Abstract
BackgroundNitric oxide (NO) plays an important role in lung cancer. However, the results of previous studies about NO in the occurrence, progress and therapy were not consistent. Therefore, we conducted a meta-analysis to evaluate the relationship between NO and lung cancer.MethodWe carried out comprehensive search in the databases, and collected related studies. The data of fraction of exhaled nitric oxide (FeNO) or blood NO in different populations (lung cancer patients and control subjects) and different time points (before therapy and after therapy) were extracted by two investigators. A random effect model was applied to analyze the differences of FeNO and blood NO in different populations and different time points. To further compare NO level of each subgroup with different pathological types and different stages, a network meta-analysis (NMA) was performed.ResultsFifty studies including 2551 cases and 1691 controls were adopted in this meta-analysis. The FeNO (SMD 3.01, 95% CI 1.89–4.13, p < 0.00001) and blood NO (SMD 1.34, 95% CI 0.84–1.85, p < 0.00001) level in lung cancer patients was much higher than that in control subjects. NMA model indicated blood NO level in each cancer type except SCLC was higher than that in control patients. There was no significant difference of blood NO level among four kinds of lung cancer patients. Blood NO level in LCC patients (SUCRA = 83.5%) was the highest. Blood NO level in advanced stage but not early stage was higher than that in control subjects. Patients in advanced stage (SUCRA = 95.5%) had the highest blood NO level. No significant difference of FeNO (SMD -0.04, 95% CI -0.46-0.38, p > 0.05) and blood NO level (SMD -0.36, 95% CI -1.08-0.36, p > 0.05) was observed between pretreatment and posttreatment in all patients. However, FeNO level elevated (SMD 0.28, 95% CI 0.04–0.51, p = 0.02) and blood NO level decreased in NSCLC patients (SMD -0.95, 95% CI -1.89-0.00, p = 0.05) after therapy.ConclusionFeNO and blood NO level would contribute to diagnosis of lung cancer and evaluation of therapy effect, especially for NSCLC patients.
Highlights
Lung cancer, a kind of tumor with the highest incidence, is the leading cause of cancer death in the world [1]
The fraction of exhaled nitric oxide (FeNO) (SMD 3.01, 95% Confidence interval (CI) 1.89–4.13, p < 0.00001) and blood Nitric oxide (NO) (SMD 1.34, 95% CI 0.84–1.85, p < 0.00001) level in lung cancer patients was much higher than that in control subjects
FeNO level elevated (SMD 0.28, 95% CI 0.04–0.51, p = 0.02) and blood NO level decreased in Non- small cell lung cancer (NSCLC) patients (SMD -0.95, 95% CI -1.89-0.00, p = 0.05) after therapy
Summary
A kind of tumor with the highest incidence, is the leading cause of cancer death in the world [1]. The pathogenesis of lung cancer is considered as a multi-stage process, which is affected by genetic background and environmental factors [3]. Nitric oxide (NO), a small molecule derived from Larginine, has been demonstrated to participate in inflammation, tumor immunity and tumor apoptosis, as well as other pathophysiological process, which are associated with the pathogenesis, progression of lung cancer [4]. A part of NO in the airway will be expired through breath movement, and the fraction of exhaled nitric oxide (FeNO) can be measured by a specific equipment. The value of FeNO is considered as an indicator of airway inflammation level and applied in other chronic respiratory diseases, such as asthma and COPD [5]. Nitric oxide (NO) plays an important role in lung cancer. We conducted a meta-analysis to evaluate the relationship between NO and lung cancer
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