[The quantitative evaluation of the serum acute phase proteins (APP) of patients undergoing a curative resection for non-small cell lung cancer (NSCLC)]

Abstract

The aim of this study was to quantitatively evaluate serum APP in patients undergoing the radical resection for NSCLC. The quantitative changes in APP were correlated with the cancer type, clinical staging and grading and the procedure type. Also, the impact of selected post-operative complications on the APP serum concentrations was evaluated. 46 patients undergoing surgery secondary to NSCLC in the years 2003-2004 were analyzed. The patients' age varied from 45 to 77 years with an average of 61.1. The most common pathological cancer type was the squamous cell cancer (24 patients) and adenocarcinoma (17 patients). The majority of the patients were stage IIB (15 patients) and IIIA (14 patients). The following APPs were evaluated in the patients' serum by Laurell rocket immunoelectrophoresis: C-reactive Protein (CRP), alfa-1 antichymotrypsine (alfa-1 ACT), alfa-1 antitrypsine (AT), alfa-2 macroglobuline (alfa2 M), ceruloplasmin (Cp), haptoglobine (Hp) and transferrin (Tf). Significantly higher serum AT level were found in patients with adenocarcinoma as compared to other pathology types. Patients with the squamous cell cancer had a significantly higher level of alfa-2 M and Cp. There was no significant difference in APP levels between the cancer grading types. In the group of patients with T3 or T4 stage the following five APPs were significantly elevated: CRP, AGP, alfa-1 ACT, alfa-2 M and Cp. Patients with regional lymph nodes metastasis (N2 or N2) had significantly higher level of AT, CRP and Hp. Patients undergoing more significant procedures (pneumonectomy, prolonged procedure time) and those with morbidities (rethoracotomy, blood transfusions) showed significantly higher levels of alfa-1 ACT, AGP and Cp. The most common post-operative complications were prolonged air-leak requiring probronchoscopy. In both complications a significantly higher level of AGP was observed. Patients with adenocarcinoma of the lung and regional lymph node metastasis have significantly higher serum levels of AT. This protein could be considered as one of the indicators of cancer involvement and could be a marker of the cancer recurrence. AGP is a protein that correlates positively with a more advanced clinical stage, and the extent of the surgical procedure as well as with the higher risk of morbidity. This could serve as a marker of higher post-operative complication rate.