Clinical significance of serum caveolin-1 levels in gastric cancer patients

Caveolin-1 plays a significant role in the pathogenesis of various carcinomas and its expression affects the survival of cancer patients. However, the molecular function of caveolin-1 and its possible clinical importance has remained uncertain in gastric cancer. No clinical trial has examined serum caveolin-1 levels in gastric cancer patients so far, instead all available results were provided from studies conducted on tissue samples. In the current study, we analyzed the soluble serum caveolin-1 levels in gastric cancer patients, and specified its associations with the clinical factors and prognosis.

MATERIAL AND METHODS

Sixty-three patients with pathologically confirmed gastric cancer were enrolled into the trial. Serum caveolin-1 concentrations were detected by ELISA method. Thirty healthy subjects were also included in the study.

RESULTS

The median age of patients was 62 years, ranging from 28 to 82 years. The serum caveolin-1 levels in gastric cancer patients were significantly higher than those in control group (p < 0.001). The common clinical parameters including patient age, sex, lesion localization, histopathology, histological grade, disease stage, and various serum tumor markers (e.g. LDH, CEA, and CA 19.9) were not found to be associated with serum caveolin-1 levels (p > 0.05). Similarly, no correlation existed between serum caveolin-1 concentration and chemotherapy responsiveness (p = 0.93). Furthermore, serum caveolin-1 level was not found to have a prognostic role (p = 0.16).

CONCLUSION

Even though it is neither predictive nor prognostic, serum caveolin-1 level may be a valuable diagnostic indicator in patients with gastric cancer.

Significance of serum neural precursor cell-expressed developmentally downregulated protein 9 in melanoma

Neural precursor cell-expressed developmentally downregulated protein 9 (NEDD9) is a promoter for various cellular functions that result in tumorigenesis. The aim of the present study was to analyse the serum levels of NEDD9 in melanoma patients in order to evaluate its prognostic, predictive and diagnostic value. Data from 112 melanoma patients were retrospectively analyzed and ELISA assays were used to measure serum NEDD9 concentration. The median serum NEDD9 levels of the patients were significantly higher compared with those of the controls. Serum NEDD9 was not found to be associated with any of the clinicopathological parameters, and was also not found to be prognostic for survival in melanoma. Therefore, serum NEDD9 may be of diagnostic value in melanoma, but its usefulness in prognosis remains controversial. The important role of NEDD9 in tumor angiogenesis necessitates efforts to elucidate its interactions with the tumor microenvironment and its potential as a therapeutic target for malignancies.

Clinical Significance of Circulating Serum Cellular Heat Shock Protein 90 (HSP90) Level in Patients with Cutaneous Malignant Melanoma

Background: Cellular heat shock proteins (HSPs) play significant roles in sustaining normal cellular conditions. The stimulated expressions of HSPs result in cellular stabilization at times of stress, such as cancer. The objective of this study was to determine the clinical significance of the serum levels of HSP90 in melanoma patients. Material and methods: A total number of 98 melanoma patients were enrolled into this study. Serum HSP90 concentrations were determined by the solid-phase sandwich ELISA method. Age and sex matched 43 healthy controls were included in the analysis. Results: The median age of patients was 51 years, ranging from 16 to 85 years. The majority of patients were male (61%), had lesions in axial localizations (54%) and had metastatic disease (61%). Moreover, most of the patients with metastatic disease had M1c diseases (73%). The baseline serum HSP90 levels of melanoma patients were significantly higher than those of the control subjects (median values 49.76 v 27.07ng/ml, respectively, p<0.001). However, clinical variables, such as age, gender, site of lesion, histology, lymph node involvement, stage, serum LDH levels and response to chemotherapy, were found not correlated with serum HSP90 concentrations (p>0.05). Moreover, serum HSP90 level was found not prognostic on survival (p=0.683). Conclusions: Serum levels of HSP90 may have a diagnostic value in melanoma. However, its predictive and prognostic values were not determined.

Role of several cytokines and adhesion molecules in the diagnosis and prediction of survival of hepatocellular carcinoma

BACKGROUND AND STUDY AIMS

There is still need for accurate markers for early diagnosis of hepatocellular carcinoma (HCC) and assessment of prognosis. The aim of this study is to investigate interleukin (IL)-32, IL-1 beta, IL-18, vascular cell adhesion molecule (VCAM)-1, and epithelial cell adhesion molecule (EpCAM) in the diagnosis and assessment of prognosis of HCC.

PATIENTS AND METHODS

Fifty patients with HCC and 15 healthy volunteers were enroled into this prospective study. Serum samples were obtained at the first admission before any treatment was given. Serum IL-32, IL-1 beta, IL-18, VCAM-1, and EpCAM levels were determined using ELISA kits.

RESULTS

The mean age of the patient group and controls was 60±9years and 56±8years, respectively. The mean serum level of IL-32 was higher in patients with HCC than in the control subjects (65.1 vs. 14.1pg/mL; p<0.001). IL-18 levels were significantly higher in the HCC group (546.5 vs. 157.8pg/mL; p<0.001). EpCAM (20.3 vs. 1.5pg/mL; p<0.001) and VCAM (6.5 vs. 1.8μg/mL; p<0.001) levels were also higher in patients with HCC. The mean level of IL-1 beta in the HCC group was similar to that in the control subjects (1.9 vs. 1.9pg/mL; p=0.97). Fifty-eight per cent of the patients with HCC died at 7.3months (median). Cytokine levels except EpCAM did not correlate with survival (p>0.05). Alpha-foetoprotein, IL-32, IL-18, EpCAM, and VCAM had valuable cutoff levels to differentiate between patients with HCC and control group (p<0.001).

CONCLUSIONS

Although cytokines can be a diagnostic marker for HCC, they did not have any significant prognostic value in patients with HCC. Only EpCAM may be used to determine the prognosis of HCC, thereby assisting with treatment management.

Clinical significance of interleukin-4 and interleukin-18 levels in aggressive non-Hodgkin's lymphoma patients

Strong evidence indicates that tumor growth can be actively controlled by the immune system, and interleukins (ILs) are known to play an influential role in immune response regulation. Moreover, inflammatory cytokines are significantly involved in lymphoma pathogenesis. We aimed to investigate serum levels of IL-4 and IL-18 in aggressive non-Hodgkin's lymphoma (A-NHL) patients and their relationship with prognostic parameters and therapy outcome. These serum factors were measured by enzyme-linked immunosorbent assay in 46 patients with pathologically verified A-NHL before and after chemotherapy, and in 20 healthy controls. No significant difference in serum IL-4 (P = 0.11) and IL-18 (P = 0.261) levels was observed between the A-NHL and controls groups. None of the prognostic parameters analyzed significantly correlated with serum IL-4 concentration, while only lactate dehydrogenase (LDH) measurements were associated with IL-18 values. Serum IL-18 was elevated in the patients with high LDH levels compared to those exhibiting normal values (P = 0.045). In addition, no correlation was found between the concentrations of serum IL-4 and IL-18 in A-NHL patients (r = 0.188, P = 0.187). While IL-18 values did not change, serum IL-4 levels decreased following chemotherapy, independently from treatment response (P = 0.002). Our study is the first to report the response of serum IL-4 levels to chemotherapy. In conclusion, although IL-4 serum concentration has no diagnostic role, it is sensitivite to standard chemotherapy in A-NHL. However, serum IL-18 measurements have no diagnostic or prognostic role in this disease.

