Is there any Potential Clinical Impact of Serum Phosphorus and Magnesium in Patients with Lung Cancer at First Diagnosis? A Multi-institutional Study

Abstract

Background: The aim of the study was to determine whether the expression of baseline phosphorus (P) and magnesium (Mg) levels were prognostic in terms of stage and overall survival (OS) in newly diagnosed non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) patients. Materials and Methods: Retrospectively, 130 patients were selected at the time of diagnosis oflung cancer (100 with NSCLC and 30 with SCLC), before the initialization of any chemo-radiotherapy. The median age was 67 (range 29-92). IA, IB, IIA, IIB, IIIA, IIIB and IV stages were present in 3, 4, 19, 6, 25, 8, and 65 patients, respectively. After centrifugation, the levels of serum P and Mg were measured using the nephelometric method/ photometry and evaluated before any type of treatment. Results: Higher than normal levels of P were found in 127/130 patients, while only four patients had elevated Mg serum values. In terms of Spearman test, higher P serum values correlated with either stage (rho=-0.334, p<0.001) or OS (rho=-0.212, p=0.016). Additionally, a significant negative correlation of Mg serum levels was found with stage of disease (rho=-0.135, P=0.042). On multivariate cox-regression survival analysis, only stage (p<0.01), performance status (p<0.01) and P serum (p=0.045) showed a significant prognostic value. Conclusions: Our study indicated that pre-treatment P serum levels in lung cancer patients are higher than the normal range. Moreover, P and Mg serum levels are predictive of stage of disease. Along with stage and performance status, the P serum levels had also a significant impact on survival. This information may be important for stratifying patients to specific treatment protocols or intensifying their therapies. However, larger series are now needed to confirm our results.

Interstitial Inorganic Phosphate as a Tumor Microenvironment Marker for Tumor Progression

“…The selective uptake of phosphorus 32 P by tumors upon intravenous injection of radioactive phosphate has been known since the 1940 report by Marshak et al 30. supported by further observations313233. Recently, Papaloucas et al 34.…”

Correlation of Glasgow Prognostic Score or Procalcitonin to Clinical Variables in Patients with Pretreatment Lung Cancer

“…Thus, phosphate is vital to normal physiological function and plays a role in intracellular signaling membrane function, energy metabolism, and bone mineralization (Sommer et al, 2007). A recent study reported that phosphorus and magnesium levels are predictive of disease in lung cancer patients, suggesting that phosphorus and magnesium levels may be important for stratifying patients to specific treatment protocols or intensifying their therapies (Kouloulias et al, 2015). Cancer cells that proliferate rapidly require a high amount of ribosome and other P-rich RNA components that are necessary to manufacture proteins (Kouloulias et al, 2015).…”

“…A recent study reported that phosphorus and magnesium levels are predictive of disease in lung cancer patients, suggesting that phosphorus and magnesium levels may be important for stratifying patients to specific treatment protocols or intensifying their therapies (Kouloulias et al, 2015). Cancer cells that proliferate rapidly require a high amount of ribosome and other P-rich RNA components that are necessary to manufacture proteins (Kouloulias et al, 2015). Consequently it is a theoretical belief that tumor cells are richer in phosphorus than the surrounding tissue, and that they are promoting their metastasis due to their nutrient demands (De Carvalho and Caramujo, 2012).…”

Development and Validation of a Nomogram to Predict the Probability of Breast Cancer Pathologic Complete Response after Neoadjuvant Chemotherapy: A Retrospective Cohort Study

“…The formation of nucleotides, membrane phospholipids, and phosphorylation intermediates in cell signaling require the participation of inorganic P. Rapidly proliferating cells, such as tumor cells, also need large amounts of P-rich ribosomes and RNA to synthesize proteins ( 25 , 26 ). Therefore, it is theoretically believed that an increase in serum P indicates that tumor cells are rapidly dividing and proliferating, which is why patients with a high P concentration have a poor response to NAC treatment.…”