Abstract
BackgroundLung cancer (LC) remains the deadliest form of cancer globally. While surgery remains the optimal treatment strategy for individuals with early-stage LC, what the metabolic consequences are of such surgical intervention remains uncertain.MethodsNegative enrichment-fluorescence in situ hybridization (NE-FISH) was used in an effort to detect circulating tumor cells (CTCs) in pre- and post-surgery peripheral blood samples from 51 LC patients. In addition, targeted metabolomics analyses, multivariate statistical analyses, and pathway analyses were used to explore surgery-associated metabolic changes.ResultsLC patients had significantly higher CTC counts relative to healthy controls with 66.67% of LC patients having at least 1 detected CTC before surgery. CTC counts were associated with clinical outcomes following surgery. In a targeted metabolomics analysis, we detected 34 amino acids, 147 lipids, and 24 fatty acids. When comparing LC patients before and after surgery to control patients, metabolic shifts were detected via PLS-DA and pathway analysis. Further surgery-associated metabolic changes were identified when comparing LA (LC patients after surgery) and LB (LC patients before surgery) groups. We identified SM 42:4, Ser, Sar, Gln, and LPC 18:0 for inclusion in a biomarker panel for early-stage LC detection based upon an AUC of 0.965 (95% CI 0.900–1.000). This analysis revealed that SM 42:2, SM 35:1, PC (16:0/14:0), PC (14:0/16:1), Cer (d18:1/24:1), and SM 38:3 may offer diagnostic and prognostic benefits in LC.ConclusionsThese findings suggest that CTC detection and plasma metabolite profiling may be an effective means of diagnosing early-stage LC and identifying patients at risk for disease recurrence.
Highlights
Lung cancer (LC) is among the most common forms of cancer globally, with 2.1 million new cases and 1.8 million LC-related deaths in 2018 alone [1]
Total circulating tumor cells (CTCs) numbers were from 1 to 30, with significantly more CTCs being present in LC patients relative to controls (P < 0.001, Fig. 2a)
This analysis revealed that a cut-off of 0.5 CTCs/3.2 mL of blood was sufficient for LC diagnosis (AUC = 0.812, 95% CI 0.722–0.883, P < 0.0001) (Fig. 2b)
Summary
Lung cancer (LC) is among the most common forms of cancer globally, with 2.1 million new cases and 1.8 million LC-related deaths in 2018 alone [1]. LC has a 5-year survival rate of < 20% This poor prognosis is attributable in part to the fact that many patients are only diagnosed when the disease is at an advanced stage, with metastases often being present. Surgery is important for treating individuals with more advanced (stage III/IV) LC [6]. Recent surgical innovations such as video-assisted thoracoscopic surgery have decreased the invasivity of these intervention protocols, allowing more patients to be candidates for surgical treatment [7]. Lung cancer (LC) remains the deadliest form of cancer globally. While surgery remains the optimal treatment strategy for individuals with early-stage LC, what the metabolic consequences are of such surgical intervention remains uncertain
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