We evaluated whether hyaluronan (HA) levels in the sputum could be used as a
noninvasive tool to predict progressive disease and treatment response, as
detected in a computed tomography scan in non-small cell lung cancer (NSCLC)
patients. Sputum samples were collected from 84 patients with histological
confirmation of NSCLC, 33 of which were in early-stage and 51 in advanced-stage
disease. Patients received systemic chemotherapy (CT) after surgery (n=36),
combined CT and immunotherapy (IO) (n=15), or targeted therapy for driver
mutation and disease relapse (N=4). The primary end-point was to compare sputum
HA levels in two different concentrations of hypertonic saline solution with
overall survival (OS) and the secondary and exploratory end-points were
radiologic responses to treatment and patient outcome. Higher concentrations of
HA in the sputum were significantly associated to factors related to tumor
stage, phenotype, response to treatment, and outcome. In the early stage,
patients with lower sputum HA levels before treatment achieved a complete tumor
response after systemic CT with better progression-free survival (PFS) than
those with high HA levels. We also examined the importance of the sputum HA
concentration and tumor response in the 51 patients who developed metastatic
disease and received CT+IO. Patients with low levels of sputum HA showed a
complete tumor response in the computed tomography scan and stable disease after
CT+IO treatment, as well as a better PFS than those receiving CT alone. HA
levels in sputum of NSCLC patients may serve as a candidate biomarker to detect
progressive disease and monitor treatment response in computed tomography
scans.
Conclusion: We identified a distinct cluster of significant metabolic biomarkers associated with early-stage NSCLC. Tryptophan is the most significant one that associated with cancer metabolome. These would be potential biomarker profile for early-stage NSCLC detection.Larger cohort is needed to be validated.
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