Author of

• 11917

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  P2.21 - Poster Session 2 - Diagnosis and Staging (ID 170)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Prevention & Epidemiology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11919

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    P2.21-002 - Identification of Malignant Pleural Effusions (MPEs) secondary to lung cancer by tumour markers: a national multi-centre trial (ID 865)

    09:30 - 09:30  |  Author(s): R. Massoud
    • Abstract

    Background
    Malignant pleural effusions (MPEs) are a common and important cause of cancer-related mortality and morbidity. Prompt diagnosis using minimally invasive procedures is a key point in the evolution of disease since the overall median survival after diagnosis is only 4-9 months. Tumour markers analysis has been proposed as a less invasive alternative for categorizing malignant and non-malignant pleural effusions. This multi-centre study aimed at establishing diagnostic cut-offs for a panel of markers in pleural fluid and plasma to identify patients with lung cancer.

    Methods
    Pleural fluid specimens and plasma samples from 112 patients (46 malignant, 66 non-malignant) consecutively admitted over one year in three Italian university hospitals were analyzed for Ca 125, Cyfra 21.1, NSE, CEA, M2PK. The diagnosis of malignant or non-malignant effusion was based on cytology, pleural biopsy, thoracoscopy, video-assisted thoracic surgery (VATS). Statistical evaluation included Kolmogorov-Smirnov, Mann-Whitney, Chi-square and Fisher’s exact tests. Non parametric (Spearman) correlations were determined. ROC curve analysis was performed to determine analyte cut-offs, sensitivity, specificity and AUC values of each marker. A p-value <0,05 was considered statistically significant.

    Results
    Cytological negative samples were analyzed to ensure that they truly represented non-malignant effusions related to other diseases such as congestive heart failure (CHF), renal imbalance, pneumonia, tuberculosis or post-traumatic. Patients with a history of malignancy or subsequent diagnosis of malignancy with a cytological negative pleural sample were excluded from the study. All examined concentrations were significantly higher in malignant effusions compared to non-malignant effusions. The value of AUC of pleural samples was always higher than in plasma for all malignant cases. The best AUC value in both pleural samples and plasma was detected for Cyfra 21.1 (0,91 vs 0,695) and CEA (0,836 vs 0,681).

    Conclusion
    Tumour markers assay in pleural fluid complements cytology and other classifying tests. A few tumour markers over-expressed in pleural fluid of patients with known malignancy have been identified. Therefore the use of a panel including the best performing markers may prevent patients with suspected malignancy from undergoing invasive procedures such as thoracoscopy or VATS. Our study shows a significant performance of pleural fluid vs plasma samples when comparing AUC values. Tailoring a specific marker assay in pleural fluid for a specific malignancy is highly advisable especially in patients with relevant comorbidity. Moreover, the evaluation of tumor markers in pleural fluid may well be considered as a prognostic factor in those patients with known malignancy undergone surgery and/or chemoradiotherapy during follow up.