title: Diagnostic and prognostic significance of lysophosphatidic acid in malignant pleural effusions.
abstract: BACKGROUND
  Lysophosphatidic acid (LPA) is an important extracellular signal transmitter and intracellular second messenger in body fluids. It can be detected in the ascitic fluid of patients with ovarian cancer. Increasing evidence shows that LPA can stimulate cancer cell proliferation and promote tumor invasion and metastasis. Our study aimed to evaluate the diagnostic value of LPA in differentiating between malignant pleural effusions (MPEs) and benign pleural effusions (BPEs) and to evaluate the association between the level of LPA in MPE and the prognosis of lung cancer patients.
  
  
  METHODS
  The level of LPA in the pleural effusions (PEs) of 123 patients (94 MPE, 29 BPE) with lung cancer was evaluated using an enzyme-linked immunosorbent assay. The performance of LPA was analyzed by standard Receiver operator characteristic curve (ROC) analysis methods, using the area under the curve (AUC) as a measure of accuracy. Overall survival (OS) curves and progression-free survival (PFS) curves were based on the Kaplan-Meier method, and the survival differences between subgroups were analyzed using the log-rank or Breslow test (SPSS software). A multivariate Cox proportional hazards model was used to assess whether LPA independently predicted lung cancer survival.
  
  
  RESULTS
  The levels of LPA differed significantly between MPE (22.08±8.72 µg/L) and BPE (14.61±5.12 µg/L) (P<0.05). Using a cutoff point of 18.93 µg/L, LPA had a sensitivity of 60% and a specificity of 83% to distinguish MPEs from BPEs with an AUC of 0.769±0.045 (SE) (P=0.000) (95% CI, 0.68-0.857). In the three pathological types of lung cancer patients with MPE, there were no significant associations between LPA levels and the length of PFS and OS (P=0.58 and 0.186, respectively). Interestingly, in the patients with MPE caused by lung adenocarcinoma there were significant associations between the LPA levels and the PFS and OS (P=0.018 and 0.026, respectively). Multivariate analysis showed that the LPA level was an independent prognostic factor for PFS in lung adenocarcinoma.
  
  
  CONCLUSIONS
  Our results indicate that LPA can be used as a new biomarker for the diagnosis of MPE caused by lung cancer and that higher levels of LPA are related to shorter PFS in adenocarcinoma of the lung.
authors.affiliation: 1 Department of Respiratory Medicine, Jinling Hospital, Nanjing clinical school, Southern Medical University (Guangzhou), Nanjing 210001, China ; 2 Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210001, China ; 3 Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu 241000, China ; 4 Department of Gastroenterology and Hepatology, Jinling Hospital, Clinical School of Nanjing, Second Military Medical University, Nanjing 210002, China.
authors.forename: Cui-Qing
authors.initials: CQ
authors.lastname: Bai
authors.affiliation: 1 Department of Respiratory Medicine, Jinling Hospital, Nanjing clinical school, Southern Medical University (Guangzhou), Nanjing 210001, China ; 2 Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210001, China ; 3 Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu 241000, China ; 4 Department of Gastroenterology and Hepatology, Jinling Hospital, Clinical School of Nanjing, Second Military Medical University, Nanjing 210002, China.
authors.forename: Yan-Wen
authors.initials: YW
authors.lastname: Yao
authors.affiliation: 1 Department of Respiratory Medicine, Jinling Hospital, Nanjing clinical school, Southern Medical University (Guangzhou), Nanjing 210001, China ; 2 Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210001, China ; 3 Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu 241000, China ; 4 Department of Gastroenterology and Hepatology, Jinling Hospital, Clinical School of Nanjing, Second Military Medical University, Nanjing 210002, China.
authors.forename: Chun-Hua
authors.initials: CH
authors.lastname: Liu
authors.affiliation: 1 Department of Respiratory Medicine, Jinling Hospital, Nanjing clinical school, Southern Medical University (Guangzhou), Nanjing 210001, China ; 2 Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210001, China ; 3 Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu 241000, China ; 4 Department of Gastroenterology and Hepatology, Jinling Hospital, Clinical School of Nanjing, Second Military Medical University, Nanjing 210002, China.
authors.forename: He
authors.initials: H
authors.lastname: Zhang
authors.affiliation: 1 Department of Respiratory Medicine, Jinling Hospital, Nanjing clinical school, Southern Medical University (Guangzhou), Nanjing 210001, China ; 2 Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210001, China ; 3 Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu 241000, China ; 4 Department of Gastroenterology and Hepatology, Jinling Hospital, Clinical School of Nanjing, Second Military Medical University, Nanjing 210002, China.
authors.forename: Xiao-Bing
authors.initials: XB
authors.lastname: Xu
authors.affiliation: 1 Department of Respiratory Medicine, Jinling Hospital, Nanjing clinical school, Southern Medical University (Guangzhou), Nanjing 210001, China ; 2 Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210001, China ; 3 Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu 241000, China ; 4 Department of Gastroenterology and Hepatology, Jinling Hospital, Clinical School of Nanjing, Second Military Medical University, Nanjing 210002, China.
authors.forename: Jun-Li
authors.initials: JL
authors.lastname: Zeng
authors.affiliation: 1 Department of Respiratory Medicine, Jinling Hospital, Nanjing clinical school, Southern Medical University (Guangzhou), Nanjing 210001, China ; 2 Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210001, China ; 3 Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu 241000, China ; 4 Department of Gastroenterology and Hepatology, Jinling Hospital, Clinical School of Nanjing, Second Military Medical University, Nanjing 210002, China.
authors.forename: Wen-Jun
authors.initials: WJ
authors.lastname: Liang
authors.affiliation: 1 Department of Respiratory Medicine, Jinling Hospital, Nanjing clinical school, Southern Medical University (Guangzhou), Nanjing 210001, China ; 2 Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210001, China ; 3 Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu 241000, China ; 4 Department of Gastroenterology and Hepatology, Jinling Hospital, Clinical School of Nanjing, Second Military Medical University, Nanjing 210002, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Yang
authors.affiliation: 1 Department of Respiratory Medicine, Jinling Hospital, Nanjing clinical school, Southern Medical University (Guangzhou), Nanjing 210001, China ; 2 Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210001, China ; 3 Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu 241000, China ; 4 Department of Gastroenterology and Hepatology, Jinling Hospital, Clinical School of Nanjing, Second Military Medical University, Nanjing 210002, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Song
keywords: Lysopohsphatidic acid (LPA); diagnosis; lung cancer; malignant pleural effusions (MPEs); prognosis