Ponholzer Florian, Neuschmid Marie-Christin, Komi Helga, Bogensperger Christina, Ng Caecilia, Maier Herbert, Lucciarini Paolo, Schneeberger Stefan, Augustin Florian
Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria.
Int J Mol Sci. 2025 Aug 25;26(17):8231. doi: 10.3390/ijms26178231.
One characteristic of tumor cells is the increased anaerobic metabolism through glycolysis leading to an acidic environment of the tumor. This acidity is linked to tumor progression, invasion and metastasis, besides stimulated survival pathways in the malignant cells. The aim of our analysis is to investigate the role of systemic acid-base parameters such as the pH, bicarbonate, baseexcess and lactate in lung cancer patients. Furthermore, alterations in electrolytes and hemoglobin were investigated regarding their impact on overall survival. Data of 937 non-small-cell lung cancer (NSCLC) patients, who underwent anatomic video-assisted thoracoscopic surgery (VATS) resection, was collected in a prospectively maintained database and analyzed. To minimize confounding effects and due to the retrospective study design, we decided to use data from the first arterial blood gas analysis during surgery and the most recent lab results prior to surgery. We found significant correlations between low systemic bicarbonate (<20 mEq/L) and overall survival ( = 0.006). Hyponatremia (<135 mmol/L) correlated with lower 5-year overall survival ( = 0.004) and decreased disease-free survival ( = 0.017). Hypochloremia (<98 mmol/L) was linked to reduced overall survival ( = 0.003) and hypocalcemia (<1.15 mmol/L) with worse disease-free survival ( = 0.015). Hemoglobin under 12 g/dL for women and 13 g/dL for men was associated with poorer outcomes ( < 0.001). Other acid-base parameters such as the pH ( = 0.563), baseexcess (BE) ( = 0.290) and lactate ( = 0.527) did not show significant differences in overall or disease-free (pH: = 0.130; BE: = 0.148; lactate: = 0.418) survival. Systemic bicarbonate, sodium, calcium, chloride and hemoglobin levels were found as prognostic markers and possible therapeutic targets to improve overall survival. Further investigations are necessary to develop therapeutic strategies.
肿瘤细胞的一个特征是通过糖酵解增加无氧代谢，导致肿瘤环境呈酸性。这种酸性除了刺激恶性细胞中的生存途径外，还与肿瘤进展、侵袭和转移有关。我们分析的目的是研究全身酸碱参数如pH值、碳酸氢盐、碱剩余和乳酸在肺癌患者中的作用。此外，还研究了电解质和血红蛋白的变化对总生存期的影响。收集了937例接受解剖性电视辅助胸腔镜手术（VATS）切除的非小细胞肺癌（NSCLC）患者的数据，并在一个前瞻性维护的数据库中进行分析。为了尽量减少混杂效应并由于回顾性研究设计，我们决定使用手术期间首次动脉血气分析的数据和手术前最近的实验室结果。我们发现低全身碳酸氢盐（<20 mEq/L）与总生存期显著相关（P = 0.006）。低钠血症（<135 mmol/L）与较低的5年总生存期（P = 0.004）和无病生存期降低相关（P = 0.017）。低氯血症（<98 mmol/L）与总生存期降低相关（P = 0.003），低钙血症（<1.15 mmol/L）与较差的无病生存期相关（P = 0.015）。女性血红蛋白低于12 g/dL和男性低于13 g/dL与较差的预后相关（P < 0.001）。其他酸碱参数如pH值（P = 0.563）、碱剩余（BE）（P = 0.290）和乳酸（P = 0.527）在总生存期或无病生存期（pH值：P = 0.130；BE：P = 0.148；乳酸：P = 0.418）方面没有显示出显著差异。全身碳酸氢盐、钠、钙、氯和血红蛋白水平被发现是改善总生存期的预后标志物和可能的治疗靶点。需要进一步研究以制定治疗策略。