D-dimer and international normalized ratio (INR) are correlated with tumor markers and disease stage in colorectal cancer patients

BACKGROUND

The aim of this study is to evaluate the correlation of coagulation tests with various clinicopathological variables and tumor markers among colorectal cancer (CRC) patients.

MATERIALS AND METHODS

Ninety-four CRC patients were included for evaluation of clinicopathological factors, coagulation assays and tumor marker levels.

RESULTS

Metastatic disease was related with elevated INR (p= 0.03). Stage III patients had higher D-dimer values compared with stage II patients (p= 0.03). Correlation of tumor markers indicated a tendency towards elevated D-dimer levels for CEA values higher than median (p= 0.01). High CA 19-9 levels were also associated with higher INR (p= 0.007). Elderly age, distant metastasis, high CEA, CA-19-9 and LDH levels were associated with poorer overall-survival. CEA level was the only independent prognostic factor in multivariate analysis.

CONCLUSIONS

Coagulation assays can be utilized as predictors of disease extent in CRC. Elevated D-dimer and INR values may indicate higher disease stage. Correlation of D-dimer levels with CEA supports their value for assessing tumor burden.

Clinical significance of serum laminin and type-IV collagen levels in cutaneous melanoma patients

Laminin and type-IV collagen constitute a significant portion of the extracellular matrix. The objective of the present study was to evaluate whether the serum concentrations of laminin and type-IV collagen may serve as biomarkers for cutaneous melanoma. Sixty pathologically confirmed melanoma patients were enrolled in the study. Serum laminin and type-IV collagen levels were assessed using an ELISA. Thirty healthy controls were also examined. No significant differences in the baseline serum levels of laminin were identified between melanoma patients and healthy controls (P=0.45). However, the baseline serum levels of type-IV collagen were significantly elevated in melanoma patients compared with those in the control group (P<0.001). Clinical parameters, including patient age, gender, localization of lesion, histopathology, stage of disease, serum lactate dehydrogenase concentrations and responsiveness to chemotherapy were found not to be associated with the serum levels of laminin and type-IV collagen (P>0.05). Furthermore, the serum levels of laminin and type-IV collagen had no prognostic value regarding the outcome for melanoma patients (P=0.36 and P=0.26, respectively). While laminin levels showed no diagnostic value, the serum concentrations of type-IV collagen were indicated to serve as a diagnostic marker in patients with cutaneous melanoma. In conclusion, type-IV collagen levels may be used as a diagnostic marker for cutaneous melanoma, while being void of any prognostic value.

Clinical significance of serum Protease-Activated Receptor-1 (PAR-1) levels in patients with cutaneous melanoma

Background

Protease-Activated Receptor-1 (PAR-1) plays an important role in the pathogenesis of multiple malignancies and its expression strongly also affects the outcomes of cancer patients. The objective of this study was to determine the clinical significance of the serum levels of PAR-1in cutaneous melanoma patients.

Methods

A total of 60 patients with a pathologically confirmed diagnosis of cutaneous melanoma were enrolled into this study. Serum PAR-1concentrations were determined by the solid-phase sandwich ELISA method.

Results

No significant difference in serum PAR-1 levels between melanoma patients and healthy controls was found (p = 0.07). The known clinical variables including age of patient, gender, site of lesion, histology, stage of disease, serum LDH levels and chemotherapy responsiveness were not correlated with serum PAR-1 concentrations (p > 0.05). Likewise, serum PAR-1 concentration had also no prognostic role on survival (p = 0.41).

Conclusion

Serum levels of PAR-1 have no diagnostic, predictive and prognostic roles in cutaneous melanoma patients.

General significance

Measurement of PAR-1 in serum is not a clinical significance in cutaneous melanoma patients.

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PAR-1 plays an important role in the pathogenesis of multiple malignancies.

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Its expression strongly also affects the outcomes of cancer patients.

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Serum levels of PAR-1 have no diagnostic, predictive and prognostic roles in cutaneous melanoma patients.

Serum IGF-1 and IGFBP-3 levels as clinical markers for patients with lung cancer

Insulin-like growth factor-1 (IGF-1) and its essential binding protein-3 (IGFBP-3) exhibit significant roles in cellular proliferation, differentiation and apoptosis in numerous malignancies, including lung cancer. The aim of the present study was to determine the clinical roles of the serum IGF-1 and IGFBP-3 levels in lung cancer patients. A total of 80 patients with lung cancer were enrolled in the study. Serum IGF-1 and IGFBP-3 concentrations were determined by ELISA methods. The median age of patients was 58.5 years old, with a range of 36-80 years. The majority of the patients had non-small cell lung cancer (NSCLC) (85%) and metastatic disease (56%). No significant differences were observed in serum IGF-1 levels between lung cancer patients and healthy subjects (P=0.403). However, baseline serum IGFBP-3 levels of the lung cancer patients were significantly lower compared to the control group (P<0.001). The male patients had elevated serum IGF-1 concentrations compared to females (P=0.025). Furthermore, patients with NSCLC histology and metastatic stage in NSCLC had elevated serum IGF-1 (P=0.022 and P=0.039, respectively) and IGFBP-3 (P=0.005 and P=0.043, respectively) levels compared with those with SCLC histology and non-metastatic stage in NSCLC. However, none of the other clinical variables, including age of patient, tumor histology and chemotherapy responsiveness, were observed as correlated with serum assays of IGF-1 and IGFBP-3 (P>0.05). There was a significant association found between IGF-1 and IGFBP-3 serum levels in lung cancer patients (P<0.001). Neither serum IGF-1 nor IGFBP-3 concentrations were associated with outcome (P=0.552 and P=0.471, respectively). In conclusion, serum concentrations of IGFBP-3 may have a diagnostic predictor in patients with lung cancer compared to serum IGF-1 concentrations. However, predictive and prognostic values of the two serum assays were not observed.

