Tanriverdi Ozgur, Cokmert Suna, Oktay Esin, Pilanci Kezban Nur, Menekse Serkan, Kocar Muharrem, Sen Cenk Ahmet, Avci Nilufer, Akman Tulay, Ordu Cetin, Goksel Gamze, Meydan Nezih
Department of Medical Oncology, Faculty of Medicine, Sitki Kocman University, Mugla, Turkey,
Med Oncol. 2014 Oct;31(10):217. doi: 10.1007/s12032-014-0217-z. Epub 2014 Sep 13.
Non-small cell lung cancer (NSCLC) is one of the most common cancers. Most of the patients are inoperable at the time of diagnosis, and the prognosis is poor. Many prognostic factors have been identified in prior studies. However, it is not clear which factor is more useful. In this study, we investigated whether uric acid, the last breakdown product of purine metabolism in humans, has a prognostic significance in advanced NSCLC. A total of 384 NSCLC patients at stage IIIB/IV and who did not meet exclusion criteria were included in this retrospective cross-sectional study. The patients' serum uric acid levels before first-line chemotherapy and demographic (age, gender, smoking), clinical (performance status, weight loss, disease stage, first-line treatment regimen), laboratory (hemoglobin, lactate dehydrogenase), and histologic (histologic type, tumor grade) characteristics were recorded. First, a cut-off value was determined for serum uric acid level. Then, the patients were stratified into four groups (quartiles) based on their serum uric acid levels. Descriptive statistics, univariate and multivariate analyses, and survival analyses were used. Majority of the patients were males, smokers and metastatic at time of diagnosis and had history of weight loss and adenocarcinoma upon pathological examination. The serum uric acid levels of all patients were determined as 4.9±2.9 (range 1.9-11.3). The patients were stratified according to quartiles of serum uric acid concentration with cutoff values defined as <3.08 mg/dL (lowest quartile, Group 1), 3.09-5.91 mg/dL (Group 2), 5.92-7.48 mg/dL (Group 3), and >7.49 mg/dL (highest quartile, Group 4). Among the patients who had serum uric acid levels over 7.49, it was observed that those who also had squamous cell carcinoma had a greater rate of brain metastasis, a shorter time lapse until brain metastasis, and lower overall survival rate. It can be assumed that NSCLC patients who had histologically shown squamous cell carcinoma display brain metastasis and poor prognosis. It can be recommended to repeat this study with larger patient series including immunohistochemical, molecular, and wider laboratory investigations.
非小细胞肺癌（NSCLC）是最常见的癌症之一。大多数患者在诊断时已无法进行手术，预后较差。先前的研究已经确定了许多预后因素。然而，尚不清楚哪个因素更有用。在本研究中，我们调查了人类嘌呤代谢的最终分解产物尿酸在晚期NSCLC中是否具有预后意义。本项回顾性横断面研究共纳入了384例ⅢB/Ⅳ期且不符合排除标准的NSCLC患者。记录了患者一线化疗前的血清尿酸水平以及人口统计学特征（年龄、性别、吸烟情况）、临床特征（体能状态、体重减轻、疾病分期、一线治疗方案）、实验室检查结果（血红蛋白、乳酸脱氢酶）和组织学特征（组织学类型、肿瘤分级）。首先，确定血清尿酸水平的临界值。然后，根据患者的血清尿酸水平将其分为四组（四分位数）。采用描述性统计、单因素和多因素分析以及生存分析。大多数患者为男性，有吸烟史，诊断时已发生转移，且经病理检查有体重减轻史和腺癌。所有患者的血清尿酸水平测定为4.9±2.9（范围1.9 - 11.3）。根据血清尿酸浓度的四分位数对患者进行分层，临界值定义为<3.08 mg/dL（最低四分位数，第1组）、3.09 - 5.91 mg/dL（第2组）、5.92 - 7.48 mg/dL（第3组）和>7.49 mg/dL（最高四分位数，第4组）。在血清尿酸水平超过7.49的患者中，观察到那些同时患有鳞状细胞癌的患者脑转移率更高，发生脑转移的时间间隔更短，总体生存率更低。可以推测，组织学显示为鳞状细胞癌的NSCLC患者会发生脑转移且预后较差。建议采用更大的患者系列重复本研究，包括免疫组化、分子和更广泛的实验室检查。
