Current status of and progress in the treatment of malignant pleural effusion of lung cancer
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Abstract:
Malignant pleural effusion (MPE) is a common complication in the late stage of malignant tumors. The appearance of MPE indicates that the primary tumor has spread to the pleura or progressed to an advanced stage. The survival time of the patients will be significantly shortened, with a median survival of only a few months. There are a variety of traditional treatments, and their advantages and disadvantages are relatively clear. There are still many problems that cannot be solved by traditional methods in clinical work. The most common one is intrapleural perfusion therapy with chemotherapy drugs, but it has a large side effect of chemotherapy. At present, with the development of medical technology, there are a variety of treatment methods, and many innovative, significant and valuable treatment methods have emerged, which also bring hope for the treatment of refractory and recurrent MPE patients. Several clinical trials had confirmed that drug-carrying microparticles has less adverse reactions and obvious curative effect. However, there is still a long way to go to completely control and cure MPE, and the organic combination of clinical work and scientific research results is needed to bring dawn to refractory MPE patients.Keywords:
Refractory (planetary science)
Objective
To assess the significance of COX-2 and VEGF in the differential diagnosis of benign and malignant pleural effusions by detecting their levels in pleural effusion.
Methods
Fifty-eight cases of pleural effusion were collected at our hospital, including 48 cases of malignant pleural effusion and 10 cases of benign pleural effusion. Expression levels of COX-2 and VEGF in pleural effusions were detected by ELISA and compared between benign and malignant pleural effusions.
Results
The expression levels of COX-2 and VEGF had no significant association with gender or age in both 48 cases of malignant pleural effusion and 10 cases of benign pleural effusion (P>0.05). The average COX-2 and VEGF levels were (788.04 ± 128.85) U/L and (365.27 ± 80.63) ng/L, respectively, in the malignant pleural effusion group, and the corresponding values in the benign pleural effusion group were (366.92 ± 41.08) U/L and (114.67 ± 15.69) ng/L. COX-2 and VEGF levels in malignant pleural effusion were significantly higher than those in benign pleural effusion (P<0.001).
Conclusion
COX-2 and VEGF expression levels are higher in malignant pleural effusion than in benign pleural effusion, and they may serve as prognostic factors to distinguish between benign and malignant pleural effusions.
Key words:
Cyclooxygenase-2; Vascular endothelial growth factor; Pleural effusion; Tumor
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Objective To detect the expressions of MMP-3 and MMP-7,assess the clinical significance in pleural effusion for directing clinical work.Methods The study included 89 cases of malignant pleural effusion as observation group and 50 cases of benign pleural effusion as control group.We detected the expressions of MMP-3 and MMP-7 by ELISA.Results Comparisons of the malignant and benign pleural effusion showed that there were significant up-regulations of MMP-3 and MMP-7 in the observation group.The expressions of MMP-3 and MMP-7 were associated with types of neoplasm.Conclusion The expressions of MMP-3 and MMP-7 have significant up-regulation in the malignant pleural effusion.MMP-3 and MMP-7 may play an important role in the malignant pleural effusion.The combined examination of MMP-3 and MMP-7 may be helpful to judge the type of neoplasm.
Clinical Significance
Neoplasm
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Background : Malignant pleural effusion described as effusion arising from direct infiltration of the pleura by cancer cells, occur in 2-23% of patients with breast cancer during the disease course. Breast cancer accounts for about one third of cases of malignant pleural effusion, second to lung cancer, and is associated with poor quality of life and increased mortality. Methods : This was a retrospective analysis of 85 patients with breast cancer who were referred after detection of pleural effusion with a posteroanterior chest x-ray from the emergency or oncology unit to the cardiothoracic unit of the Lagos University Teaching Hospital between January 2011 and December 2012. Results : A total of 85 patients were studied, with median age of 42 (25-72) years, 39(45.9%) patients were in 35-44 year group. The median disease free interval was 9 months. A high proportion of malignant pleural effusions were ipsilateral (85.9%), and haemorrhagic (61.2%). The 30 day mortality was 45.9%. The major determinants of mortality were the presence of massive haemorrhagic effusion, (OR = 19.2, 95% CI = 3.1- 120.6, p = 0.002), and pulmonary metastatic deposit (OR = 94.7, 95% CI = 9.8-916.72.4, p <0.001). Conclusion : Malignant pleural effusion is a common complication of stage IV breast cancer at our institution, with accompanying high 30 day mortality. Key words : Malignant Pleural effusion, Stage IV Breast cancer, thoracostomy, mortality
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Objective This research was to detect whether the differential expression profile of the MAGE-3 mRNA occurred in pleural effusion,and to explore the feasibility of MAGE-3 gene detection as a diagnostic marker for benign and malignant pleural effusion.Methods MAGE-3 mRNA in pleural effusion was detected by nested RT-polymerase chain reaction(nRT-PCR) in 35 cases of patients(25 malignants and 10 benigns) complicating pleural effusion.Results No MAGE-3 expression in pleural effusion of 10 patients complicating benign pleural effusion.As opposed to the benign controls,out of the 25 patients complicating malignant pleural effusion,14 ases of MAGE-3 expression amplification strap were observed in pleural effusion and the rate of positive,sensitivity,specificity,accuracy were 56.00%,56.00%,100.00%,68.57% to part.Conclusion To detect MAGE-3 mRNA of pleural effusion might be a valuable diagnostic indicator for benign and malignant pleural effusion.
