Assessment of acute phase proteins as prognostic factors in patients surgically treated for non-small cell lung cancer

Wstęp: Celem pracy była ocena zmian ilościowych białek ostrej fazy (BOF) w surowicy chorych poddanych radykalnej resekcji niedrobnokomórkowego raka płuca (NDRP) oraz ich wpływu na przeżycia odległe. Zbadano korelację zmian ilościowych BOF z typem histologicznym raka, stopniem zaawansowania klinicznego oraz stopniem zróżnicowania komórek raka. Materiał i metody: Analizie poddano grupę 46 chorych operowanych z powodu NDRP w latach 2003-2004. Wiek pacjentów wahał się od 45 do 77 lat i wynosił średnio 61 lat. Najczęstszym typem histologicznym nowotworu był rak płaskonabłonkowy (24 chorych) oraz rak gruczołowy (17 chorych). Przeważali chorzy w stopniu zaawansowania klinicznego II B (15 pacjentów) i III A (14 chorych). Badany materiał stanowiła surowica chorych, w której metodą immunoelektroforezy rakietkowej według Laurella zbadano stężenie następujących białek ostrej fazy (BOF): białka C-reaktywnego (CRP), α1-kwaśnej glikoproteiny (AGP), α1-antychymotrypsyny (ACT), α1-antytrypsyny (AT), α2-makromoduliny (M), ceruloplazminy (Cp), haptoglobiny (Hp) i transferyny (Tf). Wyniki: Stwierdzono znamiennie wyższe stężenie we krwi AT u chorych na raka gruczołowego w porównaniu z innymi typami histologicznymi. Natomiast u chorych na raka płaskonabłonkowego istotnie wyższe było stężenie M i Cp. Nie stwierdzono istotnej statystycznie różnicy w poziomach BOF w zależności od stopnia zróżnicowania komórek raka. W grupie chorych z guzem sklasyfikowanym jako T3 lub T4 znamiennie wyższe były stężenia pięciu białek: CRP, AGP, ACT, M i Cp. Chorzy z przerzutami w regionalnych węzłach chłonnych (N1 lub N2) charakteryzowali się istotnie wyższymi stężeniami białek AT, CRP i Hp. Na podstawie analizy wieloczynnikowej wykazano istotny statystycznie wpływ na przeżycia odległe (3-letnie) następujących czynników: obecność przerzutów w regionalnych węzłach chłonnych, typ histologiczny raka oraz przedoperacyjne stężenie AGP i Hp w surowicy. Wnioski: U chorych na NDRP stężenie niektórych BOF w surowicy może korelować z bardziej agresywnym przebiegiem klinicznym. U pacjentów z rakiem gruczołowym płuca i przerzutami w regionalnych węzłach chłonnych stwierdza się znamiennie wyższe stężenia AT we krwi. Wydaje się, że podwyższone stężenie w surowicy AGP i Hp może niekorzystnie wpływać na przeżycia odległe. Białka te mogłyby służyć jako czynniki prognostyczne w ocenie ryzyka nawrotu choroby nowotworowej po leczeniu operacyjnym.Introduction: The aim of the study was to assess quantitative acute phase protein (APP) level changes in patients with non-small cell lung cancer (NSCLC) subjected to radical resections, as well as their influence on long-term survival. We analysed the correlation between quantitative APP changes and the histological type of the carcinoma, as well as the TNM stage and grade. Material and methods: The study group comprised 46 patients subjected to surgical treatment of NSCLC during the period between 2003 and 2004. Average patient age amounted to 61 years (ranging between 45 and 77 years). The most frequent histological types of cancer were: squamous cell lung cancer (24 patients) and adenocarcinoma (17 patients). The majority of patients were diagnosed with stage II B (15 patients) and III A (14 patients). We evaluated the levels of the following APP: C-reactive protein (CRP), α1-acid glycoprotein (AGP), α1-antichymotrypsin (ACT), α1-antitrypsin (AT), α2-macroglobulin (M), ceruloplasmin (Cp), haptoglobin (Hp), and transferrin (Tf) by means of rocket immunoelectrophoresis (Laurell’s method). Results: The level of AT was significantly higher in patients with adenocarcinoma, as compared to other histological types of cancer. In the case of patients with squamous cell lung cancer, significantly higher M and Cp levels were observed. We found no correlation between the APP level and tumour grading. The levels of five APP: CRP, AGP, ACT, M and Cp were significantly higher in the group of patients with T3 or T4 category, while N1 or N2 patients presented with significantly higher concentrations of AT, CRP and Hp. Multivariate analysis confirmed the influence of the following factors on long-term survival: N stage, histological type of cancer and preoperative serum levels of AGP and Hp. Conclusions: The serum concentration of some acute phase proteins can correlate with the more aggressive clinical course of non-small cell lung cancer (NSCLC). Patients with adenocarcinoma and local lymph node metastases present with significantly higher levels of AT. Thus, it seems that the elevated preoperative levels of AGP and Hp might unfavourably influence long-term survival. The above-mentioned proteins might prove useful as prognostic factors when assessing the risk of neoplastic recurrence following surgical management

