Cytotoxic Natural Killer Subpopulations as a Prognostic Factor of Malignant Pleural Effusion

• Published in: Lung Vol. 197; no. 1; pp. 53 - 60
• Main Authors: Herrera Lara, Susana, Fernández-Fabrellas, Estrella, Juan Samper, Gustavo, Marco Buades, Josefa, Andreu Lapiedra, Rafael, Pinilla Moreno, Amparo, Morales Suárez-Varela, María
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.02.2019; Springer; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Benign; Biomarkers - blood; Care and treatment; CD16 antigen; CD56 antigen; CD56 Antigen - blood; CD57 antigen; CD57 Antigens - blood; Cytotoxicity; Decision trees; Diagnosis; Diagnostic systems; Female; GPI-Linked Proteins - blood; Humans; Immunophenotyping - methods; Killer cells; Killer Cells, Natural - immunology; Lungs; Lymphocyte Subsets - immunology; Male; Medical diagnosis; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Natural killer cells; Patients; Peripheral blood; Phenotype; Physiological aspects; Pleural Disease; Pleural effusion; Pleural Effusion, Malignant - blood; Pleural Effusion, Malignant - diagnosis; Pleural Effusion, Malignant - immunology; Pleural Effusion, Malignant - therapy; Pleural fluid; Pneumology/Respiratory System; Predictive Value of Tests; Prognosis; Prospective Studies; Receptors, IgG - blood; Regression analysis; Subpopulations; Tumors; Spain; Flow cytometry; Biomarker; Prognosis; Pleural effusion; Diagnosis; Natural killer cells; Cancer
• ISSN: 0341-2040; 1432-1750
• DOI: 10.1007/s00408-018-0186-7

Background Malignant pleural effusion (MPE) is a sign of advanced disease of poor prognosis. As natural killer (NK) cells are involved in the first line of tumour defence, we aimed to validate a new diagnostic and prognostic indicator for MPE based on NK subpopulations of pleural fluid (PF) and peripheral blood (PB). Methods NK subpopulations were determined in PF and PB in 71 patients with malignant, paramalignant or benign pleural effusion. The receiver operating characteristic (ROC) curves, Kaplan–Meier, multivariable Cox model and decision trees created with the CHAID (Chi-square automatic interaction detector) methodology were employed. Results We demonstrated that the PF/PB ratios of the CD56 bright CD16− and CD56 dim CD16− NK subpopulations were higher ( p  = 0.013 and p  = 0.003, respectively) in MPEs and paramalignant pleural effusions (PPEs) than in benign ones, with an AUC of 0.757 and 0.741, respectively. The PF/PB ratio of CD16+ NK and CD57+ NK obtained a higher hazard ratio (HR) in the crude Cox’s regression analysis. In the adjusted Cox’s regression analysis, the PF/PB ratio of CD16+ NK gave the highest HR (HR 6.1 [1.76–21.1]) ( p  = 0.004). In the decision tree created for the MPE prognosis, we observed that the main predictor variable among the studied clinical, radiological, and analytical variables was lung mass, and that 92.9% of the patients who survived had a PF/PB ratio of the CD56 dim CD16+ NK subpopulation ≤ 0.43. Conclusions Our data suggest that both the PF/PB ratios of cytotoxic subpopulations CD57+ NK and CD16+ NK are useful as a prognostic factor of MPE. Other subpopulations (CD56 bright CD16− and CD56 dim CD16− NK) could help to diagnose MPE.