Pulmonary complications in chronic lymphocytic leukemia

BACKGROUND: Although pulmonary complications account for significant morbidity and mortality in patients with chronic lymphocytic leukemia (CLL), to the authors' knowledge there are sparse data available in published literature. The authors evaluated pulmonary complications in patients with CLL and identified prognostic variables that predict hospital mortality in these patients. METHODS: Clinical data were analyzed retrospectively from patients with CLL who required hospitalization for a respiratory illness at a tertiary care institution from January 1993 to December 2001. A logistic regression analysis with a backward elimination procedure was carried out to determine prognostic variables that predict hospital mortality. RESULTS: There were 110 patients who were admitted on 142 occasions with a pulmonary complication. The median age was 75 years (range, 43-97 years), and the male:female ratio was 1.7:1.0. Among 142 admissions, 68% were high risk according to the Rai criteria, 68% of patients admitted had received prior therapy for CLL, and 35% had received treatment within 3 months of admission. The most common pulmonary complications were pneumonias (75%), malignant pleural effusion/and or lung infiltrate due to CLL (9%), pulmonary leukostasis (4%), Richter transformation or nonsmall cell lung carcinoma (3%), and upper airway obstruction (2%). Forty-four of 110 patients (40%) died. In multivariate analysis, admission absolute neutrophil counts /= 20 mg/dL (odds ratio, 3.0; 95% CI, 1.1-8.3) were correlated significantly with mortality. CONCLUSIONS: Pneumonia was the major pulmonary complication in hospitalized patients with CLL. Severe neutropenia and high BUN levels were correlated significantly with increased mortality.     

胸水中CEA CYFRA21-1 NSE和LDH对肺癌的临床诊断

目的:探讨CEA、CYFRA21-1、NSE、LDH水平对癌性胸水的诊断价值。方法:采用电化学发光方法检测胸水中的CEA、CYFRA21-1和NSE,采用酶法检测LDH。结果:恶性胸水的CEA、CYFRA21-1、NSE、LDH水平明显高于良性胸水(P<0.01),肺腺癌CEA明显高于鳞癌和小细胞肺癌(P<0.01),肺鳞癌CYFRA21-1水平明显高于腺癌(P<0.05)和小细胞肺癌(P<0.01),小细胞肺癌NSE明显高于鳞癌(P<0.01)。4项标志物联合检测的敏感性、准确性均比单项检测高。结论:联合检测胸水中的CEA、CYFRA21-1、NSE和LDH对肺癌的诊断具有重要的临床意义。     

Diagnostic Value of Sialic Acid in Pleural Effusion

The present study was conducted in 30 patients of malignant pleural effusion and 30 patients of non malignant pleural effusion. Pleural fluid and blood samples were taken at the time of admission,before starting any treatment. Sialic acid levels were estimated in serum and pleural fluid by Warren's TBA method. In the present study,serum sialic acid levels were higher in group II as compared to group I. In the present study,pleural fluid sialic acid levels and PF/S ratio was higher in malignant pleural effus...     

Vandetanib and Indwelling Pleural Catheter for Non–Small-Cell Lung Cancer With Recurrent Malignant Pleural Effusion

Introduction/BackgroundNon–small-cell lung cancer patients with malignant pleural effusion have a poor overall median survival (4.3 months). VEGF is a key regulator of pleural effusion production. It is unknown if pharmacological inhibition of VEGF signaling modifies the disease course of non–small-cell lung cancer patients with recurrent malignant pleural effusion. We report the final results of a single-arm phase II clinical trial of the VEGF receptor inhibitor, vandetanib, combined with intrapleural catheter placement in patients with non–small-cell lung cancer and recurrent malignant pleural effusion, to determine whether vandetanib reduces time to pleurodesis.Patients and MethodsNon–small-cell lung cancer patients with proven metastatic disease to the pleural space using pleural fluid cytology or pleural biopsy who required intrapleural catheter placement were eligible for enrollment. On the same day of the intrapleural catheter insertion, the patients were started on a daily oral dose of 300 mg vandetanib, for a maximum of 10 weeks. The primary end point was time to pleurodesis, with response rate as the secondary end point. Exploratory analyses included measurement of pleural fluid cytokines and angiogenic factors before and during therapy.ResultsTwenty eligible patients were included in the trial. Eleven patients completed 10 weeks of treatment. Median time to pleurodesis was 35 days (95% confidence interval, 15-not applicable). Median time to pleurodesis in the historical cohort was 63 days (95% confidence interval, 45-86) when adjusted for Eastern Cooperative Oncology Group performance status ≤ 2.ConclusionVandetanib therapy was well tolerated; however, it did not significantly reduce time to pleurodesis.     