Clinical significance of serum laminin levels in patients with lung cancer

Cellular adhesion molecules are considered useful markers in the diagnosis and prognosis of several types of malignant tumors. Laminin, a major structural component of the basement membrane, is a strong promoter of cell adhesion, migration, differentiation and proliferation via integrins and other cell surface receptors. The present study aimed to evaluate the clinical significance of the serum level of laminin in lung cancer patients. A total of 80 patients with lung cancer were enrolled in the study. The serum laminin level was measured by the solid-phase sandwich enzyme-linked immunosorbent assay method. The median age was 58.5 years (range, 36-80 years). The majority of the patients had non-small cell lung carcinoma (85%) and stage IV disease (56%). The baseline serum laminin levels of patients were significantly higher compared to the control group (median values 1.17 vs. 0.78 ng/ml, P=0.033). However, the clinical variables, such as age, gender, histology, stage of disease and response to chemotherapy, were not correlated with serum laminin level (P>0.05). Similarly, serum laminin level was not associated with survival (P=0.68). In conclusion, the serum level of laminin may have a diagnostic value in lung cancer patients. However, its predictive and prognostic roles were not observed.

Clinical significance of serum protease-activated receptor-1 levels in gastric cancer patients

Protease-activated receptor-1 (PAR-1) has a significant role in the pathogenesis of various malignancies and its expression mainly affects the survivals of cancer patients. The aim of the present study was to determine the clinical significance of the serum concentrations of PAR-1 in patients with gastric carcinoma. A total of 63 pathologically confirmed gastric cancer patients were enrolled in this study, with a median age of 62 years. Serum PAR-1 concentrations were determined by the enzyme-linked immunosorbent assay method and no significant difference in the baseline serum PAR-1 concentrations was found between patients and normal controls (P=0.5). The investigated clinical variables, including patient age, gender, localization of lesion, histology, grade of pathology, disease stage and serum tumor markers (lactate dehydrogenase, carcinoembryonic antigen and carbohydrate antigen 19-9) were not correlated with serum PAR-1 levels (P>0.05). Furthermore, no association was identified between the serum PAR-1 level and chemotherapy responsiveness (P=0.43). Serum PAR-1 level also had no prognostic role for survival (P=0.27). In conclusion, the serum PAR-1 concentration has no diagnostic, predictive and prognostic values in gastric cancer patients.

Levels of serum fibronectin as a biomarker in gastric cancer patients: Correlation with clinical diagnosis and outcome

Fibronectin is an important component of the extracellular matrix and serves a role in the pathogenesis of multiple malignancies. The expression of fibronectin also affects the outcome for patients with cancer. The objective of the present study was to determine the clinical significance of the serum fibronectin levels in patients with gastric cancer. A total of 63 patients with a pathologically confirmed diagnosis of gastric cancer were enrolled into the present study. Serum fibronectin concentrations were determined by the solid-phase sandwich enzyme-linked immunosorbent assay method. Age and sex matched healthy controls (n=30) were included in the analysis. The median age at diagnosis was 62 years (range 28-82 years). The baseline serum fibronectin levels of the patients with gastric cancer were significantly higher compared with those in the control group (median values, 606, vs. 193 ng/ml; P<0.001). The known clinical variables, including the age of the patient, gender, site of lesion, histology, histological grade, stage of disease and serum tumor markers, including lactate dehydrogenase, carcinoembryonic antigen and cancer antigen 19.9, were not found to be correlated with serum fibronectin concentrations (P>0.05). In addition, no correlation was observed in serum fibronectin level and response to chemotherapy (P=0.12). Serum fibronectin concentration demonstrated no prognostic role on survival (P=0.43). In conclusion, the serum levels of fibronectin may have a good diagnostic marker in patients with gastric cancer. However, its predictive and prognostic values remain to be elucidated.

Circulating serum levels of angiopoietin-1 and angiopoietin-2 in nasopharynx and larynx carcinoma patients

We aimed to determine the serum levels of angiogenic factors, namely angiopoietins, in nasopharyngeal and laryngeal carcinoma patients. We also aimed to seek the relation of these molecules with tumor grade and their utility as diagnostic biomarkers. We evaluated angiopoietin 1 and 2 levels innasopharynx and larynx cancer patients before treatment. Angiopoietin 2 levels were significantly elevated in larynx carcinoma patients and tended to be elevated in nasopharynx cancer patients compared with healthy controls. However, angiopoietin 1 levels were similar in cancer patients and controls. Angiopoietin 1 levels were significantly higher in nasopharyngeal cancer patients with advanced stages compared to earlier stages. On the other hand, angiopoietin 2 levels were similar in advanced and earlier stage cancer patients.

Clinical significance of serum protease activated receptor1 levels in patients with lung cancer

OBJECTIVE

Protease-activated receptors (PAR) are G protein coupled receptors and they regulate many biological processes, including coagulation and cell survival and they might be good markers in some types of malignant tumors, providing useful information in diagnosis and prognosis. The objective of this study was to determine the clinical significance of the serum levels of PAR1 in lung cancer patients.

PATIENTS AND METHODS

Eighty patients with lung cancer were enrolled into this study. Serum PAR1 levels were determined by the solid-phase sandwich ELISA method. Median age was 58.5-years old, range 36 to 80 years.

RESULTS

The majority of the patients had NSCLC (85%) and stage IV disease (56%). The baseline serum PAR1 concentrations of the lung cancer patients were significantly higher than control group (median values 26.45 ng/mL v 0.07 ng/mL, p < 0.001). However, clinical variables including age, gender, histology, stage of disease, and response to chemotherapy were not found to be correlated with serum PAR1 levels (p > 0.05). Moreover, it failed to show any prognostic value on the survival of the lung cancer patients.

CONCLUSIONS

The serum levels of PAR1 might have a diagnostic value in lung cancer patients. However, its predictive and prognostic values were not determined.

Elevated circulating monocyte chemoattractant protein 1 (MCP-1/CCL-2) level may be an unfavorable predictive factor to platinum- and taxane-based combination chemotherapy in patients with gastric cancer

PURPOSE

Monocyte chemoattractant protein 1 (MCP-1/CCL-2) is a member of the CC chemokine family and a potent chemotactic factor for monocytes that regulate migration and infiltration of monocytes and macrophages. It plays an important role in the pathogenesis of multiple malignancies, and its expression strongly also affects the outcomes of cancer patients. The objective of this study was to determine the clinical significance of the serum levels of MCP-1/CCL-2 in gastric cancer patients.

MATERIALS AND METHODS

A total of 78 patients diagnosed with gastric cancer were enrolled in this study. Serum MCP-1/CCL-2 concentrations were determined by the solid-phase sandwich ELISA method. Age- and sex-matched 30 healthy controls were included in the analysis.