Assessment of Acute Phase Proteins as Prognostic Factors in Patients Surgically Treated for Non-Small Cell Lung Cancer

Introduction: The aim of the study was to assess quantitative acute phase protein (APP) level changes in patients with non-small cell lung cancer (NSCLC) subjected to radical resections, as well as their influence on long-term survival. We analysed the correlation between quantitative APP changes and the histological type of the carcinoma, as well as the TNM stage and grade. Materials and methods: The study group comprised 46 patients subjected to surgical treatment of NSCLC during the period between 2003 and 2004. Average patient age amounted to 61 years (ranging between 45 and 77 years). The most frequent histological types of cancer were: squamous cell lung cancer (24 patients) and adenocarcinoma (17 patients). The majority of patients were diagnosed with stage II B (15 patients) and III A (14 patients). We evaluated the levels of the following APP: C-reactive protein (CRP), α1-acid glycoprotein (AGP), α1-antichymotrypsin (ACT), α1-antitrypsin (AT), α2-macroglobulin (M), ceruloplasmin (Cp), haptoglobin (Hp), and transferrin (Tf) by means of rocket immunoelectrophoresis (Laurell’s method). Results: The level of AT was significantly higher in patients with adenocarcinoma, as compared to other histological types of cancer. In the case of patients with squamous cell lung cancer, significantly higher M and Cp levels were observed. We found no correlation between the APP level and tumour grading. The levels of five APP: CRP, AGP, ACT, M and Cp were significantly higher in the group of patients with T3 or T4 category, while N1 or N2 patients presented with significantly higher concentrations of AT, CRP and Hp. Multivariate analysis confirmed the influence of the following factors on long-term survival: N stage, histological type of cancer and preoperative serum levels of AGP and Hp. Conclusions: The serum concentration of some acute phase proteins can correlate with the more aggressive clinical course of non-small cell lung cancer (NSCLC). Patients with adenocarcinoma and local lymph node metastases present with significantly higher levels of AT. Thus, it seems that the elevated preoperative levels of AGP and Hp might unfavourably influence long-term survival. The above-mentioned proteins might prove useful as prognostic factors when assessing the risk of neoplastic recurrence following surgical management

An Effect of Nuss Procedure on Lung Function Among Patients with Pectus Excavatum

The aim of the studywas to evaluate lung function among patients who underwent Nuss Procedure. The analysis included spirometric evaluation of the lung function before Nuss Procedure, during perioperative period and after removing steel bars from behind the sternum. Material and methods.The study group involved patients operated on the pectus excavatum in the Department of Thoracic Surgery in Poznań in years 2002-2004. The study group consisted of 44 patients (5 females and 39 males). Aged between 10 to 32 years old, the mean age was 16. The following spirometric parameters were analysed: vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1s (FEV1), FEV1/VC ratio, peak expiratory flow (PEF), forced expiratory flow for 25% (FEF25), 50% (FEF50) and 75% FVC (FEF75). Results.The values of the FVC, FEV1, FEF25, and FEV1/VC ratio in the study group were significantly higher in the postoperative period in comparison with the preoperative period. There was a statistically significant correlation between the improvement in spirometric parameters after Nuss Procedure and the impairment of spirometric values in preoperative period. There were no statistical differences between the value of initial chest deformation and spirometric parameters improvement. There were also no statistically significant correlations between age, height and weight of the patient in the study group and spirometric values improvement. Conclusion.There is a statistical improvement in lung function in patients who underwent Nuss Procedure. The improvement in spirometric parameters correlates with the impairment of spirometric values in the preoperative period