Diagnostic accuracy of vascular endothelial growth factor for malignant pleural effusion: A meta-analysis

Shen,Yong-Chun; Liu,Meng-Qi; Wan,Chun; Chen,Lei; Wang,Tao; Wen,Fu-Qiang

doi:10.3892/etm.2012.514

Diagnostic accuracy of vascular endothelial growth factor for malignant pleural effusion: A meta-analysis

Authors:
- Yong-Chun Shen
- Meng-Qi Liu
- Chun Wan
- Lei Chen
- Tao Wang
- Fu-Qiang Wen
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Affiliations: Department of Respiratory Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Sichuan, P.R. China, Department of Radiology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, P.R.China
Published online on: March 14, 2012 https://doi.org/10.3892/etm.2012.514
Pages: 1072-1076

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Abstract

Since the diagnostic accuracy of conventional examinations for malignant pleural effusion (MPE) is limited, a number of studies have investigated the utility of pleural vascular endothelial growth factor (VEGF) in the diagnosis of MPE. The present meta-analysis aimed to determine the overall accuracy of a VEGF test in the diagnosis of MPE. A systematic review of studies published in English was conducted and the data concerning the accuracy of pleural VEGF assays in the diagnosis of MPE were pooled with random effects models. The overall test performance was summarized using receiver operating characteristic curves. Ten studies, based on 1,025 patients, met the inclusion criteria for the meta-analysis and the summary estimates for VEGF in the diagnosis of MPE were: sensitivity 0.75 [95% confidence interval (CI), 0.72-0.79], specificity 0.72 (95% CI, 0.68-0.76), positive likelihood ratio 2.94 (95% CI, 1.97-4.41), negative likelihood ratio 0.38 (95% CI, 0.27-0.51) and diagnostic odds ratio 9.05 (95% CI, 4.60-17.80). The summary receiver operating characteristic curve indicated that the maximum joint sensitivity and specificity was 0.75; the area under the curve was 0.82. Our findings suggest that the determination of pleural VEGF may improve the accuracy of MPE diagnosis, while the results of VEGF assays should be interpreted in parallel with conventional test results and other clinical findings.

