Diagnostic and Prognostic Value of Survivin in Pleural Effusion

Background: Survivin is an inhibitor of apoptosis that may be a novel diagnostic and prognostic marker of cancer. Our study is to investigate the diagnostic and prognostic value of survivin for pleural effusions. Methods: Sixty-five pleural effusion patients were enrolled prospectively. Pleural effusion samples were examined for survivin level by ELISA. Pleural effusions were divided into three groups: Group I, malignant pleural effusion (MPE) (n = 36); Group II, tuberculous pleurisy (TPE) (n = 18); and Group III, transudative pleural effusion (n = 11). The accuracy of diagnosis and the correlation between survivin level and survival in malignant pleural effusions (MPE) were analyzed. Results: Survivin level was 320.50 ± 228.24 pg/ml in MPE, 328.35 ± 146.79 pg/ml in TPE and 318.87 ± 208.39 pg/ml in transudative pleural effusion respectively. ROC curves for MPE versus TPE were analyzed, area under the ROC curve was 0.419, and for the cutoff value of 254.85 pg/ml sensitivity was 44.4% and specificity 55.6%. Survivin had no discriminative power in differentiating exudative effusions of MPE from non-MPE (p = 0.648). There was no correlation between survivin level and age, sex. However, statistically significant difference was found between primary lung carcinoma (238.66 ± 48.19 pg/ml) and extra-pulmonary metastatic carcinomas (435.09 ± 320.62 pg/ml) according to survivin level (p = 0.033). Survivin levels can distinguish patients who had poor prognosis (median survival 96 days) and those who had good prognosis (median survival 206 days) in MPE. Conclusion: survivin levels detected with ELISA had no discriminative power in differentiating exudative effusions included MPE and TPE. However, over-expression of survivin correlates with poor prognosis in cancer patients. Our results suggest that survivin may be a potential prognostic marker in MPE.