62657. [PMID: 28977977 PMCID: PMC5617537 DOI: 10.18632/oncotarget.16061] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/22/2017] [Indexed: 01/15/2023] Open
Abstract
This study aimed to investigate the role of bevacizumab in patients with advanced non-small cell lung cancer (NSCLC) who had developed acquired resistance to EGFR-TKIs therapy that manifested as malignant pleural effusion (MPE). In total, 86 patients were included. 47 patients received bevacizumab plus continued EGFR-TKIs and 39 patients received bevacizumab plus chemotherapy. The curative efficacy rate for MPE in bevacizumab plus EGFR-TKIs group was significantly higher than that in bevacizumab plus chemotherapy group (89.4% vs. 64.1%, respectively; P = 0.005). Patients in bevacizumab plus EGFR-TKIs group had longer progression-free survival (PFS) than those in bevacizumab plus chemotherapy group (median PFS 6.3 vs. 4.8 months, P = 0.042). While patients with acquired T790M mutation in bevacizumab plus EGFR-TKIs group had a significantly longer PFS than those in bevacizumab plus chemotherapy group (median PFS 6.9 vs. 4.6 months, P = 0.022), patients with negative T790M had similar PFS (median PFS 6.1 vs. 5.5 months, P = 0.588). Overall survival (OS) was similar between two groups (P = 0.480). In multivariate analysis, curative efficacy was an independent prognostic factor (HR 0.275, P = 0.047). In conclusion bevacizumab plus EGFR-TKIs could be a valuable treatment for NSCLC patients presenting with MPE upon resistant to EGFR-TKIs therapy, especially for those with acquired T790M mutation.
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Affiliation(s)
- Tao Jiang
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, P.R. China
| | - Aiwu Li
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, P.R. China
| | - Chunxia Su
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, P.R. China
| | - Xuefei Li
- Department of Lung Cancer and Immunology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, P.R. China
| | - Chao Zhao
- Department of Lung Cancer and Immunology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, P.R. China
| | - Shengxiang Ren
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, P.R. China
| | - Caicun Zhou
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, P.R. China
| | - Jun Zhang
- Department of Internal Medicine, Division of Hematology, Oncology and Blood & Marrow Transplantation, Holden Comprehensive Cancer Center, University of Iowa, Carver College of Medicine, Iowa, IA, USA
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Keshishyan S, Harris K. Asymptomatic malignant pleural effusion: to observe or to manage. J Thorac Dis 2017; 9:S1146-S1147. [PMID: 29214072 DOI: 10.21037/jtd.2017.06.52] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Sevak Keshishyan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Interventional Pulmonology Section, Westchester Medical Center, Valhalla, NY, USA
| | - Kassem Harris
- Division of Pulmonary, Critical Care, and Sleep Medicine, Interventional Pulmonology Section, Westchester Medical Center, Valhalla, NY, USA
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Prognostic impact of a new score using neutrophil-to-lymphocyte ratios in the serum and malignant pleural effusion in lung cancer patients. BMC Cancer 2017; 17:557. [PMID: 28830378 PMCID: PMC5567470 DOI: 10.1186/s12885-017-3550-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 08/14/2017] [Indexed: 12/17/2022] Open
Abstract
Backgrounds Various studies have reported that the neutrophil-to-lymphocyte ratio in the serum (sNLR) may serve as a cost-effective and useful prognostic factor in patients with various cancer types. However, no study has reported the prognostic impact of the NLR in malignant pleural effusion (MPE). To address this gap, we investigated the clinical impact of NLR as a prognostic factor in MPE (mNLR) and a new scoring system that use NLRs in the serum and MPE (smNLR score) in lung cancer patients. Methods We retrospectively reviewed all of the patients who were diagnosed with lung cancer and who presented with pleural effusion. To maintain the quality of the study, only patients with malignant cells in the pleural fluid or tissue were included. The patients were classified into three smNLR score groups, and clinical variables were investigated for their correlation with survival. Results In all, 158 patients were classified into three smNLR score groups as follows: 84 (53.2%) had a score of 0, 58 (36.7%) had a score of 1, and 16 (10.1%) had a score of 2. In a univariate analysis, high sNLR, mNLR, and increments of the smNLR score were associated with shorter overall survival (p < 0.001, p = 0.004, and p < 0.001, respectively); moreover, age, Eastern Cooperative Oncology Group performance status (ECOG PS), histology, M stage, hemoglobin level, albumin level, and calcium level were significant prognostic factors. A multivariable analysis confirmed that ECOG PS (p < 0.001), histology (p = 0.001), and smNLR score (p < 0.012) were independent predictors of overall survival. Conclusions The new smNLR score is a useful and cost-effective prognostic factor in lung cancer patients with MPE. Although further studies are required to generalize our results, this information will benefit clinicians and patients in determining the most appropriate therapy for patients with MPE. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3550-8) contains supplementary material, which is available to authorized users.
