Low TGF-β1 in Wound Exudate Predicts Surgical Site Infection After Axillary Lymph Node Dissection

Abstract

Surgical site infection (SSI) after axillary lymph node dissection (ALND) for breast cancer increases morbidity and delays the onset of adjuvant treatment. Only a few studies have investigated the feasibility of wound exudate analysis in SSI prediction. This study assessed changes in cytokine levels in postsurgical wound exudate after ALND and examined their predictive value for the early diagnosis of SSI.Methods: An observational prospective pilot study was conducted in 47 patients with breast cancer undergoing ALND. Wound exudate samples were collected on the first and sixth postoperative days (POD). Interleukin (IL)-1 α, IL-1 β, IL-4, IL-10, IL-13, tumor necrosis factor alpha (TNF-α), transforming growth factor beta1 (TGF-β1) and vascular endothelial growth factor (VEGF) C and D levels were measured by immunoassay. Patients were followed to detect SSI.Results: SSI was diagnosed in 8/47 (17.0%) patients. Four SSI patients were hospitalized and treated with intravenous antibiotics. The concentration of TGF-β1 in wound exudate was significantly lower on POD#1 in the SSI group compared to the no SSI group (p = 0.008). The receiving operator characteristics (ROC) curve for TGF-β1 showed an area under curve of 0.773 (p = 0.0149) indicating good diagnostic potential. On POD#6, the concentration of TGF-β1 remained significantly lower (p = 0.043) and the concentrations of IL-10 (p = 0.000) and IL-1 β (0.004) significantly higher in the SSI group compared to the no SSI group. Conclusion:To our knowledge, this is the first study suggesting a predictive role of wound exudate TGF-β1 levels for SSI. Our results suggest that the risk for SSI can be detected already

TGF-β signaling in health, disease, and therapeutics

“…Moreover, the identification of the applicable population for each therapeutic approach is also important for better efficacy and less toxicity. Serum and tissue levels of TGF-β have shown potential as predictors or indicators of the development, [1074][1075][1076][1077] complication, [1078][1079][1080] response, [1081][1082][1083][1084] recurrence, [1085][1086][1087] and outcomes [1088][1089][1090] of various kinds of diseases, meanwhile, bioinformatic tools of TGF-β signaling-related gene expression signatures have also been developed for patient stratification. 863,1091 But so far, TGF-β or related factors as clinical biomarkers still need further development and assessment.…”