Milman Nils, Pedersen Lars Møller
Department of Pulmonary Medicine, Naestved Hospital, DK-4700 Naestved, Denmark.
Oncol Rep. 2002 Jan-Feb;9(1):193-8.
The prognostic significance of serum ferritin on survival in lung cancer was evaluated. One hundred and ninety-seven patients were referred for evaluation of pulmonary lesions; 115 patients (85 men) had primary lung cancer. Their median age was 57 years. Seventy-four patients (43 men) with benign lung disease were enrolled as controls. Their median age was 53 years. Serum ferritin was measured at diagnosis. Non-small cell lung cancer (NSCLC) (n=90) was graded according to the TNM-system and small cell lung cancer (SCLC) (n=25) in limited and extensive disease. Follow-up was median 30 months (range 23-36). Patients with lung cancer had higher median ferritin than controls (245 vs. 145 microg/l, p<0.00001): the prevalence of ferritin >300 microg/l was 37% in patients with lung cancer and 14% in controls (p<0.001). There was no significant difference in ferritin between patients with different stages either in NSCLC or in SCLC. Patients with SCLC had higher median ferritin than patients with NSCLC (344 vs. 233 microg/l, p<0.05). No significant differences in ferritin could be demonstrated among the other histological tumour types. The overall survival rate in patients with lung cancer was 52% after 1 year, 33% after 2 years, and 13% after 3 years. Survival rate was lower in patients with ferritin >300 microg/l than in those with ferritin < or =300 microg/l (p<0.0001). The probability of survival 1, 2 and 3 years after diagnosis in patients with ferritin >300 microg/l was 36, 20 and 4%, respectively, and in patients with ferritin < or =300 it was 63, 42 and 18%, respectively (p<0.0001). An elevated ferritin was a significant prognostic factor (p<0.01) even after adjustment for performance status, age, sex, TNM stage, and histological tumour type. TNM stage and performance status were likewise predictors of survival (p<0.01 and p<0.001, respectively). There exists a clinically relevant relationship between serum ferritin concentration and the prognosis of survival in patients with primary lung cancer. The routine use of serum ferritin should be considered in the evaluation and follow-up of pulmonary malignancies.
评估了血清铁蛋白对肺癌患者生存的预后意义。197例患者因肺部病变前来评估；115例患者（85名男性）患有原发性肺癌。他们的中位年龄为57岁。74例患有良性肺部疾病的患者（43名男性）作为对照纳入研究。他们的中位年龄为53岁。在诊断时测量血清铁蛋白。非小细胞肺癌（NSCLC）（n = 90）根据TNM系统分级，小细胞肺癌（SCLC）（n = 25）分为局限性和广泛性疾病。随访时间中位数为30个月（范围23 - 36个月）。肺癌患者的铁蛋白中位值高于对照组（245 vs. 145 μg/l，p < 0.00001）：铁蛋白>300 μg/l在肺癌患者中的患病率为37%，在对照组中为14%（p < 0.001）。NSCLC或SCLC不同分期患者之间的铁蛋白无显著差异。SCLC患者的铁蛋白中位值高于NSCLC患者（344 vs. 233 μg/l，p < 0.05）。在其他组织学肿瘤类型中，铁蛋白无显著差异。肺癌患者1年后的总生存率为52%，2年后为33%，3年后为13%。铁蛋白>300 μg/l的患者生存率低于铁蛋白≤300 μg/l的患者（p < 0.0001）。铁蛋白>300 μg/l的患者诊断后1年、2年和3年的生存概率分别为36%、20%和4%，铁蛋白≤300 μg/l的患者分别为63%、42%和18%（p < 0.0001）。即使在对体能状态、年龄、性别、TNM分期和组织学肿瘤类型进行校正后，铁蛋白升高仍是一个显著的预后因素（p < 0.01）。TNM分期和体能状态同样是生存的预测因素（分别为p < 0.01和p < 0.001）。原发性肺癌患者血清铁蛋白浓度与生存预后之间存在临床相关关系。在肺部恶性肿瘤的评估和随访中应考虑常规检测血清铁蛋白。
