European Journal of Clinical Investigation 2018 January 23 [Epub ahead of print] [Link]

Arellano-Orden E et. al.


SURVIVIN: is a well-known member of the inhibitor of apoptosis family, and has been related with increased tumour aggressivity, both in tissue and in pleural fluid.

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 pleurodesis outcome and patient survival.

We investigated 84 patients with malignant pleural effusion who underwent talc pleurodesis. Of them, 32 had breast cancer, 25 lung cancer, and 27 mesothelioma. Serial samples of pleural fluid were obtained before thoracoscopy (baseline) and 24 h thereafter.

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 < 0.001). Patients with higher pleural fluid survivin levels at baseline had a significantly poorer pleurodesis outcome (p = 0.004). A 30 pg/ml cutoff for baseline survivin in pleural fluid predicted failure of pleurodesis with a 54% sensitivity and 79% specificity (p = 0.009). Moreover, median post-pleurodesis 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 < 0.001). 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.