VEGF、VEGFR-1和MMP-9对良恶性胸腔积液的诊断价值

目的 探讨血管肉皮生长因子(VEGF)、受体VEGFR-1和基质金属蛋白酶-9(MMP-9)表达在良、恶性胸腔积液鉴别诊断中的价值.方法 采用ELISA法,检测35例恶性胸腔积液、33例良性胸腔积液患者胸腔积液中VEGF,VEGFR-1和MMP-9表达水平,并进行相关性比较分析.结果 恶性胸腔积液组中VEGF、VEGFR-1表达均明显高于良性胸腔积液,MMP-9表达明显低于良性胸腔积液,差异均有统计学意义(P＜0.05).恶性胸腔积液中VEGF,VEGFR-1和MMP-9表达水平呈正相关.VEGF,VEGFR-1和MMP-9与恶性胸腔积液的病理类型无相关性.结论 胸腔积液中VEGF,VEGFR-1和MMP-9表达可以作为良性和恶性胸腔积液鉴别诊断的标志物.     

乳腺癌恶性胸腔积液的临床特征及预后因素分析

目的研究有症状乳腺癌恶性胸腔积液患者的临床特征及影响疗效的相关因素。方法回顾性总结分析了2008年11月至2010年12月我科收治的36例有症状胸腔积液乳腺癌患者的一般临床资料[年龄、东部肿瘤协作组(ECOG)、手术病理分期、手术后无病生存期(DFS)、胸腔积液是否为初次复发部位、是否复发后一线化疗、是否伴有其他积液、是否双侧胸腔积液],胸腔积液的情况[是否血性胸腔积液、胸水细胞数、胸水单核细胞数、乳酸脱氢酶(LDH)、癌胚抗原(CEA)、CA153、CA125、蛋白、胸水量]及胸腔积液的治疗情况(胸腔局部治疗方式、胸腔局部化疗药物、是否使用IL-2)中各种因素对于胸腔积液疗效及控制时间的影响。结果患者手术至出现胸腔积液的中位时间44月(0～180月)。手术至出现胸腔积液的时间>44月有效率显著高于手术后DFS≤44月者(P=0.046),分别为66.7%,33.3%;复发后一线化疗者有效率显著高于复发后二线及以上化疗者(P=0.044),分别为65.0%和31.3%;胸水单核细胞数>1×106/L的患者有效率显著高于胸水单核细胞数≤1×106/L(P=0.046)的患者,分别为66.7%,33.3%。胸腔积液中位控制时间为4月,胸腔积液LDH≤400 u/ml较LDH>400 u/ml的患者的胸腔积液控制时间显著延长(P=0.032),胸腔积液中位控制时间分别为6月和2月。结论胸腔积液是乳腺癌患者常见的临床表现,术后DFS时间长、复发后一线化疗及胸水单核细胞高者有效率高,胸腔积液LDH浓度高是胸水控制时间短的不良预后因素。     

Clinical utility of pleural fluid YKL-40 as a marker of malignant pleural effusion

