Clinical significance of tumor cells and CD133+ cells from malignant pleural effusion in patients with lung cancer
Authors: Yong Chen , Min Ling‐feng , Yang Jun‐jun , Xu Wen‐jing , Bian Jia‐rong , Jun Li , Zhang Xi‐zhi , Xu Xing‐xiang 
Published: July 2017

Objective

The composition of malignant pleural effusion in lung cancer is so complex that it is very difficult to obtain high‐purity tumor cells from pleural effusions. Based on the establishment of the negative enrichment method using immunomagnetic beads to obtain high‐purity tumor cells, the present study investigated the clinical significance of tumor cells and CD133+ cells in lung cancer patients with malignant pleural effusion.

Methods

From 1 April 2013 to 31 August 2014, 21 untreated lung cancer patients with pathologically confirmed malignant pleural effusions were enrolled in a study from the Respiratory Department of Clinical Medical School of Yangzhou University. All patients were treated with chemotherapy or gefitinib. Before treatment, 10 mL of pleural effusion was collected. Tumor cells and CD133+ cells from 10 mL pleural effusion were counted by using negative enrichment technology, chromosomal fluorescence in situ hybridization and fluorescent staining with anti‐CD133 antibody. In addition, the relationships between the numbers of tumor cells and CD133+ cells, and clinical characteristics were further analyzed.

Results

Among the 21 patients, the median number of tumor cells and CD133+ cells was 4000/10 mL and 19/10 mL, respectively. There were no significant differences in the numbers of tumor cells and CD133+ cells in patients of different gender (χ2 = 0.597, P = 0.550 and χ2 = 0.225, P = 0.822, respectively), age (χ2 = 0.533, P = 0.594 and χ2 = 1.288, P = 0.198, respectively) and different pathological types of lung cancer (χ2 = 3.253, P = 0.197 and χ2 = 0.034, P = 0.983, respectively). The numbers of tumor cells and CD133+ cells were significantly higher in patients with pulmonary, distant lymph node or other organ metastasis than in patients without distant metastasis or with only regional lymph node metastasis (χ2 = 4.398, P = 0.036 and χ2 = 4.605, P = 0.032, respectively). After treatment with two cycles of chemotherapy or gefitinib for 2 months, 0 patients had complete response, seven had partial response, nine had stable disease, five had progressive disease, and the total response rate was 33.33%. The numbers of tumor cells and CD133+ cells were significantly different between the patients with different treatment efficacies (χ2 = 7.575, P = 0.023 and χ2 = 7.247, P = 0.027, respectively). The numbers of tumor cells and CD133+ cells in patients with partial response were the lowest, whereas the numbers of tumor cells and CD133+ cells in patients with progressive disease were the highest. The patients were divided into three groups according to the median number of tumor cells and CD133+ cells: low cell numbers (both tumor cell and CD133+ cell numbers were equal to or less than the median number), moderate cell numbers (tumor cells > median and CD133+ cells ≤ median or CD133+ cells > median and tumor cells ≤ median) and high cell numbers (both tumor cell and CD133+ cell numbers were more than the median numbers). The incidence of pulmonary, distant lymph node or other organ metastasis in patients with a moderate‐to‐high cell numbers was significantly higher than that in patients with a low cell numbers (χ2 = 12.634, P = 0.002). Furthermore, the treatment efficacy in patients with a low cell number was better than that in patients with a moderate‐to‐high cell numbers (χ2 = 10.886, P = 0.01).

Conclusion

Tumor cells and CD133+ cells in pleural effusions might be used as an effective predictor of disease progression and treatment efficacy in patients with advanced lung cancer.