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Sreter KB, Jakopovic M, Janevski Z, Samarzija M, Zarogoulidis P, Kioumis I, Mparmpetakis N, Pataka A, Zarogoulidis K, Tsiouda T, Kosmidis C, Mpaka S, Huang H, Hohenforst-Schmidt W, Charalampidis C, Machairiotis N, Zaric B, Milovancev A. A pilot study-is there a role for mitoxantrone pleurodesis in the management of pleural effusion due to lung cancer? ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:162. [PMID: 27275475 DOI: 10.21037/atm.2016.04.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Lung cancer is the leading cause of malignant pleural effusion (MPE). Management of MPEs remains a clinical challenge due to recurrence and poor quality of life. An ideal sclerosing agent has yet to be found. The aim of this cohort pilot study was to evaluate the role of mitoxantrone pleurodesis (MP) as an alternative to talc sclerotherapy for managing MPEs in lung cancer patients. METHODS A retrospective chart review was conducted on consecutively admitted patients with MPE to the Department of Post-Intensive Care at the Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, in Croatia. RESULTS Of 34 patients with MPE, twenty-one (64.8±9.46 years; 47-84 years) with primary lung carcinoma who received MP (30 mg of mitoxantrone) between December 2003 and February 2009 were included in this study. Chest radiographs taken prior to sclerotherapy and at 1-, 2-, and 3-month follow-up were compared. At the post-sclerotherapy evaluation periods, overall success (OS) rates of MP were 88.2% [17.6%, complete response (CR); 70.6%, partial response (PR)], 53.9% (7.7% CR; 46.2% PR), and 45.5% (PR), respectively. Kaplan-Meier median survival from MP until death was 5.2 months, while that from diagnosis of primary lung cancer was 12.3 months. CONCLUSIONS MP may be a safe and effective method of managing MPE due to lung cancer. Future randomized controlled studies comparing mitoxantrone and talc pleurodesis in lung cancer patients are warranted to elucidate whether a significant difference exists between these agents. Factors affecting success, survival probability, and quality of life also require further investigation.
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Affiliation(s)
- Katherina-Bernadette Sreter
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Marko Jakopovic
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Zoran Janevski
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Miroslav Samarzija
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Paul Zarogoulidis
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Ioannis Kioumis
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Nikolaos Mparmpetakis
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Athanasia Pataka
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Konstantinos Zarogoulidis
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Theodora Tsiouda
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Christoforos Kosmidis
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Sofia Mpaka
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Haidong Huang
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Wolfgang Hohenforst-Schmidt
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Charalampos Charalampidis
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Nikolaos Machairiotis
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Bojan Zaric
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Aleksandar Milovancev
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
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Bai CQ, Yao YW, Liu CH, Zhang H, Xu XB, Zeng JL, Liang WJ, Yang W, Song Y. Diagnostic and prognostic significance of lysophosphatidic acid in malignant pleural effusions. J Thorac Dis 2014; 6:483-90. [PMID: 24822107 DOI: 10.3978/j.issn.2072-1439.2014.02.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 02/26/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Lysophosphatidic acid (LPA) is an important extracellular signal transmitter and intracellular second messenger in body fluids. It can be detected in the ascitic fluid of patients with ovarian cancer. Increasing evidence shows that LPA can stimulate cancer cell proliferation and promote tumor invasion and metastasis. Our study aimed to evaluate the diagnostic value of LPA in differentiating between malignant pleural effusions (MPEs) and benign pleural effusions (BPEs) and to evaluate the association between the level of LPA in MPE and the prognosis of lung cancer patients. PATIENTS AND METHODS The level of LPA in the pleural effusions (PEs) of 123 patients (94 MPE, 29 BPE) with lung cancer was evaluated using an enzyme-linked immunosorbent assay. The performance of LPA was analyzed by standard Receiver operator characteristic curve (ROC) analysis methods, using the area under the curve (AUC) as a measure of accuracy. Overall survival (OS) curves and progression-free survival (PFS) curves were based on the Kaplan-Meier method, and the survival differences between subgroups were analyzed using the log-rank or Breslow test (SPSS software). A multivariate Cox proportional hazards model was used to assess whether LPA independently predicted lung cancer survival. RESULTS The levels of LPA differed significantly between MPE (22.08±8.72 µg/L) and BPE (14.61±5.12 µg/L) (P<0.05). Using a cutoff point of 18.93 µg/L, LPA had a sensitivity of 60% and a specificity of 83% to distinguish MPEs from BPEs with an AUC of 0.769±0.045 (SE) (P=0.000) (95% CI, 0.68-0.857). In the three pathological types of lung cancer patients with MPE, there were no significant associations between LPA levels and the length of PFS and OS (P=0.58 and 0.186, respectively). Interestingly, in the patients with MPE caused by lung adenocarcinoma there were significant associations between the LPA levels and the PFS and OS (P=0.018 and 0.026, respectively). Multivariate analysis showed that the LPA level was an independent prognostic factor for PFS in lung adenocarcinoma. CONCLUSIONS Our results indicate that LPA can be used as a new biomarker for the diagnosis of MPE caused by lung cancer and that higher levels of LPA are related to shorter PFS in adenocarcinoma of the lung.