Pleural effusion is a common presenting feature of malignancy. Malignant pleural effusion is primarily diagnosed by pleural fluid cytology, pleural biopsy, and tumor markers. The glycoprotein YKL-40 is a new tumor marker that has shown to have a good diagnostic accuracy to detect malignant pleural effusion. However, there are only a few studies that have evaluated pleural fluid YKL-40 for detecting malignant pleural effusions. Hence, we conducted this study to evaluate the utility of pleural fluid YKL-40 to detect malignant pleural effusion. This is a cross-sectional study conducted between February 2016 and December 2017 in a tertiary care referral hospital. One hundred and forty-seven consecutive patients with pleural effusion were included in the study. These patients were divided into 3 groups, viz malignant, tuberculous, and parapneumonic pleural effusion, based on clinical features, radiological examination, and pleural fluid analysis. Pleural fluid YKL-40 levels were measured using enzyme-linked immunosorbent assay. Out of the 147 consecutive patients included in the study, 47 patients (31.97%) had malignant pleural effusion, 51 patients (34.69%) had tuberculous pleural effusion, and 49 patients (33.33%) had parapneumonic pleural effusion. The median pleural fluid YKL-40 level was higher in malignant pleural effusion (114.80 ng/mL) compared to tuberculous (93.17 ng/mL) and parapneumonic pleural effusion (89.87 ng/mL; P < 0.05). A diagnostic cut-off for pleural fluid YKL-40 value of 99.76 ng/mL detected malignant pleural effusion with 83% sensitivity, 87% specificity, positive predictive value (PPV) of 75%, negative predictive value (NPV) of 91.58%, and diagnostic accuracy of 85.71%. The level of pleural fluid YKL-40 is significantly elevated in malignant pleural effusion. In lymphocytic pleural effusions presenting with low adenosine deaminase levels and high YKL-40 levels, a thorough diagnostic search for malignancy is warranted.     

六种肿瘤标志物在肺癌胸腔积液中的诊断价值

目的通过对胸腔积液和血清中6种肿瘤标志物的检测及胸腔积液脱落细胞学检查,探讨各指标在肺癌胸腔积液中的诊断价值。方法应用化学发光法和酶联免疫分析法测定50例肺癌和30例肺良性疾病患者的胸腔积液和血清中的癌胚抗原（CEA）、糖类抗原19—9（CA19—9）、鳞状细胞癌抗原（SCC）、神经元特异性烯醇化酶（NSE）、细胞角蛋白19片段（CYFRA21—1）、胃泌素前体释放肽（ProGRP）水平,同时对胸腔积液标本进行脱落细胞学检查,并根据受试者工作特性曲线（ROC）建立合理的临床判断临界值。结果肺癌患者胸腔积液中6种肿瘤标志物水平均高于肺良性疾病者,其中CEA、CA19-9、CYFRA21—1、ProGRP水平显著高于肺良性疾病组（P〈0．05）。胸腔积液CEA、血清CYFRA21—1及CEA含量在胸腔积液与血清中的比值（P／S）在各组中的ROC曲线下面积最大。结论胸腔积液CEA、血清CYFRA21—1及CEA的P／S值在鉴别良、恶性胸腔积液中有一定的辅助诊断价值,胸腔积液CEA的诊断价值最大。     

Evaluation of pleural fluid human epididymis 4 (HE4) as a marker of malignant pleural effusion

Pleural effusion is a commonly encountered problem in clinical practice, and pleural fluid analysis is usually the first step towards identifying the underlying etiology. Numerous studies have been published analyzing the potential utility of measuring biomarkers in pleural fluid as possible indicators of a malignant effusion; however, there are no studies that have examined the presence of human epididymis 4 (HE4) in pleural effusions. The aims of this study were to assess pleural effusion and serum concentrations of HE4 in patients with different types of pleural effusions and to evaluate the diagnostic performance of HE4 in detecting malignant pleural effusion. A prospective cohort study was carried out of 88 consecutive patients presenting with pleural effusions. The patients were divided into three groups: 22 patients with transudative effusions, 32 patients with non-malignant exudative effusions, and 34 patients with malignant pleural effusions. Blood and pleural fluid HE4 levels were measured using immunoassay. Both serum HE4 levels and pleural effusion HE4 levels were significantly higher in patients with malignant effusions than in patients with transudative or non-malignant exudative effusions. A pleural fluid HE4 cutoff value of 1,675?pmol/L was found to predict malignant pleural effusions with a diagnostic sensitivity of 85.3?% and specificity of 90.7?%. The current study reports a novel finding of increased serum and pleural fluid HE4 levels in patients with malignant effusions compared to non-malignant effusions. This finding has the potential to strengthen the diagnostic performance of tumor markers in detecting malignant pleural effusions.     

