Survivin is a negative prognostic factor in malignant pleural effusion

Eur J Clin Invest. 2018 Apr;48(4). doi: 10.1111/eci.12895. Epub 2018 Feb 13.


Background: Survivin is a well-known member of the inhibitor of apoptosis family, and has been related to increased tumour aggressivity, both in tissue and in pleural fluid.

Objectives: In patients with malignant pleural effusion, we sought to investigate the changes in pleural fluid survivin concentrations induced by talc instillation into the pleural space. Those changes were also examined in relation to pleurodesis outcome and patient survival.

Methods: We investigated 84 patients with malignant pleural effusion who underwent talc pleurodesis. Of them, 32 had breast cancer, 25 lung cancer and 27 had mesothelioma. Serial samples of pleural fluid were obtained before thoracoscopy (baseline) and 24 hours thereafter.

Results: Survivin levels were successfully quantified in all pleural fluid samples, and they were significantly higher in samples obtained after thoracoscopic talc poudrage compared with baseline (P < .001). Patients with higher pleural fluid survivin levels at baseline had a significantly poorer pleurodesis outcome (P = .004). A 30 pg/mL cut-off for baseline survivin in pleural fluid predicted failure of pleurodesis with a 54% sensitivity and 79% specificity (P = .009). Moreover, median postpleurodesis survival of patients with baseline survivin levels ≥30 pg/mL was 4 months (range: 0.1-38), compared with 13 months (range: 0.1-259) in patients below that cut-off (P < .001).

Conclusion: Elevated pleural fluid survivin concentrations are useful to predict failure of pleurodesis and are associated with shorter survival in patients with malignant pleural effusion.

Keywords: malignant pleural effusion; pleurodesis; survival; survivin.

MeSH terms

  • Aged
  • Biomarkers / metabolism
  • Breast Neoplasms / complications
  • Breast Neoplasms / mortality
  • Female
  • Humans
  • Inhibitor of Apoptosis Proteins / metabolism*
  • Lung Neoplasms / complications
  • Lung Neoplasms / mortality
  • Male
  • Mesothelioma / complications
  • Mesothelioma / mortality
  • Middle Aged
  • Pleural Cavity / chemistry
  • Pleural Effusion, Malignant / complications
  • Pleural Effusion, Malignant / mortality*
  • Pleural Effusion, Malignant / therapy
  • Pleurodesis / mortality
  • Prognosis
  • ROC Curve
  • Sensitivity and Specificity
  • Survivin
  • Treatment Outcome


  • BIRC5 protein, human
  • Biomarkers
  • Inhibitor of Apoptosis Proteins
  • Survivin