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35
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Predicting Malignant and Paramalignant Pleural Effusions by Combining Clinical, Radiological and Pleural Fluid Analytical Parameters. Lung 2017; 195:653-660. [PMID: 28656381 DOI: 10.1007/s00408-017-0032-3] [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: 02/20/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The usefulness of clinical, radiological and pleural fluid analytical parameters for diagnosing malignant and paramalignant pleural effusion is not clearly stated. Hence this study aimed to identify possible predictor variables of diagnosing malignancy in pleural effusion of unknown aetiology. METHODS Clinical, radiological and pleural fluid analytical parameters were obtained from consecutive patients who had suffered pleural effusion of unknown aetiology. They were classified into three groups according to their final diagnosis: malignant, paramalignant and benign pleural effusion. The CHAID (Chi-square automatic interaction detector) methodology was used to estimate the implication of the clinical, radiological and analytical variables in daily practice through decision trees. RESULTS Of 71 patients, malignant (n = 31), paramalignant (n = 15) and benign (n = 25), smoking habit, dyspnoea, weight loss, radiological characteristics (mass, node, adenopathies and pleural thickening) and pleural fluid analytical parameters (pH and glucose) distinguished malignant and paramalignant pleural effusions (all with a p < 0.05). Decision tree 1 classified 77.8% of malignant and paramalignant pleural effusions in step 2. Decision tree 2 classified 83.3% of malignant pleural effusions in step 2, 73.3% of paramalignant pleural effusions and 91.7% of benign ones. CONCLUSIONS The data herein suggest that the identified predictor values applied to tree diagrams, which required no extraordinary measures, have a higher rate of correct identification of malignant, paramalignant and benign effusions when compared to techniques available today and proved most useful for usual clinical practice. Future studies are still needed to further improve the classification of patients.
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Hiensch R, Belete H, Rashidfarokhi M, Galperin I, Shakil F, Epelbaum O. Unusual Patterns of Thoracic Metastasis of Urinary Bladder Carcinoma. J Clin Imaging Sci 2017; 7:23. [PMID: 28584690 PMCID: PMC5450457 DOI: 10.4103/jcis.jcis_9_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 02/05/2017] [Indexed: 12/19/2022] Open
Abstract
Urinary bladder carcinoma (UBC) is the ninth most common malignancy and the second most common urological malignancy after prostate cancer in men. Thoracic metastases occur in more than half of those with muscle-invasive disease, and these generally assume the form of multiple solid parenchymal lesions characteristic of hematogenous seeding of the lung. Unusual patterns of thoracic spread of UBC have also been described albeit sporadically in the form of case reports and series. The aim of our case series is to provide illustrations of several atypical patterns of thoracic involvement by UBC such as isolated mediastinal lymphadenopathy, cavitary lung metastases, malignant pleural effusion, endobronchial disease, and pulmonary tumor embolism. This review is meant to highlight the intersection of the fields of urological oncology and thoracic radiology in the care of patients with UBC.