CA—50和二胺氧化酶联合检测对恶性胸水的诊断价值

本研究测定了４５例良恶性胸水患者胸水，血清ＣＡ—５０和二胺氧化酶水平。结果表明，癌性胸水和血清ＣＡ—５０、二胺氧化酶均明显高于良性胸水。如胸水和血清ＣＡ—５０以２０ｕ／ｍｌ作为界值，其敏感性为７７．８％和５９．２％，特异性９４．４％。若胸水二胺氧化酶以２５０ｕ／ｍｌ作为界值，其敏感性为７０．４％，特异性８８．９％。综合测定胸水ＣＡ一５０，二胺氧化酶，可提高癌性胸术诊断率。     

MAGE基因mRNA在良、恶性胸腔积液中的表达

背景与目的MAGE基因是肿瘤特异性基因。本研究的目的是探讨检测MAGE基因诊断良、恶性胸腔积液的可能性。方法采用RT-PCR方法，检测MAGE-1、-2、-3、-4基因mRNA在40例良、恶性胸腔积液中的表达。结果18例良性胸腔积液中MAGE表达均为阴性。在22例恶性胸腔积液患者中，8例瘤细胞学检查阳性的胸腔积液标本中MAGE表达均为阳性（8／8）；14例胸腔积液查瘤细胞阴性但胸膜活检为阳性者中，11例胸腔积液和胸膜活检标本中MAGE均表达为阳性，另外3例胸腔积液和胸膜活检标本中MAGE均为阴性。结论检测胸腔积液中MAGE基因mRNA的表达，可成为鉴别诊断良、恶性胸腔积液的有效方法之一。     

联合检测EGFR、CEA对恶性胸腔积液的诊断价值

目的:评价联合检测胸腔积液患者的胸水细胞块表皮生长因子受体（epidermal growth factor receptor,EGFR）基因拷贝数,以及胸水、血清CEA水平对良恶性胸腔积液鉴别诊断的价值。方法:应用荧光原位杂交技术（Fish法）检测恶性胸腔积液（n=35）、良性胸腔积液（n=30)组患者胸水细胞块EGFR基因拷贝数水平。采用电化学发光全自动生化分析仪检测胸水及血清中CEA水平,根据受试者工作特性曲线（ROC）选取最佳灵敏性和特异性的点作为临界值,评价CEA及联合检测EGFR基因拷贝数对良恶性胸腔积液的诊断价值。结果:35例恶性胸腔积液完成Fish检测。恶性胸腔积液中15例阴性,20例阳性,阳性率为57.1％。其中13例为EGFR基因高度多体性,7例为EGFR基因扩增。肺腺癌16例中,EGFR基因高度多体性、扩增14例,肺腺癌扩增率为87.5％;肺鳞癌14例中,EGFR基因簇状扩增3例(21.4％),点状扩增3例(21.4％),无扩增8例(57.1％),肺鳞癌扩增率为42.9％。腺癌Fish阳性率(87.5％)高于鳞癌(42.9％）,P<0．01。30例良性胸腔积液中有1例脓胸患者EGFR Fish检测阳性,阳性率为3.3%,余检测结果均阴性。恶性胸腔积液患者胸水及血清CEA分别为（220.9±71.65）ng/ml、(18.11±11.38）ng/ml,显著高于良性胸腔积液组（2.31±1.29)ng/ml、(1.67±1.06）ng/ml,差异有统计学意义（P<0.01）。其中,恶性胸腔积液胸水CEA明显高于血清CEA,而良性胸腔积液组中,胸水CEA与血清CEA无明显差异。肺腺癌所致胸水及血清CEA分别为（441.02±102.65)ng/ml、(32.87±28.66）ng/ml,鳞癌所致胸水及血清CEA分别为（28.75±21.39）ng/ml、（5.99±5.32）ng/ml,腺癌显著高于鳞癌,差异有统计学意义（P<0.01）。比较胸水EGFR、CEA对良恶性胸腔积液诊断的效能,两者之间无明显差异（P=0.453＞0.05）。Spearman相关性分析胸水EGFR同CEA之间存在显著正相关。结论:EGFR在恶性胸腔积液的形成中起重要作用,通过Fish技术检测胸水细胞块EGFR基因拷贝数可行,其敏感性为57.1%。对肺腺癌导致恶性胸腔积液的诊断敏感性为87.5%。CEA（临界值5.0ng/ml）在恶性胸腔积液及血清中显著高于良性,其中胸水CEA检测诊断敏感性为65.7%,而在腺癌中为87.5%,其在胸水及血清中的比值＞1.5有助于恶性胸腔积液的诊断。EGFR基因突变阳性与肿瘤标记物CEA阳性表达呈正相关,尤见于肺腺癌患者,两者联合检测可提高诊断性试验的准确性。     

