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

Abstract

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.