RESULTS

The median age at diagnosis was 60 years, range 21–84 years. The baseline serum MCP-1/CCL-2 concentrations of the gastric cancer patients were significantly higher than of healthy subjects (p < 0.001). The known clinical variables including gender, age, site of lesion, histopathology, tumor size, lymph node involvement, and stage of disease were not found to be correlated with serum MCP-1/CCL-2 concentrations (p > 0.05). However, a significant relationship was shown between serum MCP-1/CCL-2 levels and response to chemotherapy (p = 0.05). Chemotherapy non-responsive patients had higher serum MCP-1/CCL-2 concentrations. Serum MCP-1/CCL-2 concentrations were not associated with prognosis on both progression-free and overall survival (p = 0.53 and p = 0.39, respectively).

CONCLUSION

Elevated circulating MCP-1/CCL-2 level may be an unfavorable predictive factor to chemotherapy based on platinum and taxane in patients with gastric cancer. However, serum MCP-1/CCL-2 concentrations were not associated with prognosis on both progression-free and overall survival.

Clinical significance of serum caveolin-1 levels in melanoma patients

BACKGROUND

Caveolin-1 plays an important role in the pathogenesis of multiple malignancies, and its expression also strongly affects the outcomes of patients with cancer. The objective of this study was to determine the clinical significance of the serum levels of caveolin-1 in patients with melanoma.

MATERIALS AND METHODS

A total of 60 patients with a pathologically confirmed diagnosis of melanoma were enrolled into this study. Serum caveolin-1 concentrations were determined by the solid-phase sandwich enzyme-linked immunosorbent assay method. Thirty age- and sex-matched healthy controls were included in the analysis.

RESULTS

The median age at diagnosis was 53.5 years, range 16-88 years. The baseline serum caveolin-1 levels of the patients with melanoma were significantly higher than in those in the control group (0.47 vs. 0.37 ng/ml, respectively, P = 0.05). Known clinical variables, including age of patient, gender, site of lesion, histology, stage of disease, serum lactic dehydrogenase levels, and response to chemotherapy, were not found correlated with serum caveolin-1 concentrations (P > 0.05). Moreover, serum caveolin-1 concentration was found to have no prognostic role on survival (P = 0.44).

CONCLUSIONS

Serum levels of caveolin-1 may have a diagnostic marker in melanoma patients. However, its predictive and prognostic value was not determined.

Circulating annexin A2 as a biomarker in gastric cancer patients: correlation with clinical variables

Annexin A2 (ANXA2) plays an important role in the pathogenesis of multiple malignancies and its expression strongly also affects the outcomes of cancer patients. The objective of this study was to determine the clinical significance of the serum levels of ANXA2 in patients with gastric cancer. A total of 63 patients with a pathologically confirmed diagnosis of gastric cancer were enrolled into this study. Serum ANXA2 concentrations were determined by the solid-phase sandwich ELISA method. Age- and sex-matched 30 healthy controls were included in the analysis. The median age at diagnosis was 62years, range 28 to 82years. The baseline serum ANXA2 levels of the gastric cancer patients were a significantly higher than those in the control group (P<0.001). The known clinical variables including age of patient, gender, site of lesion, histology, histological grade, stage of disease, and serum levels of LDH, carcinoembryonic antigen (CEA), and carbohydrate antigen (CA) 19.9 were not found to be correlated with serum ANXA2 concentrations (P>0.05). However, the chemotherapy-unresponsive patients had higher serum ANXA2 levels compared with chemotherapy-responsive ones (P=0.04). Conversely, serum ANXA2 concentration was found no prognostic role on survival (P=0.53). In conclusion, serum levels of ANXA2 may have a good diagnostic and predictive marker for response to chemotherapy in patients with gastric cancer and have not associated with prognosis.

Clinical significance of serum M30 and M65 levels in patients with breast cancer

M30 and M65 are relatively new assays that detect different circulating forms of the epithelial cell structural protein cytokeratin18. The objective of this study was to determine the clinical significance of the serum levels of M30 and M65 in patients with breast cancer. A total of 80 patients with a pathologically confirmed diagnosis of breast cancer were enrolled into the study. Serum M30 and M65 concentrations were determined by the solid-phase sandwich ELISA method. Serum samples were obtained on first admission before any type of treatment. The median age at diagnosis was 52 years, range 30 to 81 years. The baseline serum M30 and M65 levels in patients with metastatic disease were significantly higher than those in the non-metastatic patients (P=0.017 and P=0.003, respectively). Moreover, serum M65 level was also elevated in patients with large tumor size (P=0.02). No correlation was found between these serum assay levels and response to chemotherapy (P>0.05). However, the significant relationship was found between the serum levels of M30 and M65 (rs=0.96, P<0.001). Neither serum M30 nor serum M65 had significantly effect on survival (P=0.50, and P=0.52, respectively). In conclusion, although both serum M30 and M65 levels are elevated in metastatic disease, no predictive and prognostic roles on survival were found in patients with breast cancer.

Diagnostic value of serum M30 and M65 in patients with nasopharyngeal carcinoma

M30 and M65 are circulating fragments of cytokeratin 18 released during apoptotic cell death and regarded as markers of cell death in patients with various tumor types. Our aim was to investigate the clinical and prognostic significance of the serum M30 and M65 concentrations in patients with advanced nasopharyngeal carcinoma. Thirty-two patients with nasopharyngeal cancer and 32 control subjects were investigated. Serum samples were obtained on first admission before any treatment was initiated. Serum M30 and M65 concentrations were measured by quantitative enzyme-linked immunosorbent assay. Median serum M30 (181.5 vs. 45.5 U/L, p < 0.001) and M65 (384.2 vs. 179.1 U/L, p < 0.001) concentrations were significantly higher in patients with advanced nasopharyngeal carcinomas than in controls. receiver operating characteristic (ROC) analysis showed that a cutoff for M30 of 225 U/L had a sensitivity of 62.5% and a specificity of 73.9% (area under the curve (AUC) = 0.592, 95% confidence interval (CI) 35.3-83.2, p = 0.44), while a cutoff for M65 of 423.4 U/L had a sensitivity of 75.1% and a specificity of 65.6% (AUC = 0.562, 95 % CI 36.0-76.5, p = 0.60). However, serum M30 and M65 were not important prognostic factors for progression-free survival. There were no statistically significant correlations between serum M30 and M65 concentrations and clinicodemographical variables. Serum M30 and M65 concentrations were found to have a diagnostic value in nasopharyngeal cancer. However, neither M30 nor M65 serum levels played a prognostic role in the outcome in nasopharyngeal cancer patients.