胸腔积液与血清癌胚抗原比值对胸腔积液性质的诊断效果

目的 探讨胸腔积液与血清癌胚抗原比值对胸腔积液性质的诊断效果.方法 选取2018年1月至2019年10月间上海市宝山区罗店医院收治的86例胸腔积液患者,按照胸腔积液良恶性质将患者分为恶性组34例和良性组52例.使用电化学发光免疫分析法检测患者的胸腔积液、血清癌胚抗原水平,计算两者比值,比较两组患者及恶性组不同病理类型的...     

Tumour stage,node stage,p53 gene status,and bcl-2 protein expression as predictors of tumour response to platin-fluorouracil chemotherapy in patients with squamous-cell carcinoma of the head and neck

The purpose of this study was to establish the relative contribution of tumour stage, node stage, p53 gene status, p53 expression, and bcl-2 protein expression to tumour response to platin-fluorouracil chemotherapy in 141 patients with squamous-cell carcinomas of the head and neck. Tumour response was measured at the primary site after three cycles of chemotherapy. Exons 2-10 and the coding part of exon 11 were sequenced on both strands. Bcl-2 or p53 expression was detected by immunohistochemistry. Predictor variables of objective response (reduction of at least 50% of tumour size) were tested in univariate and multivariate analyses. P53 mutations were found in 52 patients (37%). Tumour cells expressed p53 in 84 cases (59%) and bcl-2 in 25 cases (18%). T1 or T2 stage (adjusted odds ratio, 3.3; 95% confidence interval 1.3-8.7; P=0.01), N0 node stage (adjusted odds ratio, 2.7; 95% confidence interval 1.1-6.4; P=0.03), p53 wild-type gene (adjusted odds ratio, 4.0; 95% confidence interval 1.7-9.5; P=0.002), and bcl-2 protein expression (adjusted odds ratio, 20; 95% confidence interval 2.3-170; P=0.006), were positively associated with tumour response. P53 protein expression was not predictive of response. In conclusion, tumour stage, node stage, p53 gene status, and bcl-2 expression are independent predictors of tumour response to platin-fluorouracil in patients with squamous-cell carcinomas of the head and neck.     

经多色流式细胞术确诊多发性骨髓瘤并发恶性胸腔积液6例临床特征分析

  目的:  分析由多色流式细胞术（flow cytometry,FCM）诊断的多发性骨髓瘤（multiple myeloma,MM）并发恶性胸腔积液（my-eloma pleural effusion,MPE）患者的临床特点。   方法:  回顾性分析江苏省苏北人民医院2016年7月至2020年5月经FCM确诊的6例MM并发MPE患者的临床特征、实验室指标和转归情况。   结果:  6例患者中位发病年龄为62（49~72）岁,男女比为2:1。其中,IgA型3例,IgG型2例,轻链型1例,所有患者常规脱落细胞学检查均为阴性,但FCM均能找到浆细胞。随访截至2020年5月1日,4例患者死亡,2例患者存活。FCM检测胸水浆细胞比例与胸水总蛋白、白蛋白、球蛋白、乳酸脱氢酶（lactate dehydrogenase,LDH）水平、腺苷脱氨酶（adenosine deaminase,ADA）及初诊时骨髓浆细胞比例成正相关（P < 0.05）,与胸水常规红细胞数、单个核细胞数、白细胞数以及血清血红蛋白、血小板、总蛋白、白蛋白、LDH水平、ADA、β2-微球蛋白均无明显相关性（P>0.05）。   结论:  MM并发MPE的患者较少见,FCM诊断的阳性率明显高于常规脱落细胞学检查,可将其作为常规胸水检查的必要联合检查项目,此类患者生存期短,预后较差。       

Diagnostic value of tumor markers for differentiating malignant and benign pleural effusions of Iranian patients