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Affiliation(s)
- Cui-Qing Bai
- 1 Department of Respiratory Medicine, Jinling Hospital, Nanjing clinical school, Southern Medical University (Guangzhou), Nanjing 210001, China ; 2 Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210001, China ; 3 Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu 241000, China ; 4 Department of Gastroenterology and Hepatology, Jinling Hospital, Clinical School of Nanjing, Second Military Medical University, Nanjing 210002, China
| | - Yan-Wen Yao
- 1 Department of Respiratory Medicine, Jinling Hospital, Nanjing clinical school, Southern Medical University (Guangzhou), Nanjing 210001, China ; 2 Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210001, China ; 3 Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu 241000, China ; 4 Department of Gastroenterology and Hepatology, Jinling Hospital, Clinical School of Nanjing, Second Military Medical University, Nanjing 210002, China
| | - Chun-Hua Liu
- 1 Department of Respiratory Medicine, Jinling Hospital, Nanjing clinical school, Southern Medical University (Guangzhou), Nanjing 210001, China ; 2 Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210001, China ; 3 Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu 241000, China ; 4 Department of Gastroenterology and Hepatology, Jinling Hospital, Clinical School of Nanjing, Second Military Medical University, Nanjing 210002, China
| | - He Zhang
- 1 Department of Respiratory Medicine, Jinling Hospital, Nanjing clinical school, Southern Medical University (Guangzhou), Nanjing 210001, China ; 2 Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210001, China ; 3 Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu 241000, China ; 4 Department of Gastroenterology and Hepatology, Jinling Hospital, Clinical School of Nanjing, Second Military Medical University, Nanjing 210002, China
| | - Xiao-Bing Xu
- 1 Department of Respiratory Medicine, Jinling Hospital, Nanjing clinical school, Southern Medical University (Guangzhou), Nanjing 210001, China ; 2 Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210001, China ; 3 Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu 241000, China ; 4 Department of Gastroenterology and Hepatology, Jinling Hospital, Clinical School of Nanjing, Second Military Medical University, Nanjing 210002, China
| | - Jun-Li Zeng
- 1 Department of Respiratory Medicine, Jinling Hospital, Nanjing clinical school, Southern Medical University (Guangzhou), Nanjing 210001, China ; 2 Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210001, China ; 3 Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu 241000, China ; 4 Department of Gastroenterology and Hepatology, Jinling Hospital, Clinical School of Nanjing, Second Military Medical University, Nanjing 210002, China
| | - Wen-Jun Liang
- 1 Department of Respiratory Medicine, Jinling Hospital, Nanjing clinical school, Southern Medical University (Guangzhou), Nanjing 210001, China ; 2 Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210001, China ; 3 Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu 241000, China ; 4 Department of Gastroenterology and Hepatology, Jinling Hospital, Clinical School of Nanjing, Second Military Medical University, Nanjing 210002, China
| | - Wen Yang
- 1 Department of Respiratory Medicine, Jinling Hospital, Nanjing clinical school, Southern Medical University (Guangzhou), Nanjing 210001, China ; 2 Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210001, China ; 3 Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu 241000, China ; 4 Department of Gastroenterology and Hepatology, Jinling Hospital, Clinical School of Nanjing, Second Military Medical University, Nanjing 210002, China
| | - Yong Song
- 1 Department of Respiratory Medicine, Jinling Hospital, Nanjing clinical school, Southern Medical University (Guangzhou), Nanjing 210001, China ; 2 Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210001, China ; 3 Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu 241000, China ; 4 Department of Gastroenterology and Hepatology, Jinling Hospital, Clinical School of Nanjing, Second Military Medical University, Nanjing 210002, China
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