Submit Your Article CMED MEACR meeting
Home Print this page Email this page Users Online: 277
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 4  |  Issue : 1  |  Page : 6-8

Sialic acid Levels in smokers and nonsmokers with malignant pleural effusion


1 Department of Biochemistry, Pt B D Sharma University of Health Sciences, Rohtak, India
2 Department of Tuberculosis and Respiratory Medicine, Pt B D Sharma University of Health Sciences, Rohtak, India

Date of Web Publication9-Jan-2015

Correspondence Address:
Simmi Kharb
H No 1447, Sector 1, Urban Estate, Rohtak - 124001, Haryana
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-0513.149021

Rights and Permissions
  Abstract 

Objective: The present study is designed to measure sialic acid in pleural effusion and in serum samples of patients to differentiate between malignant and nonmalignant diseases. Materials and Methods: The present study was conducted on 30 patients with malignant pleural effusion and 30 patients with nonmalignant pleural effusion. Pleural fluid and blood samples were taken at the time of admission, before starting any treatment. Sialic acid levels were estimated in serum and pleural fluid by Warren's Thiobarbituric Acid (TBA) method. Results: In the present study, serum sialic acid levels were higher in group II as compared to group I. In the present study, pleural fluid (PF) sialic acid levels and PF/serum(S) ratio was higher in malignant pleural effusion (though difference was not statistically significant). Smokers in group II had higher serum sialic acid as compared to group 1 (P < 0.05). The sensitivity and specificity of PF/S sialic acid ratio with cut off value of 0.7 were 76.67% and 20%, respectively, whereas taking the cut off value of 70mg/dl for pleural fluid sialic acid in malignant pleural effusions, the sensitivity was 63.33%, specificity 60%, and positive predictive value 46.34%. Conclusion: These findings indicate that determination of sialic acid levels in pleural fluid has diagnostic value as a cheap, simple, and reliable marker for malignant pleural effusion.

Keywords: Pleural effusion, pleural fluid, serum, sialic acid


How to cite this article:
Kharb S, Bansal A, Tandon S. Sialic acid Levels in smokers and nonsmokers with malignant pleural effusion. Clin Cancer Investig J 2015;4:6-8

How to cite this URL:
Kharb S, Bansal A, Tandon S. Sialic acid Levels in smokers and nonsmokers with malignant pleural effusion. Clin Cancer Investig J [serial online] 2015 [cited 2019 Oct 18];4:6-8. Available from: http://www.ccij-online.org/text.asp?2015/4/1/6/149021


  Introduction Top


Malignant disease involving pleura is the second leading cause of exudative pleural effusions after parapneumonic effusions. It is one of the most common diagnostic problems encountered by specialist requiring detailed investigation. [1] An increasing number of biochemical parameters have been reported to have diagnostic value in malignant pleural effusions. [2],[3],[4] Sialic acid levels have been found to be elevated in neoplastic cells derived from lung, breast, stomach, colon, ovary, prostate, and liver tumors. [5] Recently, sialic acid has been reported to have a diagnostic value. [4] Hence, the present study is designed to measure sialic acid in pleural effusion and serum samples of patients to differentiate between malignant and nonmalignant diseases.


  Materials and methods Top


The present study was conducted on 60 patients attending Outpatient Department of Tuberculosis and Respiratory Medicine in collaboration with Department of Biochemistry. They were subdivided into two groups of 30 patients each: Group I (patients with pleural effusion proved malignant by pleural biopsy) and Group II (controls with nonmalignant pleural effusion). There were 14 smokers in Group I and 21 smokers in Group II. Inclusion criteria: Sputum negative for acid-fast bacilli (AFB) (at least on three occasions), confirmed malignant by pleural biopsy, and exudative pleural effusion. All the cases were subjected to detailed clinical history, thorough clinical examination, and routine investigations. Pleural fluid and blood samples were taken at the time of admission, before starting any treatment. Sialic acid levels were estimated in serum and pleural fluid by Warren's Thiobarbituric Acid (TBA) method. [6] Data so obtained was analyzed statistically; student's t- test was applied and regression analysis was carried out.


  Observations Top


The clinical characteristics of the two groups are given in [Table 1]. In group I, there were 14 patients who were smokers, whereas in group 2, there were 21 smokers. In group I, 4 out of 30 patients were cases of benign pleural effusion, 18 had tubercular etiology, 10 had pneumonitis, and 2 cases were with chylothorax. In group II, 5 had malignant effusion, 25 had lung cancer, and 1 had mediastinal neoplasia.
Table 1: Clinical characteristics (mean)

Click here to view


Pleural effusion and serum sialic acid levels were higher in group II as compared to group I, although the difference was not statistically significant [Table 2]. Pleural fluid/serum (PF/S) ratio was higher in group II as compared to group I, although difference was not statistically significant. Also, smokers had high pleural fluid and serum sialic acid levels and PF/S ratio as compared to nonsmokers. Smoker in groups II had higher serum sialic acid as compared to group 1 (P < 0.05).
Table 2: Sialic acid levels in the two groups (mean±SD, mg/dl)

Click here to view



  Discussion Top


In the present study, serum sialic acid levels were higher in group II as compared to group I. Raised serum sialic acid levels have been reported in various cancers. [5] Our findings are in agreement with those reported by Krolikowsky et al. [7] High serum sialic acid levels have been reported in malignant pleural effusions although difference was not statistically significant and high pleural fluid sialic acid levels and PF/S ratio were also observed. [8]