In order to evaluate the diagnostic yield of tumor markers in differentiating malignant and benign pleural effusions, we carried out a prospective study in a group of Iranian people. Pleural and serum levels of carcinoembryonic antigen (CEA), carbohydrate antigen 15-3 (CA15-3), neuron-specific enolase (NSE) and cancer antigen 125 (CA 125) were assayed prospectively in patients with pleural effusion (40 malignant and 37 benign). The highest sensitivity was obtained with a combination of CA 15-3 in serum, and CA 15-3 and CEA in pleural fluid (80%), also with combination of CA 15-3 in serum, and CA 15-3, NSE and CEA in pleural fluid (80%). The highest specificity was obtained with combination of CA 15-3 in serum, and CA 15-3 and NSE in pleural fluid (100%), and also with combination of CA 15-3 in serum, and CA 15-3, NSE and CEA in pleural fluid (100%).     

胸水脱落细胞DNA含量及VEGF,p53和CEA表达在良恶性胸腔积液鉴别中的意义

目的：探讨检测胸水细胞的DNA倍体以及VEGF、p53、CEA表达鉴别良恶性胸腔积液的价值。方法：73例胸腔积液患者，良性组13例，恶性组60例。图像细胞光度技术（image cytometry，ICM）进行DNA含量检测，免疫组化Envision法检测VEGF、p53、CEA。结果：良性胸水DNA异倍体率仅占23．1％。恶性胸水的异倍体率占77．8％，两者有统计学差异（P=0．001）。良性胸腔积液患者VEGF、p53、CEA表达率分别为12．5％、0、0。恶性胸腔积液VEGF、p53、CEA表达率分别为17．5％，17．5％和68．4％，与良恶性胸腔积液中CEA的表达相比有统计学差异（P〈0．001），VEGF和p53的表达无显著差异（P=0．722，P=0．198）。经DNA倍体联合VEGF、p53、CEA检测，敏感率可达90．4％，特异度87．5％，符合率90％。结论：ICM检测胸水细胞的DNA倍体联合VEGF、p53、CEA表达值得进一步探讨．有可能成为鉴别良恶性胸腔积液的又一方法。     

HIF-1α和VEGF鉴别诊断结核性胸腔积液与肺癌伴癌性胸腔积液的意义

目的 探讨缺氧诱导因子-1α（HIF-1α）和血管内皮生长因子（VEGF）在结核性胸腔积液与肺癌伴癌性胸腔积液鉴别诊断中的意义。方法 从本院2012年1月至2013年12月的108例胸腔积液患者中筛选出符合要求的45例患者,根据胸腔积液性质分为肺癌伴癌性胸腔积液组（CA组）25例和结核性胸腔积液组（TB组）20例,检测两组血清及胸水中HIF-1α、VEGF水平并计算胸水与血清VEGF比值（胸水／血清VEGF）和胸水与血清HIF-1α比值（胸水／血清HIF-1α）,采用受试者工作特征曲线（ROC）分析HIF-1α、VEGF、胸水／血清HIF-1α和胸水／血清VEGF鉴别肺癌伴癌性胸腔积液和结核性胸腔积液的效能,分析胸水HIF-1α、血清HIF-1α、胸水VEGF及血清VEGF两两联合及四者联合的敏感度、特异度和诊断符合率。结果 CA组胸水HIF-1α水平为（2.29±0.89） ng／ml, 高于TB组的 （0.88±0.69）ng／ml,差异有统计学意义（P<0.01）;CA组血清HIF-1α水平为（2.00±1.00）ng／ml,TB组为（1.85±0.77）ng／ml,差异无统计学意义（P＞0.05）。CA组和TB组胸水VEGF水平分别为（1035.31±687.64）pg／ml和（732.97±493.61）pg／ml,血清VEGF水平分别为（491.25±278.33）pg／ml和（463.42±288.15）pg／ml,差异无统计学意义（P＞0.05）。CA组胸水／血清HIF-1α水平为1.26±0.49,高于TB组的0.56±0.55,差异有统计学意义（P<0.01）;CA组和TB组的胸水／血清VEGF水平分别为2.85±2.73和2.02±1.58,差异无统计学意义（P＞0.05）。在结核性胸腔积液与肺癌伴癌性胸腔积液的鉴别诊断中,单独检测胸水HIF-1α的敏感度为88%,特异度为85%,单独检测胸水／血清HIF-1α的敏感度为92%,特异度为85%,而联合检测血清及胸水HIF-1α和VEGF的敏感度为64%,特异度为100%。结论 胸水HIF-1α和胸水／血清HIF-1α水平对于结核性胸腔积液与肺癌伴癌性胸腔积液鉴别诊断有一定临床意义。联合检测血清HIF-1α、胸水HIF-1α、血清VEGF和胸水VEGF可提高特异度。     

