Skip to main content

Advertisement

SpringerLink
Log in

Pleural Fluid Adenosine Deaminase (ADA) Predicts Survival in Patients with Malignant Pleural Effusion

  • Published:
Lung Aims and scope Submit manuscript

Abstract

Purpose

Systemic and local inflammations have been described as relevant prognostic factors in patients with cancer. However, parameters that stand for immune activity in the pleural space have not been tested as predictors of survival in patients with malignant pleural effusion. The objective of this study was to evaluate pleural lymphocytes and Adenosine Deaminase (ADA) as predictors of survival in patients with recurrent malignant pleural effusion.

Methods

Retrospective cohort study includes patients who underwent pleurodesis for malignant pleural effusion in a tertiary center. Pleural fluid protein concentration, lactate dehydrogenase, glucose, oncotic cytology, cell count, and ADA were collected before pleurodesis and analyzed. Survival analysis was performed considering pleurodesis as time origin, and death as the event. Backwards stepwise Cox regression was used to find predictors of survival.

Results

156 patients (out of 196 potentially eligible) were included in this study. Most were female (72 %) and breast cancer was the most common underlying malignancy (53 %). Pleural fluid ADA level was stratified as low (<15 U/L), normal (15 ≤ ADA < 40), and high (≥40). Low and high ADA levels were associated with worse survival when compared to normal ADA (logrank: 0.0024). In multivariable analysis, abnormal ADA (<15 or ADA ≥ 40) and underlying malignancies different from lymphoma, lung, or breast cancer were associated with worse survival. Pleural fluid cell count and lymphocytes number and percentage did not correlate with survival.

Conclusions

Pleural fluid Adenosine Deaminase levels (<15 or ≥40 U/L) and neoplasms other than lung, breast, or lymphoma are independent predictors of worse survival in patients with malignant pleural effusion who undergo pleurodesis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Light RW (2007) Pleural diseases, 5th edn. Lippincott Williams & Wilkins, Baltimore

    Google Scholar 

  2. Terra RM, Kim SY, Pego-Fernandes PM, Teixeira LR, Vargas FS, Jatene FB (2011) Is silver nitrate pleurodesis for patients with malignant pleural effusion feasible and safe when performed in an outpatient setting? Ann Surg Oncol 18:50–1145

    Article  Google Scholar 

  3. Sahn SA, Good JT Jr (1988) Pleural fluid pH in malignant effusions: diagnostic, prognostic, and therapeutic implications. Ann Intern Med 108:9–345

    Article  Google Scholar 

  4. Rodriguez-Panadero F, Lopez-Mejias J (1989) Survival time of patients with pleural metastatic carcinoma predicted by glucose and pH studies. Chest 95:4–320

    Article  Google Scholar 

  5. Burrows CM, Mathews C, Colt HG (2000) Predicting survival in patients with recurrent symptomatic malignant pleural effusions: an assessment of the prognostic values of physiologic, morphologic, and quality of life measures of extent of disease. Chest 117:73–78

    Article  CAS  PubMed  Google Scholar 

  6. Gonlugur TE, Gonlugur U (2008) Pleural fluid findings as prognostic factors for malignant pleural mesothelioma. J Clin Lab Anal 22:6–334

    Article  Google Scholar 

  7. DeLong P, Carroll RG, Henry AC, Tanaka T, Ahmad S, Leibowitz MS, Sterman DH, June CH, Albelda SM, Vonderheide RH (2005) Regulatory T cells and cytokines in malignant pleural effusions secondary to mesothelioma and carcinoma. Cancer Biol Ther 4:6–342

    Article  Google Scholar 

  8. Clive AO, Kahan BC, Hooper CE et al (2014) Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score. Thorax 69(12):104–1098

    Google Scholar 

  9. Ascierto ML, De Giorgi V, Liu Q et al (2011) An immunologic portrait of cancer. J Transl Med 9:146

    Article  PubMed  PubMed Central  Google Scholar 

  10. Pagès F, Galon J, Dieu-Nosjean MC, Tartour E, Sautès-Fridman C, Fridman WH (2010) Immune infiltration in human tumors: a prognostic factor that should not be ignored. Oncogene 29:102–1093

