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Japanese Journal of Clinical Oncology Advance Access published online on November 22, 2009
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hyp151
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© The Author (2009). Published by Oxford University Press. All rights reserved

Increased Survivin mRNA in Malignant Pleural Effusion is Significantly Correlated with Survival

Chou-Chin Lan1,2, Yao-Kuang Wu1,2, Chih-Hsin Lee1,2, Yi-Chih Huang1,2, Chun-Yao Huang1,2, Ying-Huang Tsai3, Shiu-Feng Huang4,5 and Thomas Chang-Yao Tsao6

1 Division of Pulmonary Medicine, Buddhist Tzu Chi General Hospital, Taipei Branch
2 School of Medicine, Tzu-Chi University, Hualien
3 Division of Pulmonary and Critical Care Medicine, Chang-Gung Memorial Hospital, Taipei
4 Department of Pathology, Buddhist Tzu Chi General Hospital, Taipei Branch
5 Department of Pathology, Tzu-Chi University, Hualien
6 Division of Pulmonary Medicine, Chung Shan Medical University Hospital and School of Medicine, Chung Shan Medical University, Taichung, Taiwan

For reprints and all correspondence: Thomas Chang-Yao Tsao, Division of Pulmonary Medicine, Chung Shan Medical University Hospital and School of Medicine, Chung Shan Medical University, Taiwan. E-mail: tcyt{at}csmu.edu.tw

Received July 9, 2009; accepted October 10, 2009

Objective: The sensitivity of cytologic examination of pleural effusions is variable and not predictive of prognosis. Survivin is an inhibitor of apoptosis that may be a novel diagnostic/prognostic marker of cancers. This study aimed to determine the diagnostic and prognostic value of measuring survivin mRNA levels in pleural effusions.

Methods: Eighty-eight consecutive pleural effusion samples were examined for both cytology and survivin mRNA level. The accuracy of diagnosis and the correlation between survivin mRNA level and survival in malignant pleural effusion (MPE) were determined. Pleural effusions were divided into three groups: Group I, malignancy-associated (n = 44); Group II, inflammatory (n = 27); and Group III, transudative (n = 17).

Results: Survivin mRNA levels in Group I (1.03 ± 0.61, range 0–2.96) were significantly higher than those in Groups II (0.45 ± 0.69, range 0–3.30) and III (0.08 ± 0.22, range 0–0.71) (P < 0.001). Survivin mRNA level was significantly higher in MPE than in non-MPE. The cut-off value for survivin mRNA levels in pleural effusions was 0.074 for the diagnosis of malignancies, with sensitivity, specificity, and positive and negative predictive values of 96%, 45%, 45% and 96%, respectively. Survivin mRNA level in pleural effusions of cancer patients significantly correlated with poor survival.

Conclusions: Survivin mRNA level is significantly higher in MPEs. Over-expression of survivin mRNA correlates with poor prognosis in cancer patients.

Key Words: survivin • cancer • pleural effusion • prognosis


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