Abstract
BackgroundRapidly growing cancer cells secrete growth-promoting polypeptides and have increased proteolytic activity, contributing to tumor progression and metastasis. Their presentation in malignant pleural effusion (MPE) and their predictive value for the outcome of pleurodesis and survival were studied.MethodsBetween February 2011 and March 2012, MPE samples were prospectively collected from 61 patients. Twenty-five patients with non-malignant pleural effusion in the same period were included as controls. Pleural fluid osteopontin (OPN), vascular endothelial growth factor (VEGF), and urokinase-type plasminogen activator (uPA) concentrations were measured.ResultsPatients with MPE had higher pleural fluid OPN, VEGF, and uPA concentrations than those with non-malignant pleural effusion, but only differences in VEGF were statistically significant (p = 0.045). Patients with distant metastases had significantly elevated pleural fluid VEGF concentrations than those without (p = 0.004). Pleural fluid OPN, VEGF, and uPA concentrations were positively correlated in most patients. However, there was no significant difference in pleural fluid OPN, VEGF, and uPA concentrations between patients with successful pleurodesis and those without. There was also no significant difference in cancer-specific survival between sub-groups with higher and lower pleural fluid OPN, VEGF, or uPA concentrations. Patients with successful pleurodesis had significantly longer cancer-specific survival than those without (p = 0.015).ConclusionsPleural fluid OPN, VEGF, and uPA concentrations are elevated in MPE but are not satisfactory predictors of pleurodesis outcome or survival. Patients with higher pleural fluid VEGF concentration have higher risk of distant metastasis. Evaluating the benefits of therapy targeting the VEGF pathway in these patients warrants further studies.
Highlights
Growing cancer cells secrete growth-promoting polypeptides and have increased proteolytic activity, contributing to tumor progression and metastasis
There was no significant difference in pleural fluid OPN, Vascular endothelial growth factor (VEGF), urokinase-type plasminogen activator (uPA), and plasminogen activator inhibitor-1 (PAI-1) concentrations between different sub-groups except for those with distant metastases in addition to malignant pleural effusion (MPE)
Positive correlations among pleural fluid OPN, VEGF, and uPA concentrations in patients with MPE Pleural fluid OPN, VEGF, and uPA concentrations positively correlated with each other (Table 3)
Summary
Growing cancer cells secrete growth-promoting polypeptides and have increased proteolytic activity, contributing to tumor progression and metastasis. Their presentation in malignant pleural effusion (MPE) and their predictive value for the outcome of pleurodesis and survival were studied. Growing cancer cells frequently secrete growth-promoting polypeptides and have increased proteolytic activity. Vascular endothelial growth factor (VEGF) can increase vascular permeability and the proliferation and migration of endothelial cells. Both OPN and VEGF are involved in the production of urokinase-type plasminogen activator (uPA) and the formation of MPE [7,8,9,10]
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