    Article  Google Scholar 

  11. Bindea G, Mlecnik B, Fridman WH, Pagès F, Galon J (2010) Natural immunity to cancer in humans. Curr Opin Immunol 22:22–215

    Article  Google Scholar 

  12. Ye ZJ, Zhou Q, Yin W et al (2012) Differentiation and immune regulation of IL-9-producing CD4+ T cells in malignant pleural effusion. Am J Respir Crit Care Med 186:79–1168

    Article  Google Scholar 

  13. Giusti G (1974) Adenosine deaminase. In: Bergmeyer HU (ed) Methods of enzymatic analysis. New York Academic Press, New York, pp 99–1092

    Google Scholar 

  14. Lumachi F, Mazza F, Ermani M, Chiara GB, Basso SM (2012) Talc pleurodesis as surgical palliation of patients with malignant pleural effusion. Analysis of factors affecting survival. Anticancer Res 32:4–5071

    Google Scholar 

  15. Goto M, Noguchi Y, Koyama H et al (2003) Diagnostic value of adenosine deaminase in tuberculous pleural effusion: a meta-analysis. Ann Clin Biochem 40:81–374

    Article  Google Scholar 

  16. Yildirim H, Metintas M, Ak G, Erginel S, Alatas F, Kurt E, Metintas S, Ucgun I (2007) Increased pleural fluid adenosine deaminase levels in patients with malignant pleural effusions: a potential predictor of talc pleurodesis outcome. Lung 185:54–349

    Article  Google Scholar 

  17. Gaga M, Papamichalis G, Bakakos P et al (2005) Tuberculous effusion: ADA activity correlates with CD4+ cell numbers in the fluid and the pleura. Respiration 72:5–160

    Article  Google Scholar 

  18. Chen YQ, Shi HZ, Qin XJ, Mo WN, Liang XD, Huang ZX, Yang HB, Wu C (2005) CD4+ CD25+ regulatory T lymphocytes in malignant pleural effusion. Am J Respir Crit Care Med 172:9–1434

    Google Scholar 

  19. Okamoto M, Hasegawa Y, Hara T, Hashimoto N, Imaizumi K, Shimokata K, Kawabe T (2005) T-helper type 1/T-helper type 2 balance in malignant pleural effusions compared to tuberculous pleural effusions. Chest 128:5–4030

    Article  Google Scholar 

Download references

Acknowledgments

Ricardo M. Terra: Study design, data analysis, manuscript writing, and revision; Leila Antonagelo: Study design, data analysis, manuscript writing; Alessandro W. Mariani: Data collection and analysis, manuscript writing; Ricardo Lopes Moraes de Oliveira: Data collection and analysis, manuscript writing; Lisete R. Teixeira: Study design, data analysis, manuscript revision; Paulo M. Pego-Fernandes: Study design, manuscript revision.

Author information

Authors and Affiliations

  1. Thoracic Surgery Division, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, Avenida Dr. Eneas de Carvalho Aguiar, 44 – 2o Andar Sala 9, São Paulo, SP, CEP 05403-000, Brazil

    Ricardo Mingarini Terra, Alessandro Wasum Mariani, Ricardo Lopes Moraes de Oliveira & Paulo Manuel Pego-Fernandes

  2. Thoracic Surgery, Centro Oncológico do Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil

    Ricardo Mingarini Terra & Alessandro Wasum Mariani

  3. Pathology Division, Heart Institute, University of São Paulo Medical School, São Paulo, SP, Brazil

    Leila Antonangelo

  4. Pulmonology Division, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, SP, Brazil

    Lisete Ribeiro Teixeira

Authors
  1. Ricardo Mingarini Terra
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leila Antonangelo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alessandro Wasum Mariani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ricardo Lopes Moraes de Oliveira
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lisete Ribeiro Teixeira
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Paulo Manuel Pego-Fernandes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ricardo Mingarini Terra.

Ethics declarations

Conflict of interest

All Authors disclose no commercial interest or conflict regarding this manuscript.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Terra, R.M., Antonangelo, L., Mariani, A.W. et al. Pleural Fluid Adenosine Deaminase (ADA) Predicts Survival in Patients with Malignant Pleural Effusion. Lung 194, 681–686 (2016). https://doi.org/10.1007/s00408-016-9891-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00408-016-9891-2

Keywords

Search

Navigation