Prognostic Value of Serum Transferrin Level Before Radiotherapy on Radio-Sensitivity and Survival in Patients with Nasopharyngeal Carcinoma

Overview

Journal J Pers Med

Date 2023 Mar 29

PMID 36983693

Authors

Yuping Zhan

Li Su

Qiaojing Lin

Xiaoxian Pan

Xiaoxia Li

Weitong Zhou

Weijian Zhang

Jinsheng Hong

Affiliations

Soon will be listed here.

Abstract

Purpose: To investigate the prognostic value of serum transferrin (TRF) level before intensity-modulated radiation therapy (IMRT) on radio-sensitivity and overall survival (OS) in patients with nasopharyngeal carcinoma (NPC).

Methods: From October 2012 to October 2016, a total of 348 patients with NPC in the First Affiliated Hospital of Fujian Medical University were retrospectively analyzed in our study. The concentration of serum TRF was detected by the method of enzyme-linked immunosorbent assay (ELISA). In the whole group, 46 patients received IMRT, and 302 patients received IMRT plus chemotherapy. The radio-sensitive tumor was defined when the local tumor lesions disappeared completely in the nasopharyngeal MRI scan and no tumor residues were found under the electronic nasopharyngoscope one month after the end of radiotherapy.

Results: The serum TRF level before IMRT was (1.34-3.89) g/L, with a median of 2.16 g/L and a mean of (2.20 ± 0.42) g/L. In the whole group, 242 cases (69.5%) were radiosensitive, and 106 cases (30.5%) were insensitive. The number of radiosensitive patients in the group of HTRF (transferrin > 2.16 g/L) and LTRF (transferrin ≤ 2.16 g/L) before radiotherapy was 129 (74.6%) and 113 (64.6%), respectively. The difference in radio-sensitivity between the two groups was statistically significant ( = 4.103, = 0.043). Logistic regression analysis showed that the level of TRF before radiotherapy ( = 1.702; 95% 1.044~2.775; = 0.033) was an independent factor for radio-sensitivity. The log-rank test showed that patients in the LTRF group achieved a significantly worse OS ( = 5.388, = 0.02) than those in the HTRF group. Cox regression analysis showed that baseline TRF level ( = 1.706; 95% 1.065~2.731; = 0.026) was an independent prognostic factor for overall survival.

Conclusions: The low level of TRF before IMRT is a risk factor for radio-sensitivity and a prognostic factor for poor OS in NPC patients. It may be a promising marker to predict radio-sensitivity and OS in NPC patients who accept IMRT.

References

Ho Y, