Abstract
BackgroundTo select optimal candidates for limited lung resection, it is necessary to accurately differentiate the non-invasive tumors from other small-sized lung cancer. Urinary N1, N12-diacetylspermine (DiAcSpm) has been reported to be a useful tumor marker for various cancers. We aimed to examine the correlation between preoperative urinary DiAcSpm levels and specific clinicopathological characteristics such as the histological tumor invasiveness in patients with clinical stage IA non-small cell lung cancer (NSCLC).MethodsWe defined non-invasive tumors as NSCLC showing no vascular invasion, lymphatic permeation, pleural invasion, or lymph node metastasis. Preoperative urine samples were obtained from 516 consecutive patients with NSCLC resected at our institution between April 2008 and January 2013. Urinary DiAcSpm values were determined for all preoperative urine samples using the colloid gold aggregation procedure. Among these patients, 171 patients with clinical stage IA NSCLC met the criteria of our study cohort. Finally, we investigated the correlation between non-invasive tumor and urinary DiAcSpm levels.ResultsThe median urine DiAcSpm for males was 147.2 nmol/g creatinine and 161.8 nmol/g creatinine in females. These median values were set as the cut-off values for each gender. Patients with higher urinary DiAcSpm levels frequently had significantly elevated serum CEA (p = 0.023) and greater lymph node metastasis (p = 0.048), lymphatic permeation (p = 0.046), and vascular invasion (p = 0.010). Compared with patients with non-invasive tumors, patients with invasive tumors had a tumor size >2.0 cm (p = 0.001), serum CEA >5.0 mg/dL (p < 0.001), high urinary DiAcSpm (p = 0.002), and a tumor disappearance rate (TDR) <0.75 (p < 0.001). Multivariate analysis revealed that a tumor size < 2.0 cm (RR = 2.901, 95% CI; 1.372-6.136, p = 0.005), high urinary DiAcSpm (RR = 3.374, 95% CI; 1.547-7.361, p = 0.002), and TDR < 0.75 (RR = 4.673, 95% CI; 2.178-10.027, p < 0.001) were independent predictors for invasive tumors.ConclusionsWe successfully showed that there was a significant correlation between urinary DiAcSpm levels and pathological tumor invasiveness in patients with clinical stage IA NSCLC. Further research would elucidate the clinical usefulness of DiAcSpm levels as a predictor of tumor invasiveness.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1068-5) contains supplementary material, which is available to authorized users.
Highlights
To select optimal candidates for limited lung resection, it is necessary to accurately differentiate the non-invasive tumors from other small-sized lung cancer
A recent report described that the presence of a micropapillary component was independently associated with an increased risk of recurrence in patients with stage I non-small cell lung cancer (NSCLC) treated with limited resection [9]
We aimed to examine the correlation between preoperative urinary DiAcSpm levels and clinicopathological characteristics such as the histological invasiveness of tumors in patients with clinical stage IA NSCLC
Summary
To select optimal candidates for limited lung resection, it is necessary to accurately differentiate the non-invasive tumors from other small-sized lung cancer. We aimed to examine the correlation between preoperative urinary DiAcSpm levels and specific clinicopathological characteristics such as the histological tumor invasiveness in patients with clinical stage IA non-small cell lung cancer (NSCLC). Recent advancements in diagnostic techniques have increased the accuracy and frequency of detection of small-sized lung tumors [2] Using these advancements, a number of researchers have attempted to prove the effectiveness of limited lung resection; their studies have shown a higher local recurrence rate after limited resection, even though a negative surgical margin had been confirmed pathologically [3,4,5]. In order to select optimal candidates for limited resection it is necessary to accurately differentiate between non-invasive tumors that have been confirmed histologically and other small-sized lung cancers. A recent report described that the presence of a micropapillary component was independently associated with an increased risk of recurrence in patients with stage I NSCLC treated with limited resection [9]
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