Survivin is a negative prognostic factor in malignant pleural effusion

Our plain-English summary of Survivin is a negative prognostic factor in malignant pleural effusion, by E. Arellano-Orden, B. Romero-Romero, V. Sánchez-López, et al (European Journal of Clinical Investigation, 2018).

The study

• Authors: E. Arellano-Orden, B. Romero-Romero, V. Sánchez-López, J. Martín-Juan, F. Rodríguez-Panadero, R. Otero-Candelera
• Journal: European Journal of Clinical Investigation
• Published: 2018;48(4)
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

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 pleurodesis 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 thoracoscopy (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.

© 2018 Stichting European Society for Clinical Investigation Journal Foundation.

In plain English

Researchers in Seville, Spain measured survivin, a protein that blocks cells' natural self-destruction, in chest fluid from 84 patients with malignant pleural effusion, which is cancer-related fluid around the lungs. Of these, 32 had breast cancer, 25 lung cancer and 27 mesothelioma. All underwent talc pleurodesis, in which 5 g of asbestos-free talc was placed in the chest to seal the space. Fluid was sampled before and 24 hours after. The article reports no asbestos exposure data. Survivin was significantly higher after talc than before. Patients with higher starting levels had significantly poorer pleurodesis results. A cutoff of 30 pg/ml predicted failure with 54% sensitivity and 79% specificity. Median survival after pleurodesis was 4 months in the 30 patients at or above 30 pg/ml and 13 months in the 54 below it (p less than 0.001). The medians were 5 versus 18 months for breast cancer (p less than 0.001), 2 versus 7 for lung cancer, and 8 versus 10 for mesothelioma. The authors concluded that elevated survivin is useful to predict pleurodesis failure and is associated with shorter survival.

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: Observational clinical study of patients undergoing talc pleurodesis, with pleural fluid survivin measured before and 24 hours after the procedure
• Who was studied: 84 patients with malignant pleural effusion at Hospital Universitario Virgen del Rocío, Seville, Spain: 32 with breast cancer, 25 with lung cancer and 27 with mesothelioma (20 epithelial, four sarcomatous, three mixed-type); study dates not given
• Exposure: Thoracoscopic talc poudrage using 5 g of asbestos-free, sterile talc per patient; the factor studied was survivin concentration in pleural fluid. No asbestos exposure data are reported.
• Main results:
  • In all patients, survivin levels in pleural fluid were significantly higher 24 hours after talc poudrage than at baseline (p < 0.001)
  • Patients with breast cancer had significantly higher pleural fluid survivin than those with lung cancer or mesothelioma (p = 0.004)
  • In the whole series, patients with higher baseline survivin had a significantly poorer pleurodesis outcome (p = 0.004)
  • Within individual tumor types the pattern was consistent but not statistically significant
  • Pleurodesis failed in 67% of patients with baseline survivin of 30 pg/ml or more in the overall series (p = 0.002)
  • A baseline survivin cutoff of 30 pg/ml predicted pleurodesis failure with 54% sensitivity and 79% specificity
  • Median post-pleurodesis survival was 4 months (range 0.1-38) for patients with baseline survivin of 30 pg/mL or more, versus 13 months (range 0.1-259) for those below (p < 0.001)
  • The group below 30 pg/ml had 54 patients and the group at or above 30 pg/ml had 30 patients
  • Median survival above versus below the 30 pg/ml cutoff was 5 vs 18 months in breast cancer (p < 0.001), 2 vs 7 months in lung cancer, and 8 vs 10 months in mesothelioma; p-values were reported only for breast cancer
  • Survivin measured 24 hours after talc was positively correlated with pleural tumor burden (rho = 0.257, p = 0.019)
  • Baseline survivin was negatively correlated with pleural fluid pH (rho = -0.314, p = 0.015)
• The authors' conclusion: The authors concluded that elevated pleural fluid survivin concentrations are useful to predict failure of pleurodesis and are associated with shorter survival in patients with malignant pleural effusion

Topics

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Apoptosis, Talc, Pleurodesis, Talc Pleurodesis, Lung Cancer, Mesothelioma, Thoracoscopy.

Related studies

• Is survivin expression prognostic or predictive in malignant pleural mesothelioma? — J. Hmeljak, N. Erčulj, et al. (2013)
• Low Merlin expression and high Survivin labeling index are indicators for poor prognosis in patients with malignant pleural mesothelioma — M. Meerang, K. Bérard, et al. (2016)
• BIRC5 promoter SNPs do not affect nuclear survivin expression and survival of malignant pleural mesothelioma patients — J. Hmeljak, N. Erčulj, et al. (2011)
• Preclinical development of HIvax: Human survivin highly immunogenic vaccines — P.R. Hoffmann, M. Panigada, et al. (2015)
• Serum Survivin Levels and Outcome of Chemotherapy in Patients with Malignant Mesothelioma — K. Goričar, V. Kovač, et al. (2015)
• Prognostic factors for survival after surgical palliation of malignant pleural effusion — J.E. Pilling, M.E. Dusmet, et al. (2010)

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