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Affiliation(s)
- Robert Hiensch
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York
| | - Habtamu Belete
- Division of Pulmonary and Sleep Medicine, Lenox Hill Hospital, Hofstra Northwell School of Medicine, Hofstra University, Hempstead, NY, USA
| | - Mahsan Rashidfarokhi
- Division of Pulmonary and Critical Care Medicine, Elmhurst Hospital Center, Icahn School of Medicine, Elmhurst, NY, USA
| | - Irene Galperin
- Division of Pulmonary and Sleep Medicine, Lenox Hill Hospital, Northwell Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Fouzia Shakil
- Department of Pathology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Oleg Epelbaum
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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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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Tunneled Pleural Catheter for the Treatment of Malignant Pleural Effusion: A Systematic Review and Meta-analysis. Am J Ther 2017; 23:e1300-e1306. [PMID: 25654292 DOI: 10.1097/mjt.0000000000000197] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Tunneled pleural catheter (TPC) has been widely used to control malignant pleural effusion (MPE); however, it is still not clear whether it is more effective than chemical pleurodesis. We performed a systematic review with meta-analysis to evaluate success and complication rate of TPC as compared with chemical pleurodesis in the management of MPE. PubMed, EMBASE, Cochrane central register of controlled trials, and MEDLINE were searched for English-language studies of clinical controlled trials comparing TPC with chemical pleurodesis until May 2014. Overall success and complication rate were evaluated. Relative risks (RRs) were estimated using random-effects model, and statistical heterogeneity was assessed using I test. Three trials involving 307 patients with MPE were included. The success rate was comparable between TPC and chemical pleurodesis group when all studies included in the analysis (RR, 0.8; 95% confidence interval, 0.53-1.19; P = 0.27). TPC had slightly higher complication rate but was not statistically significant (RR, 2; 95% confidence interval, 0.91-4.4; P = 0.09). Current evidence suggests that TPC and chemical pleurodesis are both effective treatment for recurrent MPE with similar success and complication rate. Further randomized controlled trials are needed to compare TPC with other therapies in patients with MPE.
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Zank S, Abboud E, Jaber W, Alraiyes AH. Letter To The Editor: Catheter Track Metastasis With Indwelling Pleural Catheter. Ochsner J 2017; 17:309-310. [PMID: 29230111 PMCID: PMC5718439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Affiliation(s)
- Sara Zank
- Interventional Pulmonary Section, Department of Medicine, Cancer Treatment Center of America, Zion, IL
| | - Elham Abboud
- Department of Pathology, Cancer Treatment Center of America, Zion, IL
| | - Wissam Jaber
- Interventional Pulmonary Section, Department of Medicine, Cancer Treatment Center of America, Phoenix, AZ
| | - Abdul Hamid Alraiyes
- Interventional Pulmonary Section, Department of Medicine, Cancer Treatment Center of America, Zion, IL
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rosalind Franklin University, North Chicago, IL
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Diagnostic value of tumor markers for lung adenocarcinoma-associated malignant pleural effusion: a validation study and meta-analysis. Int J Clin Oncol 2016; 22:283-290. [DOI: 10.1007/s10147-016-1073-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 12/02/2016] [Indexed: 12/30/2022]
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Abstract
Interventional oncologists are playing an ever greater role in improving the quality of life of their patients through minimally invasive procedures, many of which can be performed on an outpatient basis. Some of the most common palliative procedures currently performed will be discussed including management of intractable ascites and pleural effusions, neurolytic plexus blocks, and palliation of pain and bleeding associated with metastatic tumors.
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Taghizadeh N, Fortin M, Tremblay A. US Hospitalizations for Malignant Pleural Effusions: Data From the 2012 National Inpatient Sample. Chest 2016; 151:845-854. [PMID: 27876589 DOI: 10.1016/j.chest.2016.11.010] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/06/2016] [Accepted: 11/02/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Malignant pleural effusion (MPE) is a common complication of advanced malignancy, but little is known regarding its prevalence and overall burden on a population level. METHODS We conducted a retrospective analysis of MPE-associated hospitalizations using the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample, Agency for Healthcare Research and Quality (HCUP-NIS 2012). Cases were included if MPE was coded as a primary or secondary diagnosis or if an unspecified pleural effusion was coded in addition to a diagnosis of cancer with either of these being the primary diagnosis. RESULTS A weighted sample of 126,825 admissions (0.35%) for MPE was identified among the 36,484,846 weighted admissions included in the database in 2012. Of these admissions, 70,750 (55.8%) were for female patients. The median age at admission was 68.0 years (interquartile range [IQR]), 58.4-77.2 years). Lung (37.8%), breast (15.2%), hematologic (11.2%), GI tract (11.0%), and gynecologic (9.0%) cancers were the most common primary malignancies associated with MPE. The median length of stay was 5.5 days (IQR, 2.7-10.1 days), and the inpatient mortality rate was 11.6%. Median hospitalization total charges were $42,376 (IQR, $21,618-$84,679). In the multivariate analyses, female sex, large fringe county residential area, Medicare insurance, and elective type of admission were independently associated with a lower risk of inpatient mortality. CONCLUSIONS There is a considerable inpatient burden and high inpatient mortality associated with MPE in the United States, with potential demographic, geographic, and socioeconomic disparities.
