Differences in Pleural Fluid Amylase Levels in Patients with Malignant Pleural Effusion Based on Cancer Type, Histologic Type, and Epidermal Growth Factor Receptor Mutations

Abstract

Objective High pleural amylase levels have been reported in patients with malignant pleural effusion; however, the characteristics of this association are uncertain. Therefore, this study investigated the factors, such as cancer type and oncogenic drivers, related to pleural amylase levels in patients with malignant pleural effusion. Methods We retrospectively collected the data of 362 cancer patients (lung adenocarcinoma [n=256], lung squamous carcinoma [n=12], small-cell lung carcinoma [n=32], other lung cancers [n=5], mesothelioma [n= 31], and metastatic cancer [n=26]) with malignant pleural effusion at Fukujuji Hospital from January 2012 to October 2022. Pleural amylase levels were compared. Results Pleural amylase levels were significantly higher in patients with lung adenocarcinoma (median 58.6 IU/L [interquartile range (IQR) 33.8-139.3]) than in those with small-cell lung carcinoma (median 37.2 IU/L [IQR 26.3-63.7], p=0.012). The median pleural amylase level was higher in patients with lung adenocarcinoma than in those with other cancer or histologic types, although the difference was not significant. Pleural amylase levels were higher in epidermal growth factor receptor (EGFR) mutation-positive patients than in EGFR mutation-negative patients (median 95.8 IU/L [IQR 52.7-246.5] vs. median 51.2 IU/L [IQR 27.8-96.9], p<0.001). The Kaplan-Meier survival curves of pleural amylase ! 75 IU/L were higher than those of pleural amylase <75 IU/L (log rank test p<0.001, hazard ratio 0.54 [95% confidence interval: 0.41-0.71]). Conclusion This study demonstrates that pleural amylase levels were elevated in patients with lung adenocarcinoma and EGFR mutations. Furthermore, a high pleural amylase level was associated with a good prognosis.

Pleural effusion in a patient with previous alcohol excess

“…Mildly raised pancreatic enzyme levels can be seen in other pleural effusions up to ∼200 U·L −1 [ 10 , 11 ]. In malignant effusions, this may be due to ectopic secretion of amylase by the tumour, or via tumour obstruction of pleural lymphatics [ 12 , 13 ]. Salivary amylase is found in effusions secondary to oesophageal rupture, as gastric contents move upwards into the pleural space with the negative intrathoracic pressure of inspiration.…”