Journal of thoracic disease · 2026
Pleural fluid C-C motif chemokine ligand 2 as a diagnostic biomarker for malignant pleural effusion.
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Wei Li-Shuang, Wang Wen-Xiang, Li Hong-Xia, Wang Qi, Hu Ming-Ming, Wang Yin, Zhai Kan, Ma Li
Аннотация
BACKGROUND: Accurate diagnosis of malignant pleural effusion (MPE) using biomarkers remains challenging. C-C motif chemokine ligand 2 (CCL2) is involved in immune regulation and has been implicated in the pleural immune microenvironment associated with MPE. This study aimed to evaluate the diagnostic accuracy of CCL2 for MPE.
METHODS: From June 2019 to April 2022, 184 patients with exudative pleural effusion admitted to our hospital were enrolled and randomly divided into a training group (70.1%, n=129) and an internal validation group (29.9%, n=55). Clinical indicators, including pleural fluid carcinoembryonic antigen (CEA), were collected. Pleural fluid CCL2 concentrations were determined using enzyme-linked immunosorbent assay. Analyses included receiver operating characteristic (ROC) curves, univariate logistic regression, and nomogram construction. Model performance was evaluated by the area under the curve (AUC), concordance index (c-index), and calibration plots.
RESULTS: Pleural fluid CCL2 levels were significantly higher in MPE than in non-MPE cases (cut-off value =612.5 pg/mL, AUC =0.734, sensitivity =61.7%, specificity =74.1%), whereas adenosine deaminase (ADA) levels were lower. Compared with other pleural fluid biochemical indicators, pleural fluid CCL2 showed competitive diagnostic accuracy, particularly for exclusion diagnosis (negative predictive value =76.9%). In addition, CCL2 exerts a significant stratification effect on the diagnosis of MPE subgroups, especially in the ADA ≥26.5 U/L group, chloride ≥109.25 mmol/L group, and CEA ≥2.62 ng/mL group, where its diagnostic efficacy is more prominent. A nomogram incorporating pleural fluid CCL2, age, and ADA demonstrated strong discriminative performance in the training cohort (AUC =0.981; sensitivity =92.7%; specificity =100%). The c-index was 0.981, indicating good agreement between predicted and observed outcomes. Internal validation analyses further supported the robustness of the model, with AUC values exceeding 0.90.
CONCLUSIONS: Pleural fluid CCL2 may serve as a useful adjunctive biomarker for the diagnostic evaluation of MPE. A CCL2-based nomogram integrating age and ADA demonstrated strong discriminative performance in internal analyses, suggesting its potential value as a minimally invasive aid for MPE identification.
METHODS: From June 2019 to April 2022, 184 patients with exudative pleural effusion admitted to our hospital were enrolled and randomly divided into a training group (70.1%, n=129) and an internal validation group (29.9%, n=55). Clinical indicators, including pleural fluid carcinoembryonic antigen (CEA), were collected. Pleural fluid CCL2 concentrations were determined using enzyme-linked immunosorbent assay. Analyses included receiver operating characteristic (ROC) curves, univariate logistic regression, and nomogram construction. Model performance was evaluated by the area under the curve (AUC), concordance index (c-index), and calibration plots.
RESULTS: Pleural fluid CCL2 levels were significantly higher in MPE than in non-MPE cases (cut-off value =612.5 pg/mL, AUC =0.734, sensitivity =61.7%, specificity =74.1%), whereas adenosine deaminase (ADA) levels were lower. Compared with other pleural fluid biochemical indicators, pleural fluid CCL2 showed competitive diagnostic accuracy, particularly for exclusion diagnosis (negative predictive value =76.9%). In addition, CCL2 exerts a significant stratification effect on the diagnosis of MPE subgroups, especially in the ADA ≥26.5 U/L group, chloride ≥109.25 mmol/L group, and CEA ≥2.62 ng/mL group, where its diagnostic efficacy is more prominent. A nomogram incorporating pleural fluid CCL2, age, and ADA demonstrated strong discriminative performance in the training cohort (AUC =0.981; sensitivity =92.7%; specificity =100%). The c-index was 0.981, indicating good agreement between predicted and observed outcomes. Internal validation analyses further supported the robustness of the model, with AUC values exceeding 0.90.
CONCLUSIONS: Pleural fluid CCL2 may serve as a useful adjunctive biomarker for the diagnostic evaluation of MPE. A CCL2-based nomogram integrating age and ADA demonstrated strong discriminative performance in internal analyses, suggesting its potential value as a minimally invasive aid for MPE identification.