Pleural effusion VEGF levels as a prognostic factor of malignant pleural mesothelioma

Our plain-English summary of Pleural effusion VEGF levels as a prognostic factor of malignant pleural mesothelioma, by N. Hirayama, C. Tabata, R. Tabata, et al (Respiratory Medicine, 2011).

The study

• Authors: N. Hirayama, C. Tabata, R. Tabata, R. Maeda, A. Yasumitsu, S. Yamada, K. Kuribayashi, K. Fukuoka, T. Nakano
• Journal: Respiratory Medicine
• Published: 2011;105(1):137-42
• Cited by: 45 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Malignant pleural mesothelioma (MPM) is an aggressive malignant tumor of mesothelial origin associated with asbestos exposure. MPM has a limited response to conventional chemotherapy and radiotherapy so early diagnosis of MPM is very important. Vascular endothelial growth factor (VEGF), a potent mitogen for the vascular endothelium, is also known to be an autocrine growth factor for MPM. Here, we investigated the pleural effusion VEGF levels in patients with MPM and compared them to those of a population with a non-malignant pleuritis or lung cancer involving malignant pleural effusion.

Methods: The pleural effusion VEGF concentrations were measured in 46 MPM patients and 45 individuals with non-MPM individuals (25 individuals with non-malignant pleural effusions, and 20 individuals with lung cancer involving malignant pleural effusion).

Results: We demonstrated that patients with MPM had significantly higher pleural effusion VEGF levels than a population with non-malignant pleuritis or lung cancer involving malignant pleural effusion, and the patients with advanced stage MPM showed higher levels of VEGF than the early stage MPM patients. The difference in overall survival between the groups with pleural effusion VEGF levels lower and higher than the assumed cut-off of 2000pg/ml was significant.

Conclusions: Our data suggest that the pleural effusion VEGF concentration could be useful as an aid for the diagnosis of MPM and as a prognostic factor.

Copyright © 2010 Elsevier Ltd. All rights reserved.

In plain English

Researchers at Hyogo College of Medicine Hospital, Japan, measured a protein called VEGF in pleural fluid (fluid around the lungs) from 91 patients seen from 2005 to 2009. Forty-six had malignant pleural mesothelioma with a documented asbestos exposure history. Twenty-five had non-cancerous pleural effusions, 5 of them benign asbestos pleurisy. Twenty had lung cancer with malignant effusion. Mean VEGF was reported as 5303.6 pg/ml in the mesothelioma group, 1172.2 pg/ml in the non-cancerous group and 2429.9 pg/ml in the lung cancer group. Both differences from the mesothelioma group were statistically significant. At a cut-off of 2000 pg/ml, the test picked out 71.7% of mesothelioma patients and correctly excluded 76.0% of non-cancerous patients. Levels rose with mesothelioma stage. In 28 mesothelioma patients followed for up to 600 days, survival differed significantly between those below and above 2000 pg/ml. In a multivariate analysis, the hazard ratio for a level of 2000 pg/ml or more was 961.23 (95% CI 7.083 to 130446.4). The authors concluded that pleural fluid VEGF could aid diagnosis and serve as a prognostic factor.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Hospital-based biomarker study measuring VEGF in stored pleural fluid samples, comparing diagnostic groups and relating levels to survival
• Who was studied: 91 patients with pleural effusion at the Department of Respiratory Medicine, Hyogo College of Medicine Hospital, Japan, 2005 to 2009. The groups were 46 with malignant pleural mesothelioma, 25 with non-malignant pleural effusion (including 5 with benign asbestos pleurisy) and 20 with lung cancer involving malignant pleural effusion.
• Exposure: The study measured VEGF levels in pleural fluid, not asbestos exposure. The mesothelioma patients had a documented asbestos exposure history. No fiber types or doses are given.
• Main results:
  • For mesothelioma versus non-malignant pleural effusion, the area under the ROC curve was 0.8304 (95% CI 0.7528 to 0.9081).
  • At the 2000 pg/ml cut-off, sensitivity for mesothelioma was 71.7% and specificity (versus non-malignant effusion) was 76.0%.
  • Mean pleural fluid VEGF was 5303.6 pg/ml in mesothelioma patients, versus 1172.2 pg/ml in non-malignant effusion patients (p = 0.0003) and 2429.9 pg/ml in lung cancer patients (p = 0.0017).
  • In mesothelioma patients, VEGF levels showed a statistically significant tendency to rise with stage: stage I 1919.2, stage II 3764.0, stage III 3956.7, stage IV 4789.8 pg/ml (p = 0.025).
  • VEGF levels did not differ significantly by mesothelioma histology (epithelioid vs non-epithelioid) or by sex. They also did not differ significantly between benign asbestos pleurisy (1853.8 pg/ml) and benign pleurisy without asbestos exposure history (1139.6 pg/ml).
  • In 16 mesothelioma patients, pleural fluid and serum VEGF levels were significantly correlated (r = 0.51, p = 0.046).
  • 28 of the 46 mesothelioma patients were followed for up to 600 days: 11 had levels below 2000 pg/ml and 17 above. Overall survival differed significantly between the two groups (p = 0.041).
  • In Cox regression on these 28 patients, the hazard ratio for a pleural fluid VEGF of 2000 pg/ml or more versus below 2000 pg/ml was 961.23 (95% CI 7.083 to 130446.4; p = 0.0061). Age, sex and histology also had independent significant effects.
• The authors' conclusion: The authors concluded that pleural effusion VEGF concentration could be useful as an aid for diagnosing malignant pleural mesothelioma and as a prognostic factor.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Pleural Mesothelioma, Asbestos Exposure, Chemotherapy, Lung Cancer, Overall Survival.

Related studies

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• Proteome screening of pleural effusions identifies galectin 1 as a diagnostic biomarker and highlights several prognostic biomarkers for malignant mesothelioma — F. Mundt, H.J. Johansson, et al. (2014)
• Diagnostic and Prognostic Utility of the Extracellular Vesicles Subpopulations Present in Pleural Effusion — J. Javadi, A. Görgens, et al. (2021)
• Vascular endothelial growth factor in pleural fluid for differential diagnosis of benign and malignant origin and its clinical applications — A. Fiorelli, G. Vicidomini, et al. (2011)
• Pleural effusion hyaluronic acid as a prognostic marker in pleural malignant mesothelioma — J. Creaney, I.M. Dick, et al. (2013)
• Diagnostic usefulness of tumour marker levels in pleural effusions of malignant and benign origin — F. Kuralay, Z. Tokgöz, et al. (2000)

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