Diagnostic and prognostic significance of survivin levels in malignant pleural effusion

• Published in: Respiratory medicine Vol. 107; no. 8; pp. 1260 - 1265
• Main Authors: Görgün, Didem, Seçik, Funda, Midilli, Kenan, Akkaya, Vakur, Yıldız, Pınar
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.08.2013; Elsevier Limited
• Subjects: Adenocarcinoma - complications; Adenocarcinoma - diagnosis; Adolescent; Adult; Aged; Aged, 80 and over; Analysis of Variance; Biomarkers - metabolism; Biopsy; Case-Control Studies; Cellular biology; Diagnosis, Differential; Enzyme-Linked Immunosorbent Assay; Family medical history; Female; Fluids; Heart failure; Heart Failure - complications; Heart Failure - metabolism; Humans; Inhibitor of Apoptosis Proteins - metabolism; Lung Neoplasms - complications; Lung Neoplasms - diagnosis; Male; Malignant; Middle Aged; Mortality; Pleural effusion; Pleural Effusion, Malignant - diagnosis; Prognosis; Prospective Studies; Pulmonary/Respiratory; Statistical analysis; Studies; Survival analysis; Survivin; Thoracic surgery; Tuberculosis, Pulmonary - complications; Tuberculosis, Pulmonary - diagnosis; Variables; Young Adult; Pleural effusion; Prognosis; Survivin; Malignant
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2013.04.011

Summary We aimed to evaluate the diagnostic and prognostic value of measuring survivin levels, which is an inhibitor of apoptosis in pleural effusions. Methods: Group I, malignant (MPE) ( n  = 51); Group II, tuberculosis (TPE) ( n  = 18); Group III transudative (TE) ( n  = 9) effusions were enrolled prospectively. We used ELISA to analyze 78 effusions. The value for the differential diagnosis and the correlation between survivin and survival in MPE were analyzed. Results: Survivin level was 41.75 ± 76.20 in MPE, 15.83 ± 10.92 in TPE and 8.33 ± 8.67 in TE. When the patients divided two groups as malignant and non-malignant pleural effusion (non-MPE), survivin level was significantly higher in MPE (41.75 ± 76.20) than in non-MPE (13.33±2.05) ( p  = 0.012). The cutoff value for survivin levels detected by ROC curve analysis was 7.5 pg/ml, with sensitivity and specificity values of 72%, 44%, respectively. Survivin had no discriminative power in differentiating exudative effusions of MPE from TPE ( p  = 0.405). There was no correlation between survivin level and age, sex, location, fluid pH, glucose, protein, albumine and ADA level while there was significant moderate correlation with fluid LDH ( r  = 0.49; p  < 0.001). Survivin levels can distinguish patients who had poor prognosis (median survival 75 days, n  = 24) and those who had good prognosis (median survival 219 days, n  = 27, p  = 0.03) in MPE. In conclusion, survivin expression levels detected with ELISA had no discriminative power in differentiating exudative effusions included MPE and TPE. Elevated survivin levels are associated with poor survival in MPE. Our results suggest that survivin may be a potential prognostic marker in MPE.