An analysis of cytokine status in the serum and effusions of patients withtuberculous and lung cancer

The present study was designed to ascertain whether or not the pleural effu sion and serum cytokine levels (granulocyte-macrophage colony-stimulating f actor [GM-CSF], interleukin-10 [IL-10], and interferon-gamma [IFN gamma]) i n lung cancer patients differ from tuberculous (TB) pleural effusion, in wh ich a strong cellular immune reaction is found; and, whether cytokine level s are a prognostic factor in lung cancer patients with malignant effusion. A total of 202 lung cancer patients with malignant pleural effusion and 26 patients with TB pleural effusion were studied consecutively between 1995 a nd 1998. Serum and effusion cytokine levels were analyzed with ELISA assays . The results showed that pleural effusion GM-CSF and IL-10 levels were sig nificantly higher than serum levels in both cancer and TB patients. Pleural effusion IFN gamma levels were significantly higher than serum levels in T B patients. IFN gamma levels in both pleural effusion and serum were signif icantly higher in TB patients than in those with cancer. No significant dif ference was Found, between TB and cancer patients, in the serum or pleural effusion levels of either IL-10 or GM-CSF. The ratio of pleural effusion IF N gamma to serum IFN gamma, effusion IFN gamma to effusion IL-10, and effus ion IL-10 to serum IL-10, were all significantly higher in TB than in cance r patients, suggesting a higher cellular activity and T-helper 1 (Th1) reac tion in TB pleural effusion than in malignant effusions, which were predomi nantly Th2 type. Survival analysis showed no significant difference in lung cancer patients with different levels of these cytokines. It was concluded that lung cancer patients with malignant pleural effusion had poorer immun e profiles than those with TB pleurisy, both locally and systemically: and the cytokine profiles were not prognostic factors for lung cancer patients with malignant pleural effusion. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.