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1.	McGrath EE and Anderson PB: Diagnosis of pleural effusion: a systematic approach. Am J Crit Care. 20:119–127. 2011. View Article : Google Scholar : PubMed/NCBI
2.	Bennett R and Maskell N: Management of malignant pleural effusions. Curr Opin Pulm Med. 11:296–300. 2005.PubMed/NCBI
3.	Prakash UB and Reiman HM: Comparison of needle biopsy with cytologic analysis for the evaluation of pleural effusion: analysis of 414 cases. Mayo Clin Proc. 60:158–164. 1985. View Article : Google Scholar : PubMed/NCBI
4.	Lombardi G, Zustovich F, Nicoletto MO, Donach M, Artioli G and Pastorelli D: Diagnosis and treatment of malignant pleural effusion: a systematic literature review and new approaches. Am J Clin Oncol. 33:420–423. 2010. View Article : Google Scholar : PubMed/NCBI
5.	Shi HZ, Liang QL, Jiang J, Qin XJ and Yang HB: Diagnostic value of carcinoembryonic antigen in malignant pleural effusion: a meta-analysis. Respirology. 13:518–527. 2008. View Article : Google Scholar : PubMed/NCBI
6.	Liang QL, Shi HZ, Qin XJ, Liang XD, Jiang J and Yang HB: Diagnostic accuracy of tumour markers for malignant pleural effusion: a meta-analysis. Thorax. 63:35–41. 2008. View Article : Google Scholar : PubMed/NCBI
7.	Senger DR, Van de Water L, Brown LF, et al: Vascular permeability factor (VPF, VEGF) in tumor biology. Cancer Metastasis Rev. 12:303–324. 1993. View Article : Google Scholar : PubMed/NCBI
8.	Berse B, Brown LF, Van de Water L, Dvorak HF and Senger DR: Vascular permeability factor (vascular endothelial growth factor) gene is expressed differentially in normal tissues, macrophages, and tumors. Mol Biol Cell. 3:211–220. 1992. View Article : Google Scholar
9.	Zebrowski BK, Yano S, Liu W, Shaheen RM, Hicklin DJ, Putnam JB Jr and Ellis LM: Vascular endothelial growth factor levels and induction of permeability in malignant pleural effusions. Clin Cancer Res. 5:3364–3368. 1999.PubMed/NCBI
10.	Kraft A, Weindel K, Ochs A, et al: Vascular endothelial growth factor in the sera and effusions of patients with malignant and nonmalignant disease. Cancer. 85:178–187. 1999. View Article : Google Scholar : PubMed/NCBI
11.	Ishimoto O, Saijo Y, Narumi K, et al: High level of vascular endothelial growth factor in hemorrhagic pleural effusion of cancer. Oncology. 63:70–75. 2002. View Article : Google Scholar : PubMed/NCBI
12.	Lim SC, Jung SI, Kim YC and Park KO: Vascular endothelial growth factor in malignant and tuberculous pleural effusions. J Korean Med Sci. 15:279–283. 2000. View Article : Google Scholar : PubMed/NCBI
13.	Hamed EA, El-Noweihi AM, Mohamed AZ and Mahmoud A: Vasoactive mediators (VEGF and TNF-alpha) in patients with malignant and tuberculous pleural effusions. Respirology. 9:81–86. 2004. View Article : Google Scholar : PubMed/NCBI
14.	Kishiro I, Kato S, Fuse D, Yoshida T, Machida S and Kaneko N: Clinical significance of vascular endothelial growth factor in patients with primary lung cancer. Respirology. 7:93–98. 2002. View Article : Google Scholar : PubMed/NCBI
15.	Bossuyt PM, Reitsma JB, Bruns DE, et al: Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. Standards for Reporting of Diagnostic Accuracy. Clin Chem. 49:1–6. 2003. View Article : Google Scholar
16.	Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM and Kleijnen J: The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol. 3:252003. View Article : Google Scholar : PubMed/NCBI
17.	Jones CM, Ashrafian H, Skapinakis P, Arora S, Darzi A, Dimopoulos K and Athanasiou T: Diagnostic accuracy meta-analysis: a review of the basic principles of interpretation and application. Int J Cardiol. 140:138–144. 2010. View Article : Google Scholar : PubMed/NCBI
18.	Moses LE, Shapiro D and Littenberg B: Combining independent studies of a diagnostic test into a summary ROC curve: data-analytic approaches and some additional considerations. Stat Med. 12:1293–1316. 1993. View Article : Google Scholar : PubMed/NCBI
