Elevated pretreatment serum concentration of YKL-40—An independent prognostic biomarker for poor survival in patients with metastatic nonsmall cell lung cancer

Authors

  • Ina Thöm MD,

    Corresponding author
    1. Department of Oncology, Hematology, and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
    • Department of Oncology, Hematology, and BMP with Section Pneumology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany
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    • Fax: (011) 0049-40741052903

  • Birte Andritzky MD,

    1. Department of Oncology, Hematology, and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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  • Gunter Schuch MD,

    1. Department of Oncology, Hematology, and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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  • Iris Burkholder,

    1. Department of Biostatistics, German Cancer Research Center, Heidelberg, Germany
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  • Lutz Edler MD,

    1. Department of Biostatistics, German Cancer Research Center, Heidelberg, Germany
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  • Julia S. Johansen MD,

    1. Department of Rheumatology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
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  • Carsten Bokemeyer MD,

    1. Department of Oncology, Hematology, and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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  • Udo Schumacher MD,

    1. Department of Anatomy II, Experimental Morphology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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  • Eckart Laack MD

    1. Department of Oncology, Hematology, and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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  • Preliminary results from this study were presented as a poster at the 3th European Society for Medical Oncology Congress, Stockholm, Sweden, September 12-16, 2008.

Abstract

BACKGROUND:

The glycoprotein YKL-40 is synthesized both by cancer cells and by tumor-associated macrophages and plays a functional role in tumor progression. Consequently, high serum YKL-40 levels have been associated with a poor prognosis in patients with several cancer types. However, the role of YKL-40 has not been established in nonsmall cell lung cancer (NSCLC).

METHODS:

Pretreatment serum levels of YKL-40 were determined in 189 patients with NSCLC (143 men and 46 women; median age, 62 years;, age range, 41-76 years). Twelve percent of patients had stage IIIB disease, and 88% had stage IV disease. Ninety-eight patients received combined gemcitabine and vinorelbine, and 91 received combined gemcitabine, vinorelbine, and cisplatin as first-line chemotherapy. The median overall survival was 37 weeks.

RESULTS:

Patients had a median serum YKL-40 level of 209 ng/mL (range, 19-2153 ng/mL). No correlation was observed between overall survival and the type of chemotherapy regimen used, tumor stage, sex, or histologic types. Patients with high serum YKL-40 levels (greater than the median level for all patients [209 ng/mL]) had a significantly shorter survival than patients with serum YKL-40 levels below the median (median survival, 32 weeks vs 41 weeks; P = .007). In multivariate analysis, the serum YKL-40 level, the presence of bone lesions, and the serum lactate dehydrogenase level were independent, statistically significant prognostic factors.

CONCLUSIONS:

The pretreatment serum YKL-40 level was identified as a new, independent prognostic biomarker in patients with metastatic NSCLC and may help to determine the individual prognosis of these patients. Cancer 2010. © 2010 American Cancer Society.

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