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Decreased pretherapy serum apolipoprotein A-I is associated with extent of metastasis and poor prognosis of non-small-cell lung cancer

Authors Shi H, Huang H, Pu J, Shi DC, Ning Y, Dong Y, Han Y, Zarogoulidis P, Bai C

Received 5 April 2018

Accepted for publication 13 July 2018

Published 15 October 2018 Volume 2018:11 Pages 6995—7003


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 5

Editor who approved publication: Dr Sanjeev Srivastava

Hui Shi,1,* Haidong Huang,1,* Jin Pu,2 Dongchen Shi,1 Yunye Ning,1 Yuchao Dong,1 Yiping Han,1 Paul Zarogoulidis,3 Chong Bai1

1Department of Respiratory and Critical Care Medicine, Changhai Hospital Affiliated to The Second Military Medical University, Shanghai 200433, People’s Republic of China; 2Department of Special Clinic, Changhai Hospital, Affiliated to the Second Military Medical University, Shanghai 200433, People’s Republic of China; 3Pulmonary Department, Oncology Unit, “Theagenio” Cancer Hospital, Thessaloniki, Greece

*These authors contributed equally to this work

Background: Apolipoprotein A-I (ApoA-I), which recently attracted great attention as an important protein related to the increasing risk of various cancers, is a factor closely related to metabolic diseases such as ardiovascular diseases and atherosclerosis. However, the diagnostic and prognostic value of pretherapy serum ApoA-I levels in non-small-cell lung cancer (NSCLC) patients is still not very clear.
Methods: In 325 NSCLC patients and 312 healthy controls, pretherapy serum ApoA-I was measured by turbidimetric immunoassay. The association of serum ApoA-I levels with the clinicopathologic characteristics and clinical outcomes of NSCLC patients was analyzed. Receiver-operating characteristic (ROC) curve analysis and univariate and multivariate Cox regression analyses were used to assess the diagnostic and prognostic significance of serum ApoA-I levels.
Results: Serum ApoA-I levels were obviously decreased in NSCLC patients compared with healthy controls (1.22±0.27 vs 1.46±0.22 g/L, P<0.0001). Pretherapy serum ApoA-I levels were significantly decreased in the NSCLC patients with increased pretherapy C-reactive protein levels (P=0.046), lower albumin serum level (P=0.040), advanced TNM stage (P=0.004), poorer Eastern Cooperative Oncology Group PS: performance status scores (P=0.007), and more than two sites of distant metastasis (P<0.0001). ROC curve showed the optimal cut-off for ApoA-I was 1.26 g/L (Area under ROC curve=0.69, 95% CI=0.54–0.65) with a specificity of 0.75 and a sensitivity of 0.59. The whole cohort was divided into two groups: low ApoA-I levels group (ApoA-I ≤1.26 g/L) consisted of 193 (59.4%) patients and high ApoA-I levels group (ApoA-I >1.26 g/L) consisted of 132 (40.6%) patients. The median survival time of low and high ApoA-I levels patients were 16.45 and 20.90 months, respectively, which indicated a statistically significant difference (χ2=0.609, P<0.0001) between the two groups. The multivariate analysis results showed that CRP levels (HR=1.273, P=0.038), ApoA-I levels (HR=0.761, P=0.030), Eastern Cooperative Oncology Group performance status (HR=1.486, P=0.016), and extent of metastasis (HR=1.394, P=0.009) were significant independent predictors of favorable overall survival.
Conclusion: A decreased level of pretherapy ApoA-I was associated with a worse survival in patients with NSCLC. Serum ApoA-I measurement before initial treatment may be a novel and routine biomarker to evaluate for metastasis and predict prognosis for NSCLC patients in daily clinical practice.

Keywords: NSCLC, apolipoprotein A-I, metastasis, prognosis

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