High levels of tumor markers in pleural fluid correlate with poor survival in patients with adenocarcinomatous or squamous malignant effusions

Background: The aim of this study was to determine whether several pleural fluid (PF) tumor markers, either alone or in combination, could be used to predict survival time of patients with malignant pleural effusion secondary to adenocarcinoma or squamous cell carcinoma. Methods: A total of 224 patients with confirmed metastatic pleural malignancies due to adenocarcinoma or squamous cell carcinoma were enrolled. PF tumor markers were determined either by electrochemiluminescence immunoassay (CEA, CA 15-3, CYFRA 21-1) or microparticle enzyme immunoassay (CA 125) technologies. Cutoff points that predicted death during the first month after diagnoses, with a specificity of 60%, were selected for each marker, using receiver operating characteristic analysis. Results: In patients with adenocarcinomatous or squamous malignant effusion, the combination of PF CA 125 >= 1000 U/mL and CYFRA 21-1 >= 100 ng/mL predicted a lower survival (4 vs. 11.7 months, p=0.03; and 0.3 vs. 8.4 months, p=0.003 respectively). This tumor marker combination remained as an independent predictor of poor outcome when adjusted for age and tumor type. Conclusion: High PF tumor marker levels identify a subgroup of patients with a shorter median survival. (C) 2008 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.