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Affiliation(s)
- Niloofar Taghizadeh
- Division of Respiratory Medicine, University of Calgary and Alberta Thoracic Oncology Program, Calgary, AB, Canada
| | - Marc Fortin
- Division of Respiratory Medicine, University of Calgary and Alberta Thoracic Oncology Program, Calgary, AB, Canada
| | - Alain Tremblay
- Division of Respiratory Medicine, University of Calgary and Alberta Thoracic Oncology Program, Calgary, AB, Canada.
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Qi N, Li F, Li X, Kang H, Zhao H, Du N. Combination use of paclitaxel and avastin enhances treatment effect for the NSCLC patients with malignant pleural effusion. Medicine (Baltimore) 2016; 95:e5392. [PMID: 27893676 PMCID: PMC5134869 DOI: 10.1097/md.0000000000005392] [Citation(s) in RCA: 16] [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] [Indexed: 01/22/2023] Open
Abstract
The current study is conducted to investigate efficacy of the chemotherapy drug paclitaxel in combination with Avastin (Roche Diagnostics GmbH., Mannheim, Germany) (antiangiogenic agent) in treatment of malignant pleural effusions (MPEs).Twenty-four patients with non-small cell lung cancer were randomly assigned for 2 treatment approaches. Ten patients received paclitaxel (175 mg/m) alone, and 14 patients took a combination therapy of paclitaxel and Avastin (5 mg/kg). Efficacy of the treatment approaches in the patients was validated with the change in the MPE volume. Pharmacokinetic (PK) profile and urinary excretion rate of paclitaxel were analyzed with serum vascular endothelial growth factor (VEGF) level, and adverse events were examined as well.The combination therapy reduced the MPE level with a successful rate of 29% and a survival rate of 25% over the single paclitaxel treatment in the study cohort (both P < 0.05). PKs for the combined treatment displayed a rapid distribution of the anticancer drug paclitaxel with an obvious increase in its elimination half-life in the pleural fluid (both P < 0.01). Mean residence time of paclitaxel increased in the presence of Avastin (P < 0.01). Serum VEGF levels significantly reduced in the Avastin-treated patients as compared to the paclitaxel-treated ones (P < 0.01). The urinary excretion rate was similar in the study cohort. Incidence of adverse events for the 2 treatment approaches was similar in the patients.Intervention of Avastin enhances potency of paclitaxel in treatment of MPEs with the increased survival rate of the patients through inhibiting VEGF production and prolonging time of ongoing interaction between the chemotherapy drug and the tumor tissues.
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Affiliation(s)
- Nan Qi
- Department of Oncology, The First Affiliated Hospital
| | - Fang Li
- Tumor Center, Chinese PLA General Hospital, Beijing, China
| | - Xiaosong Li
- Department of Oncology, The First Affiliated Hospital
| | - Huanrong Kang
- Department of Oncology, The First Affiliated Hospital
| | - Hui Zhao
- Department of Oncology, The First Affiliated Hospital
| | - Nan Du
- Department of Oncology, The First Affiliated Hospital
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Luo J, Wang M, Li C, Liang B, Liu D, Shi C, Jiang F, Wang T, Li P, Liang Z. A Novel Combination of Calprotectin and CXCL12 for Predicting Malignancy in Patients with Exudative Pleural Effusion. Medicine (Baltimore) 2015; 94:e2105. [PMID: 26632726 PMCID: PMC5058995 DOI: 10.1097/md.0000000000002105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Pleural effusion (PE) remains a significant challenge and public health problem, which needs novel noninvasive biomarkers for the precise diagnosis. The aim of this study was to further determine the clinical efficacy and diagnostic accuracy of a novel combination of calprotectin and CXCL12 for predicting malignancy in patients with exudative PE.Calprotectin and CXCL12 concentrations were measured in 95 individuals of exudative PE, with 39 malignant PE (MPE) and 56 benign PE (BPE). The accuracy of calprotectin and CXCL12 levels for discriminating MPE from BPE or tuberculous PE were evaluated using receiver-operating characteristic (ROC) curves. Univariate and multivariate logistic regression analyses were performed to test the association between calprotectin and CXCL12 levels and MPE.Calprotectin and CXCL12 levels of patients with MPE were significantly lower than that of BPE and tuberculous PE (P < 0.05). The area under the curve (AUC) of calprotectin and CXCL12 was 0.683 and 0.641 in MPE and BPE, and a combination of calprotectin ≤500.19 ng/mL and CXCL12 ≤6.11 ng/mL rendered a sensitivity and specificity of 48.72% and 78.57%, respectively. While in MPE and tuberculous PE, the AUC of calprotectin and CXCL12 was 0.696 and 0.690, and a combination of calprotectin ≤421.73 ng/mL and CXCL12 ≤3.71 ng/mL presented a sensitivity and specificity of 25.64% and 95.45%, respectively. Multivariate logistic regression demonstrated that both calprotectin and CXCL12 were independent predictors of MPE.Calprotectin and CXCL12 in pleural fluid are informative diagnostic biomarkers for predicting patients with MPE.