Clinical significance of coagulation assays in metastatic pancreatic adenocarcinoma

PURPOSE

Activated coagulation and fibrinolytic system in cancer patients is associated with tumor stroma formation and metastasis in different cancer types. The aim of this study is to explore the correlation of blood coagulation tests for various clinicopathologic factors in patients with metastatic pancreatic adenocarcinoma (MPA).

MATERIAL

A total of 17 MPA patients were enrolled into the study. All the patients were treatment-naïve. Pretreatment blood coagulation tests including prothrombin time, activated partial thromboplastin time (APTT), international normalized ratio (INR), D-dimer, fibrinogen levels, and platelet counts were evaluated. Control group comprised 50 age- and sex-matched individuals without history of malignancy and coagulation disorder.

RESULTS

Median age of diagnosis was 59 years old (range, 35-72). The plasma level of all coagulation factors revealed statistically significant difference between patient and control group (p < 0.01). Anemic patients had associated with higher D-dimer levels (p = 0.001). Similarly, the ones with elevated serum CA19-9 exhibited significantly higher D-dimer values (p = 0.011). For APTT, significant differences were found in both between gender of patients (p = 0.01) and response to chemotherapy (p = 0.01). The patients with elevated erythrocyte sedimentation rates had associated with higher INR (p = 0.05). Univariate analysis of survival revealed that the patients with unresponsive to chemotherapy (p = 0.06) and higher INR (p = 0.078) had poor overall outcome.

CONCLUSION

Serum D-dimer level is elevated among MPA patients with higher serum CA19-9 and higher INR levels seem to be a poor prognostic factor in MPA.

Clinical significance of serum insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) in patients with breast cancer

Insulin-like growth factor-1 (IGF-1) and its primary binding protein-3 (IGFBP-3) play an important role in cellular proliferation, differentiation and apoptosis in many tumors, including breast cancer (BC). The objective of this study was to determine the clinical significance of the serum levels of IGF-1 and IGFBP-3 in BC patients. A total of 96 patients with a pathologically confirmed diagnosis of BC were enrolled into this study. Serum IGF-1 and IGFBP-3 levels were determined by the solid-phase sandwich enzyme-linked immunosorbent assay (ELISA) methods. Age- and sex-matched 30 healthy controls were included in the analysis. The median age of diagnosis was 48 years (range: 29-80). Thirty-seven (39 %) consisted of metastatic disease. No significant difference in baseline serum was found in both IGF-1 and IGFBP-3 levels between BC patients and healthy controls (p = 0.92 and p = 0.26, respectively). None of the prognostic parameters analyzed was correlated significantly with the serum assay concentrations. Likewise, no correlations were also found between these serum concentrations and response to chemotherapy. No significant correlation was found between serum IGF-1 and IGFBP-3 levels in BC patients (r s = 0.048, p = 0.66).The patients with elevated serum IGF-1 levels had favorable in survival than those with lower levels (p = 0.05). However, serum IGFBP-3 concentrations were found no prognostic role for outcome (p = 0.35). In conclusion, elevated serum IGF-1 level is afavorable prognostic factor for overall survival in BC patients.

Serum levels of vascular cell adhesion molecule-1 (VCAM-1) may have diagnostic, predictive, and prognostic roles in patients with lung cancer treated with platinum-based chemotherapy

Cellular adhesion molecules might be good markers in some types of malignant tumors and provide useful information in diagnosis and prognosis. The objective of this study was to determine the clinical significance of the serum levels of vascular cell adhesion molecule-1 (VCAM-1) in lung cancer patients treated with platinum-based chemotherapy. One hundred and thirty lung cancer patients were enrolled into this study. Serum VCAM-1 levels were determined by the solid-phase sandwich ELISA method. Age- and sex-matched 34 healthy controls were included in the analysis. Median age was 58 years old, range 35 to 80 years. The majority of the patients had non-small cell lung cancer (NSCLC) (83.8 %) and stage IV disease (60.8 %). The patients' baseline serum VCAM-1 levels were significantly higher than those in the healthy control group (p = 0.02). Male patients had higher serum VCAM-1 level compared with female patients (p = 0.04). The stage of disease and tumor histology were not correlated with serum VCAM-1 assay (p > 0.05). Elevated serum VCAM-1 levels were associated with chemotherapy unresponsive patients compared with responsive patients (p = 0.02). The patients with elevated serum VCAM-1 levels had lower survival rates than the ones with lower levels (1-year survival rate 57.6 vs 69.7 %, respectively, p = 0.04). In conclusion, serum VCAM-1 concentrations may have diagnostic, predictive, and prognostic role in lung cancer patients treated with platinum-based chemotherapy.

Serum transforming growth factor-beta 1 (TGF-β1) levels have diagnostic, predictive, and possible prognostic roles in patients with melanoma

Transforming growth factor-beta 1 (TGF-β1) plays an important role in the pathogenesis of multiple malignancies, and its expression also strongly affects the outcomes of cancer patients. The objective of this study was to determine the clinical significance of the serum levels of TGF-β1 in melanoma patients. A total of 60 patients with a pathologically confirmed diagnosis of melanoma were enrolled into this study. Serum TGF-β1 concentrations were determined by the solid-phase sandwich ELISA method. Thirty age- and sex-matched healthy controls were included in the analysis. The median age at diagnosis was 53.5 years (range 16 to 88 years). The baseline serum TGF-β1 levels of the melanoma patients were significantly higher than those in the control group (median values 171.85 vs. 19.95 pg/mL, respectively; p < 0.001). The known clinical variables including age of patient, gender, site of lesion, histology, stage of disease, and serum LDH levels were not found to be correlated with serum TGF-β1 concentrations (p > 0.05). However, the chemotherapy-responsive patients had higher serum TGF-β1 levels compared with chemotherapy-unresponsive ones (p = 0.05). Additionally, serum TGF-β1 concentration was a trend to have a prognostic role on survival (p = 0.07). Patients with elevated serum TGF-β1 concentrations had close to significantly favorable overall survival compared to those with lower levels (median 30.1 vs. 20.9 months, respectively). In conclusion, serum levels of TGF-β1 have diagnostic, predictive, and possible prognostic roles in melanoma patients.

High serum transforming growth factor beta 1 (TGFB1) level predicts better survival in breast cancer

The transforming growth factor beta 1 (TGFB1) is a regulatory cytokine with both tumor suppressor and tumor-promoting effects in breast cancer (BC) cell lines and tissue. Data about level of circulating TGFB1 and its prognostic significance in BC patients is conflicting. The objective of this study is to determine the clinical significance of the serum TGFB1 levels in BC patients. We enrolled 96 female patients with histopathologically diagnosed BC who did not receive chemotherapy (CT) or radiotherapy. Serum TGFB1 levels were measured by ELISA method and compared with 30 healthy controls. The mean serum TGFB1 level of BC patients was significantly higher than controls (0.08 vs. 0.04 ng/ml, p < 0.001). There was no significant difference according to known disease-related clinicopathological or laboratory parameters. Serum TGFB1 level had a significant impact on overall survival in both univariate (p = 0.01) and multivariate analysis (p = 0.013). Serum TGFB1 level is elevated in BC patients and has a favorable prognostic value. However, it has no predictive role on CT response.

Clinical significance of serum tenascin-C levels in breast cancer

Tenascin-C (TNC) is a key molecule in tissue remodeling, and high levels are observed in many diseases, including heart failure, thrombosis, atherosclerosis, and cancer. High TNC expression by immunohistochemical analysis has been shown in invasive and metastasizing tissues from a variety of cancers, including colon, lung, brain, and breast. This study was conducted to investigate the serum level of TNC in breast cancer patients and its relationship with tumor progression and known prognostic parameters. Ninety-six breast cancer patients were enrolled into the study. Serum samples were obtained on first admission before adjuvant and metastatic treatments were given and at follow-up. Serum TNC levels were determined by the solid-phase sandwich enzyme-linked immunosorbent assay (ELISA) method. Median age of diagnosis was 48 years old (range, 29-80). Thirty-seven (39 %) patients had metastatic breast cancer. The mean TNC levels were found to be significantly higher in patients with breast cancer (344.1 ± 42.4 pg/mL) compared to those in healthy controls (137.2 ± 26.8 pg/mL) (p = 0.005). Serum TNC level in grade 3 tumors was found to be significantly higher than in grades 1-2 tumors (p = 0.04). No correlation was detected between serum TNC levels and other prognostic parameters analyzed, including presence of metastasis, lymph node involvement, and tumor size. Serum TNC level had no significantly adverse effect on survival in univariate and multivariate analyses (p = 0.65 and p = 0.85, respectively). In conclusion, although serum TNC levels are elevated, it has no predictive or prognostic roles on survival in breast cancer patients.

Clinical and prognostic significance of coagulation assays in gastric cancer

PURPOSE

Activation of coagulation and fibrinolysis is frequently found among cancer patients. Such tumors are considered to be associated with a higher risk of invasion, metastases, and eventually, worse outcome. The aim of this study is to explore the clinical and prognostic value of blood coagulation tests in gastric cancer (GC) patients.

MATERIALS AND METHODS

A total of 44 consecutive patients with a pathologically confirmed diagnosis of GC were enrolled into the study. Pretreatment blood coagulation tests including prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR), D-dimer (DD), fibrinogen (F) levels, and platelet (PLT) counts were evaluated. Control group comprised 50 age- and sex-matched individuals without history of malignancy and coagulation disorder.

RESULTS

Median age at diagnosis was 55 years, range 19-80 years; most had men (n = 32, 73 %) and metastatic disease (n = 31, 70 %). The level of blood coagulation tests showed a statistically significant difference between the patient and the control groups (P < 0.001 for all, but p = 0.07 for PT). DD levels were significantly associated with elevated PLT and LDH levels (p = 0.009 and p = 0.01, respectively). Patients with metastatic disease had higher levels of F (p = 0.001) and INR (p = 0.027) levels. Elevated DD levels tended to be a poor prognostic factor on outcome (p = 0.06).

CONCLUSION

Change in almost all coagulation tests are found in GC patients and only DD level seems to be of prognostic value.

Increased serum level of epidermal growth factor receptor (EGFR) is associated with poor progression-free survival in patients with epithelial ovarian cancer

PURPOSE

Epidermal growth factor receptor (EGFR) plays an important role in the pathogenesis of multiple malignancies, and its expression also strongly affects the outcomes of cancer patients. The objective of this study was to determine the clinical significance of the serum levels of EGFR in epithelial ovarian cancer (EOC) patients.

MATERIALS AND METHODS

A total of 50 patients with a pathologically confirmed diagnosis of EOC were enrolled into this study. Serum EGFR levels were determined by the solid-phase sandwich ELISA method. Age and sex matched 20 healthy controls were included in the analysis.

RESULTS

Median age of patients was 56.5 years old, range 22-83 years. Majority of the patients had advanced disease (FIGO stage III-IV) (90 %). No significant difference in baseline serum EGFR levels between EOC patients and controls (65.9 vs. 65.4 ng/mL, p = 0.86). Patients with normal CA 125 had higher serum EGFR level compared with the higher CA 125 level (p = 0.02). No other clinical variables including histology, stage of disease, and response to chemotherapy were found to be correlated with serum EGFR assay (p > 0.05). The patients with increased serum EGFR levels had poor progression-free survival than those with lower levels (median survival 4 vs. 12 months, respectively, p = 0.01). However, serum EGFR level was found no prognostic role for overall survival (p = 0.15).

CONCLUSION

Increased serum level of EGFR is associated with poor progression-free survival in EOC patients.

Clinical significance of serum transforming growth factor-beta 1 (TGF-β1) levels in patients with epithelial ovarian cancer

Transforming growth factor-beta 1 (TGF-β1) plays an important role in the pathogenesis of multiple malignancies, and its expression also strongly affects the outcomes of cancer patients. The objective of this study was to determine the clinical significance of the serum levels of TGF-β1 in epithelial ovarian cancer (EOC) patients. A total of 50 patients with a pathologically confirmed diagnosis of EOC were enrolled into this study. Serum TGF-β1 concentrations were determined by the solid-phase sandwich ELISA method. Thirty age- and sex-matched healthy controls were included in the analysis. Median age of patients was 56.5 years old (range 22 to 83 years). Majority of the patients had advanced disease (FIGO stage III-IV; 90%). There was no significant difference in baseline serum TGF-β1 levels between EOC patients and the controls (p = 0.39). A trend to significant relationship was found between the serum levels of TGF-β1 and stage of disease (p = 0.06). The elevated serum TGF-β1 level was associated with metastatic disease. The other known clinical variables including histology, grade of histology, debulking surgery, and serum CA 125 levels were not found to be correlated with serum TGF-β1 concentrations (p > 0.05). Only the chemotherapy-unresponsive patients had higher serum TGF-β1 levels compared with responsive ones (p = 0.02). Serum TGF-β1 concentration was found to have no prognostic role for both progression-free and overall survivals (p = 0.42 and p = 0.09, respectively). In conclusion, although the serum level of TGF-β1 has no diagnostic and prognostic role, it is associated with sensitivity to standard chemotherapy in EOC patients.

Markers of bone metastases in breast and lung cancers

AIM AND BACKGROUND

The aim of the present study was to evaluate correlations between serum osteocalcin, osteoprotegerin and NTX (Cross-linked N-telopeptides of Type I Collagen) and urinary NTX in breast and lung cancer patients with bone metastases. These four markers are considered to have important roles in bone formation, resorption and metastases.

METHODS

Four markers were determined in the sera of 60 breast cancer and 21 lung cancer patients and healthy controls (n=30). Serum levels were studied using ELISA and EIA.

RESULTS

The median levels of serum osteoprotegerin (p<0.001) and osteocalcin (p=0.003) were higher in patients. Significant correlations were observed between the serum NTX-osteocalcin (r=0.431; p<0.001), serum NTX- osteoprotegerin (r=0.42; p=0.003) and serum NTX - urine NTX (r=0.255; p=0.022).

CONCLUSION

We conclude that osteocalcin, osteoprotegerin and NTX are independent diagnostic tools. Due to the ease of urine collection, urine NTX may be applied routinely to allow early detection of bone metastases and indicate progression of the disease.

Lack of diagnostic potential of Dickkopf-1 in colon and rectum cancers

The Wnt/b-catenin signalling pathway plays crucial roles in development and its aberrant activation is an initial and crucial event in the majority of colon cancers. The Dickkopf-1 (Dkk-1) gene encodes an extracellular Wnt inhibitor that blocks the formation of signalling receptor complexes at the plasma membrane. Here, we report the serum levels of Dkk1 in colorectal cancer patients without any therapy. The levels were determined by enzyme-linked immunosorbent assay (ELISA) in 135 colon and 160 rectum cancer patients, as well as 90 healthy subjects. Data analyses were performed using SPSS software (SPSS 16, Chicago, IL). There were no significant differences among the groups for Dkk-1 (p=0.363). In conclusion, the present study did not confirm that serum Dkk-1 levels could have any diagnostic potential in colon and rectum cancers.

Serum and urine survivin levels in breast cancer

This study was conducted to investigate the serum and urine levels of survivin in patients with breast cancer and the relationships with known prognostic parameters and therapy. Forty-three patients with breast cancer and 21 healthy control subjects were investigated. Serum samples were obtained on the first admission before adjuvant and metastatic treatment were given and after two cycles of chemotherapy. Serum and urine survivin levels were determined using enzyme immunometric assay (EIA) and enzyme-linked immunosorbent assay (ELISA), respectively. There was no significant difference in the baseline serum and urine levels between patients with breast carcinoma and healthy controls (p = 0.19 and p = 0.84, respectively). None of the prognostic parameters analyzed were significantly correlated with the urine survivin concentrations. This was also true for serum survivin values, except for nodal involvement. Serum survivin levels were significantly higher in the patients with nodal involvement compared with node negatives (p = 0.043). However, serum survivin levels were not influenced by the number of involved nodes (p = 0.77). No significant correlation was found between the serum and urine levels of survivin (r = 0.15, p = 0.27). Serum and urine levels did not change significantly after chemotherapy (p = 0.59 and p = 0.50, respectively). In conclusion, the result of this study suggested that serum survivin level could be a sensitive marker for detecting metastases in lymph nodes from breast cancer patients. However, much research continues in this field, and exciting new knowledge will ultimately emerge.

Serum Vascular Endothelial Growth Factor (VEGF) and Bcl-2 Levels in Advanced Stage Non-Small Cell Lung Cancer

The characteristic changes in cancer process are assumed to be genetic alterations about the imbalance of cell proliferation and apoptotic cell death. This study was conducted to determine the value of the circulating vascular endothelial growth factor (VEGF) and Bcl-2 in patients with advanced stage non-small cell lung cancer (NSCLC). These serum factors were measured of 52 NSCLC patients pathologically verified on before and after chemotherapy in comparison with 16 healthy controls by using ELISA method. Both of the serum levels of VEGF (p = 0.015) and Bcl-2 (p < 0.001) were increased significantly in NSCLC patients compared with the healthy controls. No statistically significant relationships between investigated elevated serum parameters and various characteristics of patients and disease such as stage and tumor burden were determined. Likewise, we also found no correlation between serum VEGF and Bcl-2. Cytotoxic therapy of patients was accompanied by unchanged serum levels of serum factors. The median survival of all patients was 27 weeks and one-year survival rate was 22.4 percent. With the median serum levels as the cut-off value, patients were divided into high- and low-serum parameter groups. While we found that patients' performance status (p < 0.0001), serum LDH level (p = 0.0002), response to chemotherapy (p = 0.0023), and stage of the disease (p = 0.0085) were prognostic factors for survival, serum VEGF (p = 0.48) and Bcl-2 (p = 0.91) levels were determined as ineffective on survival in patients with advanced NSCLC. In conclusion, our data suggest that these serum factors, VEGF and Bcl-2, are useful diagnostic factors, not predictive and prognostic markers for overall survival in advanced NSCLC patients.

Circulating levels of vascular endothelial growth factor (VEGF), matrix metalloproteinase-3 (MMP-3), and BCL-2 in malignant melanoma

Vascular endothelial growth factor (VEGF) is a critical regulator of angiogenesis that stimulates proliferation, migration, and metastasis of melanoma. In literature, all studies concerning influences of matrix metalloproteinases (MMPs) and antiapoptotic proteins on VEGF-induced angiogenesis in melanoma patients have been performed in tissue scale in melanoma. The objective of this study was to determine the value of circulating serum VEGF and its possible mechanisms of angiogenesis by circulating VEGF, MMP-3, and Bcl-2 in patients with melanoma. Fifty-one patients with cutaneous melanoma pathologically verified at different stages, and eighteen healthy controls were investigated. Serum VEGF, MMP-3, and Bcl-2 levels were quantitatively analyzed by ELISA. The serum VEGF (P = 0.034) and Bcl-2 (P = 0.005) levels were significantly higher in patients with melanoma than in the control group. However, there was no significant difference in the serum MMP-3 level between melanoma patients and controls (P = 0.51). The serum levels of VEGF were significantly influenced only by Breslow thickness (P = 0.045) and mitosis (0.039) and were not positively correlated with the stage of the disease. Among serum parameters, a significant relationship was found only between serum levels of VEGF and MMP-3 (r = 0.32, P = 0.023). In conclusion, our study demonstrates increased concentrations of VEGF and Bcl-2, but not MMP-3, in serum of melanoma patients regardless of the stage of the disease. VEGF may be a potential endothelial cell growth and survival factor. The mechanism of VEGF regulation of angiogenesis may be in part due to enhanced proliferation and survival of endothelial cells by differential expression of antiapoptotic genes and in part by activation of MMPs.

