Serum Ferritin as a Clinical Markerfor Renal Cell Carcinoma: Influenc e of Tumor Size and Volume

Abstract

Objectives: There is no established tumor marker for renal cell carcinoma (RCC). Ferritin is shown to be expressed by the tumor, and proposed as a tumor marker. The aim of this study is to assess the relation between ferritin levels and tumor volume, size and prognosis in RCC. Methods: We studied ferritin levels in serum from peripheral and renal veins of 52 patients with RCC who underwent surgery. Ferritin levels were measured by an enzyme immunoassay method. Tumor volume and the largest tumor diameter were calculated from the pathologic specimens. Results: The mean serum ferritin level from the renal vein (RVF) was statistically higher than the ferritin level from the peripheral vein (PVF) (p = 0.028). Although mean RVF level increased with increasing stage, it was not significant. While there was a correlation with tumor size, volume and RVF, PVF was in correlation with disease status. PVF in patients with metastatic and/or locally advanced disease was significantly higher than the patients with localized disease (p = 0.023). The initial RVF and PVF levels were predictive of survival (p = 0.028 and p = 0.034, respectively). Conclusions: Higher levels in the renal vein, its positive correlation with tumor size and volume suggest that ferritin is expressed by RCC. Initial peripheral serum values of ferritin can be indicative of disease status and also be a prognosticator of survival.

The Fascinating but Deceptive Ferritin

“…Serum ferritin is a marker of malignancy, such as in neuroblastoma (44,45), renal cell carcinoma (46,47), or Hodgkin's lymphoma (48). Hyperferritinemia also is associated with liver dysfunction, probably because liver is the main organ to clear circulating ferritin molecules (49).…”

Serum Ferritin Predicts Mortality Regardless of Inflammatory and Nutritional Status in Patients Starting Dialysis: A Prospective Cohort Study

“…In addition to its well-recognized relationship with inflammation and malnutrition, recent reports have shown serum ferritin to be closely connected with the presence and prognosis of malignancies such as renal cell carcinoma, neuroblastoma, pancreatic cancer, and hematologic malignancies [7,[25][26][27] . Moreover, oxidative tissue damage was found to increase tissue ferritin synthesis as well as its secretion [28] .…”

“…However, besides being an indicator of iron storage, serum ferritin levels are known to be closely influenced by non-iron related factors such as systemic inflammation and malnutrition [3] . Because of its potential to represent systemic inflammatory and nutritional status, serum ferritin has been evaluated as a prognostic factor for outcome in the general population as well as for various disease states such as liver cirrhosis, autoimmune disease, and malignancy [4][5][6][7] .…”

Acute Phase Proteins: Ferritin and Ferritin Isoforms

“…Many factors are suggested to contribute to the hyperferritinaemia associated with cancer, including inflammation, hepatic necrosis due to metastasis and chemotherapy, blood transfusions and a decrease in hepatic clearance of ferritin (Vernet et al, 1995). In addition, a modified and increased synthesis and secretion of ferritin by tumour cells occur (Aulbert & Steffens, 1990;Kirkali et al, 1999;Vernet et al, 1995;Yang et al, 2001). In many instances the increased ferritin is shown to be H-subunit rich (Bevilacqua et al, 1988;Higgy et al, 1997;Jones et al, 1980;Tripathi & Chatterjee, 1996;Vernet et al, 1995;Whittaker et al, 1984), and it has been suggested that the measurement of H-subunit rich ferritin may be of value in the diagnosis of malignancy (Jones et al, 1980).…”