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Affiliation(s)
- Jian Luo
- From the Department of Respiratory Medicine, West China School of Medicine and West China Hospital, Sichuan University, Chengdu (JL, MW, BL, CS, FJ, TW, PL, ZL); Department of Respiratory Medicine, First Affiliated Hospital of Kunming Medical University, Kunming (CL); and Department of Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Chengdu, China (DL)
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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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Abstract
Malignant pleural effusions (MPEs) are common complications that occur with advanced stages of cancer. In general, they indicate a poor prognosis and greatly affect quality of life (QOL). The treatment goal of MPEs is to provide relief of symptoms. The standard treatment for MPEs is talc pleurodesis; however, indwelling pleural catheters have become more frequently used. This article focuses on current management strategies for MPEs and assesses their influence on QOL.At a GlanceSymptoms of malignant pleural effusions (MPEs), which involve the accumulation of fluid in the pleural space, include dyspnea, shortness of breath, chest pain, and other issues that decrease functional status.Treatment for MPEs should be palliative, achieving immediate symptom relief and improved quality of life.The optimal treatment strategy for MPEs should have minimal side effects, require minimal or no hospitalization, and have low rates of recurrence.
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Affiliation(s)
- April Lenker
- Rex Hematology Oncology Associates in Raleigh, NC
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Tsai MF, Chang TH, Wu SG, Yang HY, Hsu YC, Yang PC, Shih JY. EGFR-L858R mutant enhances lung adenocarcinoma cell invasive ability and promotes malignant pleural effusion formation through activation of the CXCL12-CXCR4 pathway. Sci Rep 2015; 5:13574. [PMID: 26338423 PMCID: PMC4559673 DOI: 10.1038/srep13574] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 07/30/2015] [Indexed: 12/13/2022] Open
Abstract
Malignant pleural effusion (MPE) is a common clinical problem in non-small cell lung carcinoma (NSCLC) patients; however, the underlying mechanisms are still largely unknown. Recent studies indicate that the frequency of the L858R mutant form of the epidermal growth factor receptor (EGFR-L858R) is higher in lung adenocarcinoma with MPE than in surgically resected specimens, suggesting that lung adenocarcinoma cells harboring this mutation tend to invade the adjacent pleural cavity. The purpose of this study was to clarify the relationship between the EGFR-L858R mutation and cancer cell invasion ability and to investigate the molecular mechanisms involved in the formation of MPE. We found that expression of EGFR-L858R in lung cancer cells resulted in up-regulation of the CXCR4 in association with increased cancer cell invasive ability and MPE formation. Ectopic expression of EGFR-L858R in lung cancer cells acted through activation of ERK signaling pathways to induce the expression of CXCR4. We also indicated that Inhibition of CXCR4 with small interfering RNA, neutralizing antibody, or receptor antagonist significantly suppressed the EGFR-L858R–dependent cell invasion. These results suggest that targeting the production of CXCR4 and blocking the CXCL12-CXCR4 pathway might be effective strategies for treating NSCLCs harboring a specific type of EGFR mutation.