Intrapleural hypotonic cisplatin treatment for malignant pleural effusion in 80 patients with non-small-cell lung cancer: a multi-institutional phase II trial

To assess the effect and toxicity of hypotonic cisplatin treatment (HPT) consisting of the intrapleural administration of cisplatin in distilled water for malignant pleural effusion in patients with non-small-cell lung cancer (NSCLC). Non-small-cell lung cancer patients with cytologically proven and previously untreated malignant pleural effusion were enrolled into this study. Firstly, the lung was fully re-expanded by a tube thoracostomy, and then 25 mg cisplatin in 500 ml of distilled water was instilled through a chest tube and then the tube was clamped. After 1 h, the tube was declamped and allowed to drain. The chest tube was removed when the pleural effusion volume decreased to 200 ml or less per day. A complete response (CR) was considered to occur when the pleural effusion disappeared. A partial response (PR) was determined to occur when the volume of pleural effusion remained under (1/4) of hemithorax. The response at 4 weeks was evaluated by an extramural review. Out of 84 patients enrolled from February 1998 to August 2002, 80 patients were eligible and analysed in the present study. The toxicity of HPT was acceptable. Neither a haematological toxicity of any grade nor grade 4 nonhaematological toxicity was observed. Grade 3 nonhaematological toxicities were observed, including nausea (4%), vomiting (3%), pyothorax (1%) and dyspnoea (1%). The median time of drainage from HTP was 4 days. Twenty-seven (34%) and 39 (49%) patients achieved CR and PR, respectively, for an overall response rate of 83% (95% confidence interval, 74-91%). The median duration of the response was 206 days. The median survival time of all patients was 239 days. Hypotonic cisplatin treatment for malignant pleural effusion of NSCLC is therefore considered to be feasible and effective. A phase III study of HPT is thus warranted.     

An analysis of cytokine status in the serum and effusions of patients with tuberculous and lung cancer

The present study was designed to ascertain whether or not the pleural effusion and serum cytokine levels (granulocyte-macrophage colony-stimulating factor [GM-CSF], interleukin-10 [IL-10], and interferon-gamma [IFN gamma]) in lung cancer patients differ from tuberculous (TB) pleural effusion, in which a strong cellular immune reaction is found; and, whether cytokine levels are a prognostic factor in lung cancer patients with malignant effusion. A total of 202 lung cancer patients with malignant pleural effusion and 26 patients with TB pleural effusion were studied consecutively between 1995 and 1998. Serum and effusion cytokine levels were analyzed with ELISA assays. The results showed that pleural effusion GM-CSF and IL-10 levels were significantly higher than serum levels in both cancer and TB patients. Pleural effusion IFN gamma levels were significantly higher than serum levels in TB patients. IFN gamma levels in both pleural effusion and serum were significantly higher in TB patients than in those with cancer. No significant difference was found, between TB and cancer patients, in the serum or pleural effusion levels of either IL-10 or GM-CSF. The ratio of pleural effusion IFN gamma to serum IFN gamma, effusion IFN gamma to effusion IL-10, and effusion IL-10 to serum IL-10, were all significantly higher in TB than in cancer patients, suggesting a higher cellular activity and T-helper 1 (Th1) reaction in TB pleural effusion than in malignant effusions, which were predominantly Th2 type. Survival analysis showed no significant difference in lung cancer patients with different levels of these cytokines. It was concluded that lung cancer patients with malignant pleural effusion had poorer immune profiles than those with TB pleurisy, both locally and systemically; and the cytokine profiles were not prognostic factors for lung cancer patients with malignant pleural effusion.