19.	DerSimonian R and Laird N: Meta-analysis in clinical trials. Control Clin Trials. 7:177–188. 1986. View Article : Google Scholar : PubMed/NCBI
20.	Lijmer JG, Bossuyt PM and Heisterkamp SH: Exploring sources of heterogeneity in systematic reviews of diagnostic tests. Stat Med. 21:1525–1537. 2002.PubMed/NCBI
21.	Koniari I, Koletti B and Apostolakis E: Vascular endothelial growth factor with tumour growth factor-beta, endostatin, proteinases or cytokines might be useful for differential diagnosis of pleural effusions. Interact Cardiovasc Thorac Surg. 12:424–425. 2011. View Article : Google Scholar
22.	Kiropoulos TS, Kostikas K and Gourgoulianis KI: Vascular endothelial growth factor levels in pleural fluid and serum of patients with tuberculous pleural effusions. Chest. 128:4682005. View Article : Google Scholar : PubMed/NCBI
23.	Economidou F, Antoniou KM, Soufla G, et al: Role of VEGF-stromal cell-derived factor-1alpha/CXCL12 axis in pleural effusion of lung cancer. J Recept Signal Transduct Res. 30:154–160. 2010. View Article : Google Scholar : PubMed/NCBI
24.	Kotyza J, Havel D, Vrzalová J, Kulda V and Pesek M: Diagnostic and prognostic significance of inflammatory markers in lung cancer-associated pleural effusions. Int J Biol Markers. 25:12–20. 2010.PubMed/NCBI
25.	Bunatova K, Obermajer N, Kotyza J, Pesek M and Kos J: Levels of cathepsins S and H in pleural fluids of inflammatory and neoplastic origin. Int J Biol Markers. 24:47–51. 2009.PubMed/NCBI
26.	Economidou F, Antoniou KM, Tzanakis N, Sfiridaki K, Siafakas NM and Schiza SE: Angiogenic molecule Tie-2 and VEGF in the pathogenesis of pleural effusions. Respir Med. 102:774–779. 2008. View Article : Google Scholar : PubMed/NCBI
27.	Atanackovic D, Cao Y, Kim JW, et al: The local cytokine and chemokine milieu within malignant effusions. Tumour Biol. 29:93–104. 2008. View Article : Google Scholar : PubMed/NCBI
28.	Tomimoto H, Yano S, Muguruma H, Kakiuchi S and Sone S: Levels of soluble vascular endothelial growth factor receptor 1 are elevated in the exudative pleural effusions. J Med Invest. 54:146–153. 2007. View Article : Google Scholar : PubMed/NCBI
29.	Daniil ZD, Zintzaras E, Kiropoulos T, Papaioannou AI, Koutsokera A, Kastanis A and Gourgoulianis KI: Discrimination of exudative pleural effusions based on multiple biological parameters. Eur Respir J. 30:957–964. 2007. View Article : Google Scholar : PubMed/NCBI
30.	Yeh HH, Lai WW, Chen HH, Liu HS and Su WC: Autocrine IL-6-induced Stat3 activation contributes to the pathogenesis of lung adenocarcinoma and malignant pleural effusion. Oncogene. 25:4300–4309. 2006. View Article : Google Scholar : PubMed/NCBI
31.	Kalomenidis I, Kollintza A, Sigala I, Papapetropoulos A, Papiris S, Light RW and Roussos C: Angiopoietin-2 levels are elevated in exudative pleural effusions. Chest. 129:1259–1266. 2006. View Article : Google Scholar : PubMed/NCBI
32.	Ruiz E, Alemán C, Alegre J, et al: Angiogenic factors and angiogenesis inhibitors in exudative pleural effusions. Lung. 183:185–195. 2005. View Article : Google Scholar : PubMed/NCBI
33.	Jin HY, Lee KS, Jin SM and Lee YC: Vascular endothelial growth factor correlates with matrix metalloproteinase-9 in the pleural effusion. Respir Med. 98:115–122. 2004. View Article : Google Scholar : PubMed/NCBI
34.	Davidson B, Vintman L, Zcharia E, et al: Heparanase and basic fibroblast growth factor are co-expressed in malignant mesothelioma. Clin Exp Metastasis. 21:469–476. 2004. View Article : Google Scholar : PubMed/NCBI
35.	van Hensbergen Y, Broxterman HJ, Hanemaaijer R, et al: Soluble aminopeptidase N/CD13 in malignant and nonmalignant effusions and intratumoral fluid. Clin Cancer Res. 8:3747–3754. 2002.PubMed/NCBI
