The association of defective pleural sRAGE production with the recurrence of malignant pleural effusion after Talc pleurodesis

Symptomatic malignant pleural effusions (MPE) are treated with chemical pleurodesis to prevent recurrence. The serum soluble receptor for advanced glycation end products (sRAGE) has been linked to lung cancer progression but its role in predicting talc pleurodesis failure is unclear. A prospective cohort study was conducted from November 2023 to December 2024, encompassing subjects with confirmed MPE. Pleural fluid samples were collected prior to intercostal drainage (ICD) insertion for the measurement of sRAGE, ADAM10, MMP9, and HMGB1 levels. Participants were monitored for 90-day post-pleurodesis failure, pleural interventions, and survival. Among seventy-three adults (median age 66 [IQR 53-74 years]) with MPE who received pleurodesis, lung adenocarcinoma was the most common. Talc pleurodesis failure (24.7%) was associated with greater pleural fluid output, multiple pleurodesis attempts, longer ICD retention, and lower pH and lymphocyte fraction. Pleural sRAGE and MMP9 levels were significantly diminished (p = 0.0033 and p = 0.029, respectively), whereas HMGB1 levels were substantially elevated (p = 0.019) in the failure cases. Among biomarkers, pleural sRAGE had the most predictive value for talc pleurodesis failure, followed by HMGB1 and MMP9. However, pleural sRAGE and MMP-9 lacked prognostic significance for 90-day mortality. The present study demonstrated that lower pleural sRAGE is a potential predictive biomarker for talc pleurodesis failure despite inferiority to pleural acidity. Imbalance between sRAGE and HMGB1 in MPE may be associated with the underlying mechanism for talc pleurodesis failure.