In the present study, pleural fluid sialic acid levels and PF/S ratio was higher in malignant pleural effusion (although difference was not statistically significant). Also, smokers had high pleural fluid and serum sialic acid levels and PF/S ratio as compared to nonsmokers. Smoker in groups II had higher serum sialic acid as compared to group 1 (P < 0.05). These findings are in agreement with those reported in literature. [9],[10],[11]

Implants of malignant cells on pleura can produce effusion as well as diffusion by pleural capillaries into pleural fluid. Elevated concentration of sialic acid could be either because of production and gradual absorption of sialic acid in diseased area or elevation of both serum and pleural fluid levels, but sialic acid disappears more slowly from pleural fluid. The smokers had higher pleural fluid sialic acid levels in malignant pleural effusion as compared to nonsmokers [Table 2], (P > 0.05). In benign pleural effusion, pleural fluid sialic acid levels were higher in nonsmokers [Table 2], (P > 0.05). PF/S ratio was higher in smokers than in nonsmokers in malignant pleural effusion and lower in smokers in benign pleural effusions [Table 2], (P < 0.05, P > 0.05, respectively).

Serum sialic acid levels have been reported to be increased in smokers and alcoholics as smoking induces tissue inflammation and is a known carcinogen. [12] Hence, elevated sialic acid levels in pleural fluid could be attributed to smoking and this could possibly be a secondary process to malignancy. Studies have reported that total sialic acid levels remain unchanged following one year of smoking cessation. [12],[13] These findings are in agreement with those reported in literature. [9],[14] Thus, pleural fluid sialic acid in malignant pleural effusion along with PF/S ratio can prove to be a reliable marker in differentiating benign and malignant pleural effusion and evaluating impact of smoking in progression of malignancy.

 
  References Top

1.
Leuallen EC, Carr DT. Pleural effusion: A statistical study of 436 patients. N Engl J Med 1955;252:79-83.  Back to cited text no. 1
    
2.
Niwa Y, Kishimato H, Shimokata K. Carcinomatous and tuberculous pleural effusions: Comparison of tumor markers. Chest 1985;87:351-5.  Back to cited text no. 2
    
3.
Tamura S, Nishigaki T, Moriwaki Y, Fukioka H, Nakano T, Fuji J, et al. Tumor markers in pleural effusion diagnosis. Cancer 1988;61:298-302.  Back to cited text no. 3
    
4.
Martinez-Vea A, Gatel JM, Segura F, Heiman C, Elena M, Ballesta AM, et al. Diagnostic value of tumor markers in serous effusions. Cancer 1982;50:1783-8.  Back to cited text no. 4
    
5.
Erbil MK, Jones JD, Klee GG. Use and limitations of serum and total lipid-bound sialic acid concentrations as markers for colorectal cancers. Cancer 1985;55:404-9.  Back to cited text no. 5
    
6.
Warren L. The thiobarbituric acid assay of sialic acids. J Biol Chem 1959;234:1971-5.  Back to cited text no. 6
    
7.
Krolikowsky FJ, Reuter K, Waalkes TP, Sieber SM, Adamson RH. Serum sialic acid levels in lung cancer patients. Pharmacology 1976;14:47-51.  Back to cited text no. 7
    
8.
Bektemur G, Ozer F, Kanat F, Imecik O. Diagnostic efficiency of serum lipid-bound sialic acid level in malignant pleural effusions. Tuberk Toraks 2003;51:265-70.  Back to cited text no. 8
    
9.
Imecik O, Ozer F. Diagnostic value of sialic acid in malignant pleural effusions. Chest 1992;102:1819-22.  Back to cited text no. 9
    
10.
Alsayed S, Marzouk S. Sialic acid value in pleural effusion as a diagnostic marker of malignancy. J Egypt Soc Parasitol 2013;43:689-96.  Back to cited text no. 10
    
11.
Bansal A, Tandon S, Kharb S. Diagnostic value of sialic acid in pleural effusion. Zhongguo Fei Ai Za Zhi 2010;13:349-51.  Back to cited text no. 11
    
12.
Kakari S, Stringou E, Toumbis M, Ferderigos AS, Poulaki E, Chondros K, et al. Five tumor markers in lung cancer: Significance of total and "lipid"-bound sialic acid. Anticancer Res 1991;11:2107-10.  Back to cited text no. 12
    
13.
Crook MA, Scott DA, Stapleton JA, Palmer RM, Wilson RF, Sutherland G. Circulating concentrations of C-reactive protein and total sialic acid in tobacco smokers remain unchanged following one year of validated smoking cessation. Eur J Clin Invest 2000;30:861-5.  Back to cited text no. 13
    
14.
Kurtul N, Cil MY, Bakan E. The effects of alcohol and smoking on serum, saliva, and urine sialic acid levels. Saudi Med J 2004;25:1839-44.  Back to cited text no. 14
    



 
 
    Tables

  [Table 1], [Table 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and me...
Observations
Discussion
References
Article Tables

 Article Access Statistics
    Viewed1272    
    Printed42    
    Emailed0    
    PDF Downloaded75    
    Comments [Add]    

Recommend this journal