Effect of zoledronic acid on serum angiogenic factors in patients with bone metastases

In this study we have investigated changes in circulating angiogenic factors after a single zoledronic acid intravenous infusion. Thirty consecutive patients who had histologically confirmed breast (n=20) and lung cancer (n=10) associated with confirmation of bone metastases were included in the study. Serum was also available from 10 healthy volunteers. Four mg of Zoledronic acid (Zometa, Novartis) was administered as a 15-min infusion in 100-ml normal saline on an outpatient basis. Venous blood for assessment of serum parameters was drawn just before the beginning of drug infusion and again at 7 and 28 days after the zoledronic acid infusion. Serum levels of VEGF and bFGF were assayed with ELISA kits. Serum VEGF and bFGF levels were not significantly different from healthy control groups (P>0.05). However, we found that serum VEGF levels in lung cancer patients were significantly higher than in patients with breast cancer and controls (P=0.009, and P=0.022, respectively). We found no significant correlation between serum VEGF and bFGF levels. No statistically significant changes were seen following infusion of zoledronic acid in patients with bone metastases for both serum VEGF and bFGF levels (P>0.05). Unlike previous studies, zoledronic acid did not appear to exert an angiogenic activity as there was no reduction of VEGF and bFGF circulating levels after zoledronic acid infusion.

Serum levels of intercellular adhesion molecule ICAM-1 and E-selectin in advanced stage non-small cell lung cancer

Cell adhesion is a basic count in inter- and intra-cellular communication and plays an important role in tumor progression. This study was conducted to investigate the serum levels of intercellular adhesion molecule (ICAM-1) and E-selectin in patients with advanced stage non-small cell lung cancer (NSCLC) and the relationships with known prognostic parameters and therapy. These serum factors were measured of 57 NSCLC patients pathologically verified before and after chemotherapy in comparison with 24 healthy controls by using ELISA method. Serum levels of ICAM-1 were increased significantly in NSCLC patients compared with the healthy controls (P = 0.006). However, serum E-selectin levels were not significantly different from healthy control groups (0.643). No statistically significant relationships were found between investigated all serum parameters and various characteristics of patients, and the diseases such as stage and tumor burden. Likewise, we also found no correlation between serum ICAM-1 and E-selectin (P = 0.78). We found that serum ICAM-1 levels were decreased owing to the chemotherapy effect, independently from chemotherapy response. However, serum E-selectin levels were not changed by the chemotherapy effect. The median survival of all patients was 11.9 months and 1-year survival rate was 47.6%. We found that patients performance status (P = 0.013), age (P = 0.015), and weight loss (P = 0.007) were prognostic factors for survival. Serum E-selectin levels showed a trend (P = 0.08) related to worse prognosis, however serum ICAM-1 levels were determined as ineffective on survival (P = 0.11). Multivariate analysis revealed that only weight loss (P = 0.005) and E-selectin levels (P = 0.002) remained as an independent prognostic factor for survival in patients with advanced NSCLC. In conclusion, our data suggest that higher serum ICAM-1 can be useful for diagnosis while E-selectin levels have prognostic significance and could be a potential prognostic factor in NSCLC patients.

Serum levels of apoptosis biomarkers, survivin and TNF-alpha in nonsmall cell lung cancer

CONTEXT

This study was conducted to investigate the prognostic role and the effects of chemotherapy on serum apoptosis biomarkers consisting of survivin and tumor necrosis factor alpha (TNF-alpha) in patients with advanced stage nonsmall cell lung cancer (NSCLC).

MATERIALS AND METHODS

Fifty-seven patients with newly diagnosed NSCLC were enrolled into study. Performance status was 0 or 1 in 47 patients and 2 in 10 patients. Thirty-two of them were no or less than 10% weight loss. Patients were treated with platinum-based chemotherapy. Serum levels of TNF-alpha and survivin were determined by enzyme-linked immunosorbent assay (ELISA) technique.

RESULTS

While serum survivin levels in patients were not significantly different from controls (p=0.321), serum TNF-alpha levels in patients were found significantly higher than in controls (p=0.029). We found that serum TNF-alpha levels were increased (p<0.001), whereas serum levels of survivin (p=0.025) were decreased by the chemotherapy effects. The changes of the TNF-alpha and survivin serum levels due to chemotherapy effect showed a significant negative correlation (r=-0.36 p=0.007). The increase of serum TNF-alpha levels was independent from chemotherapy response; however, the reduction of serum survivin levels was found only significant in the chemoresponsive group (p=0.039). While older age, weight loss and performance status yielded prognostic value, neither TNF-alpha nor survivin levels proved to be significant for survival.

CONCLUSION

Our findings suggest that the reduction in the serum survivin levels of advanced NSCLC patients after chemotherapy can be used as a predictor of response to the chemotherapy but not that of survival.

Effect of maximum-tolerated doses and low-dose metronomic chemotherapy on serum vascular endothelial growth factor and thrombospondin-1 levels in patients with advanced nonsmall cell lung cancer

BACKGROUND

Angiogenesis is regulated by a balance of both angiogenic inducers and inhibitors. This study was designed to evaluate the effect of both maximum-tolerated doses (MTD) and low-dose metronomic chemotherapy (LDM) on serum vascular endothelial growth factor (VEGF), thrombospondin-1 (TSP1) and VEGFR1 concentrations in patients with advanced nonsmall cell lung cancer.

PATIENTS AND METHODS

Forty consecutive patients with advanced stage nonsmall cell lung cancer were included in this prospective study. Twenty patients received MTD chemotherapy including 75 mg/m2 of cisplatin and 75 mg/m2 of docetaxel on day 1. The LDM treatment consisted of cisplatin 25 mg/m2 and docetaxel 25 mg/m2 were given to other 20 patients on weeks 1, 2 and 3. Serum levels were prospectively measured in serum by ELISA at four times; before chemotherapy and at 1, 2 and 3 weeks following initiation of chemotherapy.

RESULTS

The major finding in this study that MTD chemotherapy but not LDM chemotherapy resulted in significant changes in VEGFR1 and TSP1 serum levels. Due to the effect of LDM chemotherapy, we showed no statistically significant change in patients for all serum VEGF, TSP1 and VEGFR1 levels. Similarly, serum VEGF levels did not also change under MTD chemotherapy. The MTD chemotherapy induced significant and long-lasting increase of TSP1 levels and decrease of VEGFR1 levels that persisted for at least 3 weeks after the chemotherapy initiation. No significant correlations were found between serum VEGF and TSP1 levels in cancer patients treated with both LDM and MTD chemotherapy. The circulating angiogenic balance (TSP1/VEGF) is decreased in cancer patients (P=0.039).

CONCLUSIONS

The continuous/metronomic chemotherapy may not achieve a more pronounced antiangiogenic effect than MTD-scheduling chemotherapy. Future studies involving a larger number of patients are needed to confirm the present findings.