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



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.



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.



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.
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. rmterra@uol.com.br.|Thoracic Surgery, Centro Oncológico do Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil. rmterra@uol.com.br.
Ricardo Mingarini
RM
Terra
Pathology Division, Heart Institute, University of São Paulo Medical School, São Paulo, SP, Brazil.
Leila
L
Antonangelo
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.|Thoracic Surgery, Centro Oncológico do Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil.
Alessandro Wasum
AW
Mariani
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 Lopes Moraes
RL
de Oliveira
Pulmonology Division, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, SP, Brazil.
Lisete Ribeiro
LR
Teixeira
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.
Paulo Manuel
PM
Pego-Fernandes
D000243:Adenosine Deaminase / Q000378:metabolism*; D000368:Aged; D005260:Female; D006801:Humans; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D016066:Pleural Effusion, Malignant / Q000201:enzymology* / Q000209:etiology* / Q000473:pathology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate
D000243:Adenosine Deaminase
Adenosine deaminase; Neoplasm metastasis; Palliative care; Pleural effusion, malignant; Survival