36.	J Strizzi L, Catalano A, Vianale G, et al: Vascular endothelial growth factor is an autocrine growth factor in human malignant mesothelioma. J Pathol. 193:468–475. 2001.PubMed/NCBI
37.	Verheul HM, Hoekman K, Jorna AS, Smit EF and Pinedo HM: Targeting vascular endothelial growth factor blockade: ascites and pleural effusion formation. Oncologist. 5(Suppl 1): 45–50. 2000. View Article : Google Scholar : PubMed/NCBI
38.	Cheng D, Lee YC, Rogers JT, Perkett EA, Moyers JP, Rodriguez RM and Light RW: Vascular endothelial growth factor level correlates with transforming growth factor-beta isoform levels in pleural effusions. Chest. 118:1747–1753. 2000. View Article : Google Scholar
39.	Yanagawa H, Takeuchi E, Suzuki Y, Ohmoto Y, Bando H and Sone S: Vascular endothelial growth factor in malignant pleural effusion associated with lung cancer. Cancer Immunol Immunother. 48:396–400. 1999. View Article : Google Scholar : PubMed/NCBI
40.	Thickett DR, Armstrong L and Millar AB: Vascular endothelial growth factor (VEGF) in inflammatory and malignant pleural effusions. Thorax. 54:707–710. 1999. View Article : Google Scholar : PubMed/NCBI
41.	Cheng D, Rodriguez RM, Perkett EA, Rogers J, Bienvenu G, Lappalainen U and Light RW: Vascular endothelial growth factor in pleural fluid. Chest. 116:760–765. 1999. View Article : Google Scholar : PubMed/NCBI
42.	Yeo KT, Wang HH, Nagy JA, et al: Vascular permeability factor (vascular endothelial growth factor) in guinea pig and human tumor and inflammatory effusions. Cancer Res. 53:2912–2918. 1993.PubMed/NCBI
43.	Momi H, Matsuyama W, Inoue K, Kawabata M, Arimura K, Fukunaga H and Osame M: Vascular endothelial growth factor and proinflammatory cytokines in pleural effusions. Respir Med. 96:817–822. 2002. View Article : Google Scholar : PubMed/NCBI
44.	Sack U, Hoffmann M, Zhao XJ, et al: Vascular endothelial growth factor in pleural effusions of different origin. Eur Respir J. 25:600–604. 2005. View Article : Google Scholar : PubMed/NCBI
45.	Shu J, Sun G, Liu H and Liu J: Clinical utility of vascular endothelial growth factor in diagnosing malignant pleural effusions. Acta Oncol. 46:1004–1011. 2007. View Article : Google Scholar : PubMed/NCBI
46.	Xue K, Xiong S and Xiong W: Clinical value of vascular endothelial growth factor combined with interferon-gamma in diagnosing malignant pleural effusion and tuberculous pleural effusion. J Huazhong Univ Sci Technolog Med Sci. 27:495–497. 2007. View Article : Google Scholar
47.	Cheng M, Chen Y, Yu X, Tian Z and Wei H: Diagnostic utility of LunX mRNA in peripheral blood and pleural fluid in patients with primary non-small cell lung cancer. BMC Cancer. 8:1562008. View Article : Google Scholar : PubMed/NCBI
48.	Duysinx BC, Corhay JL, Hubin L, Nguyen D, Henket M and Louis R: Diagnostic value of interleukine-6, transforming growth factor-beta 1 and vascular endothelial growth factor in malignant pleural effusions. Respir Med. 102:1708–1714. 2008. View Article : Google Scholar : PubMed/NCBI
49.	Zhou WB, Bai M and Jin Y: Diagnostic value of vascular endothelial growth factor and endostatin in malignant pleural effusions. Int J Tuberc Lung Dis. 13:381–386. 2009.PubMed/NCBI
50.	Chen Y, Liang B, Zhao YJ, Wang SC, Fan YB and Wu GP: Transcription expression and clinical significance of vascular endothelial growth factor mRNA and endostatin mRNA in pleural effusions of patients with lung cancer. Diagn Cytopathol. Oct. 26–2010, (E-pub ahead of print). View Article : Google Scholar
51.	Fiorelli A, Vicidomini G, Di Domenico M, et al: Vascular endothelial growth factor in pleural fluid for differential diagnosis of benign and malignant origin and its clinical applications. Interact Cardiovasc Thorac Surg. 12:420–424. 2011. View Article : Google Scholar
52.	Glas AS, Lijmer JG, Prins MH, Bonsel GJ and Bossuyt PM: The diagnostic odds ratio: a single indicator of test performance. J Clin Epidemiol. 56:1129–1135. 2003. View Article : Google Scholar : PubMed/NCBI