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Affiliation(s)
- Meng-Feng Tsai
- Department of Molecular Biotechnology, College of Biotechnology and Bioresources, Dayeh University, Changhua 51591, Taiwan
| | - Tzu-Hua Chang
- Department of Internal Medicine, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei 10002, Taiwan
| | - Shang-Gin Wu
- Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yunlin 64041, Taiwan
| | - Hsiao-Yin Yang
- Department of Internal Medicine, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei 10002, Taiwan
| | - Yi-Chiung Hsu
- Institute of Statistical Science, Academia Sinica, Taipei 11529, Taiwan
| | - Pan-Chyr Yang
- Department of Internal Medicine, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei 10002, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 10002, Taiwan
| | - Jin-Yuan Shih
- Department of Internal Medicine, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei 10002, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 10002, Taiwan
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Li S, You WJ, Zhang JC, Zhou Q, Shi HZ. Immune Regulation of Interleukin-27 in Malignant Pleural Effusion. Chin Med J (Engl) 2015; 128:1932-41. [PMID: 26168835 PMCID: PMC4717932 DOI: 10.4103/0366-6999.160556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Interleukin (IL)-27 has been reported to have anti-proliferate and anti-angiogenic activities on cancer cells. However, the involvement of IL-27 in malignant pleural effusion (MPE) remains unknown. Thus, in this research, we compared the immune functions of IL-27, interferon (IFN)-γ, and IL-17 on lung cancer cells and revealed the regulatory mechanism of IL-27 in MPE. METHODS The distribution of IL-27 in both MPE and blood was evaluated by enzyme-linked immunosorbent assay and flow cytometry. The expressions of cytokine receptors and the levels of the phosphorylated signal transducer and activator of transcription (STAT) signalings were detected by flow cytometry. As well as the effects of proliferation, apoptosis, migration, and adherent activity of IL-27, IFN-γ, and IL-17 on lung cancer cells were also explored. RESULTS The expression of IL-27 was increased in MPE when compared with blood (147.3 ± 25.1 pg/ml vs. 100.3 ± 13.9 pg/ml, P = 0.04). IL-27 was noted to suppress both proliferation (18.33 ± 0.21 vs. 27.77 ± 0.88, P = 0.0005) and migration (1.82 ± 0.44 vs. 3.13 ± 0.07, P = 0.04) of A549 cells, but obviously promoted apoptosis of A549 cells (9.47 ± 1.14 vs. 4.96 ± 0.17, P = 0.02) by activating STAT1 signaling. Interestingly, IL-27 played totally opposite effects on A549 cells by activating STAT3 pathway. Moreover, IL-27 exerted different intercellular adherent activities of A549 cells to pleural mesothelial cell monolayer by activating different STAT signalings. CONCLUSIONS IL-27 might exert an important immune regulation on lung cancer cells in human pleural malignant environment.
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Affiliation(s)
- Shi Li
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Wen-Jie You
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Jian-Chu Zhang
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Qiong Zhou
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Huan-Zhong Shi
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
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Tian P, Shen Y, Feng M, Zhu J, Song H, Wan C, Chen L, Wen F. Diagnostic accuracy of endostatin for malignant pleural effusion: A clinical study and meta-analysis. Postgrad Med 2015; 127:529-34. [PMID: 25979108 DOI: 10.1080/00325481.2015.1048180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The diagnosis of malignant pleural effusion (MPE) remains a clinical challenge. Many studies suggest that endostatin is a potential marker for MPE. This study aimed to determine the diagnostic value of endostatin with respect to MPE and to summarize the overall diagnostic performance of endostatin via a meta-analysis. METHODS Pleural effusion samples from patients with both malignant and nonmalignant disease were collected, and the pleural levels of endostatin and carcino-embryonic antigen (CEA) were subsequently measured. The diagnostic performances of endostatin and CEA were analyzed via standard receiver operator characteristic curve analysis methods, using the AUC as a measure of accuracy. The overall diagnostic accuracy of endostatin for MPE was summarized through a bivariate meta-analysis with standard method recommended. RESULTS Fifty-two patients with MPEs and 64 patients with benign pleural effusions (BPEs) were included this study. Pleural endostatin levels were significantly increased in the setting of MPE compared with BPE (104.78 ± 64.58 vs. 56.81 ± 28.84 ng/ml; p < 0.001). Using a cutoff value of 79.7 ng/ml, the sensitivity and specificity of endostatin in diagnosing MPE were shown to be 51.92% and 85.94%, respectively, and the AUC was 0.747. The combination of endostatin and CEA enhanced diagnostic performance with respect to MPE. In addition to this study, another eight studies were included in this meta-analysis. The pooled diagnostic estimates were 0.69 for sensitivity and 0.78 for specificity. The positive likelihood ratio and negative likelihood ratio for endostatin were 3.16 and 0.40, respectively. The diagnostic odds ratio was 7.89, and the AUC of the summary receiver operator characteristic curve was 0.79. CONCLUSION Pleural levels of endostatin are increased in the setting of MPE. However, endostatin exhibits a limited efficacy for the diagnosis of MPE and shows a relatively low sensitivity. The assessment of endostatin in combination with CEA may enhance diagnostic accuracy with respect to MPE.
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Affiliation(s)
- Panwen Tian
- 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 , China
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