Survivin is a negative prognostic factor in malignant pleural
Instituto de Biomedicina de Sevilla
(IBiS), Unidad M
Enfermedades Respiratorias, Hospital
Universitario Virgen del Roc
Universidad de Sevilla, Seville, Spain
CIBER de Enfermedades Respiratorias
(CIBERES), Instituto de Salud Carlos III,
Elena Arellano-Orden, Instituto de
Biomedicina de Sevilla (IBiS), Hospital
Universitario Virgen del Roc
This study was financially supported by a
grant (13/2013) from the Neumosur
Background: Survivin is a well-known member of the inhibitor of apoptosis
family, and has been related to increased tumour aggressivity, both in tissue and
in pleural fluid.
Objectives: In patients with malignant pleural effusion, we sought to investigate
the changes in pleural fluid survivin concentrations induced by talc instillation
into the pleural space. Those changes were also examined in relation to pleurode-
sis outcome and patient survival.
Methods: We investigated 84 patients with malignant pleural effusion who
underwent talc pleurodesis. Of them, 32 had breast cancer, 25 lung cancer and 27
had mesothelioma. Serial samples of pleural fluid were obtained before thora-
coscopy (baseline) and 24 hours thereafter.
Results: Survivin levels were successfully quantified in all pleural fluid samples,
and they were significantly higher in samples obtained after thoracoscopic talc
poudrage compared with baseline (P < .001). Patients with higher pleural fluid
survivin levels at baseline had a significantly poorer pleurodesis outcome
(P = .004). A 30 pg/mL cut-off for baseline survivin in pleural fluid predicted
failure of pleurodesis with a 54% sensitivity and 79% specificity (P = .009).
Moreover, median postpleurodesis survival of patients with baseline survivin
levels ≥30 pg/mL was 4 months (range: 0.1-38), compared with 13 months
(range: 0.1-259) in patients below that cut-off (P < .001).
Conclusion: Elevated pleural fluid survivin concentrations are useful to predict
failure of pleurodesis and are associated with shorter survival in patients with
malignant pleural effusion.
malignant pleural effusion, pleurodesis, survival, survivin
A malignant pleural effusion (MPE) is defined by an
increase in the volume of pleural fluid accompanied by the
presence of malignant cells. MPE may develop because of
a primary pleural malignancy, for example mesothelioma,
but more commonly occurs following metastatic cancer.
The number of new patients diagnosed with MPE diag-
nosed in Europe each year is over 100 000,
cancer being the most common underlying aetiology (ac-
counting for approximately one-third of all cases). Other
Take home: High pleural fluid survivin levels are an adverse predictor of
pleurodesis and survival in malignant pleural effusion
Received: 4 April 2017
Accepted: 18 January 2018
Eur J Clin Invest. 2018;48:e12895.
wileyonlinelibrary.com/journal/eci © 2018 Stichting European Society for Clinical
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