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We have read an interesting article from Zarogoulidis et al. (1), “Malignant pleural effusion and algorithm management”, which give us the excellent guideline for managing oncologic patient with malignant pleural effusion. In oncologic patients, malignant pleural effusion is a common cause of dyspnea, however pulmonary embolism is a frequent complication which also might present with pleural effusion. The question is “do we have to rule out pulmonary embolism in all oncologic patients who presented with shortness of breath and pleural effusion?”
Guideline
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[Objective] To evaluate the level of interlukin 18 and its significance in tuberculous pleural effusion and malignant pleural effusion. [Methods] We selected 48 patients of pleural effusion in the wards of Department of Respiratory Internal Medicine, the Second Affiliated Hospital of Harbin Medical University during January 2004 and May 2005. Forty-eight specimens of pleural effusions were collected from 48 patients with pleural effusion. Of them 24 pleural effusion were diagnosed as tuberculous, and 24 as malignant. The levels of IL-18 of pleural effusion in tubercular pleurisy and malignant pleural effusion sufferersly were detected by ELISA. [Results] The level of IL-18 in tuberculous effusion (263.37±67.64) ng/L was significant higher than that in malignant pleural effusion (92.15±26.66) ng/L (P 0.05). The cut-of values for the IL-18 was defined. It was 150 ng/L. The sensitivity and specificity of IL-18 for tuberculous pleural effusion were 83.0% and 91.7%. [Conclusion] IL-18 could be used as valuable parameters for the differentiation of tuberculous effusion from malignant.
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Objective To assess the diagnostic value of flow cytometry(FCM) DNA content analysis in benign and malignant pleural effusion.Methods Fresh pleural effusion were taken from 50 patients(30 malignant pleural effusion,20 benign pleural effusion).All pleural effusion was measured for DNA heteroploid detection with flow cytometry.The diagnostic value of this method was compared with pleural CEA and ADA detection.Results The rate of DNA heteroploid was respectively 73.3% and 5% in malignant and benign pleural effusion(P0.01).The average level of CEA was 4.7±1.5 ug/L in benign pleural effusion and 34.8±14.9 ug/L in malignant pleural effusion(P0.01).The average level of ADA was 52.7±22.2 IU/ml in benign pleural effusion and 27.1±10.8 IU/ml in malignant pleural effusion(P0.01).Sensitivity of DNA analysis was 73.3% and the specificity was 85%.Sensitivity and specificity of DNA analysis addition to pathological analysis can reach to 83.3% and 100%.Conclusions the FCM DNA content analysis has an adjunctive value in diagnosis of malignant pleural effusion and provides a beneficial method in differential diagnosis of pleural effusion.
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Objective To study the therapeutic effect of tumour infiltrating lymphocytes (TIL) on malignant pleural effusion in aged cancer patients. Methods TIL cultured and amplified product of cancer patient's own malignant pleural effusion was used for treatment in aged cancer patients by intrapleural injection once every other day for at least four times. Results In 21 cases treated, lymphocytes in pleural effusion increased, while tumour cells gradually decreased, and pleural effusion gradually absorbed. After 1 month 19 cases were effective (90 5%). Conclusions Auto pleural effusion tumour infiltrating lymphocytes might be effective for malignant pleural effusion.
Therapeutic effect
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Objective To investigate the diagnosis value of insulin like growth factor 1(IGF 1) in benign and malignant pleural effusion compared with carcinoembryonic antigen(CEA).Methods IGF 1 and CEA were analyzed by ELISA in 33 cases with benign pleural effusion and 32 cases with malignant pleural effusion.Results The concentration of IGF 1 were significantly higher in malignant pleural effusion(110.20±20.59nmol/L) than that in benign group(76.70±18.95nmol/L),P0.001.IGF 1 was slightly less valuable than CEA in diagnosis of malignant pleural effusion.Conclusion In pleural effusions IGF 1 may be an important indicator to help to differentiate between benign pleural effusions and malignant pleural effusions.
Carcinoembryonic antigen
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In non-small cell lung cancer (NSCLC), pleural effusion is a frequently observed complication, and often provides a treatment difficulties. The aim of this study is to evaluate prognostic significance of pleural effusion in patients with NSCLC.Seven hundred and eight untreated patients with NSCLC who were consecutively admitted to our department over a 20 year period up to December 1996, were analyzed using uni- and multivariate analyses.Univariate analysis showed pleural effusion to be a significant prognostic factor for NSCLC, in addition to gender, stage, performance status(PS). Multivariate analysis proved pleural effusion to be one of the significant prognostic factors, especially in patients with poor PS.Adequate palliative care to provide prolonged quality survival remains the primary goal of therapy for patients with poor performance status and pleural effusion until better treatments are developed.
Univariate analysis
Performance status
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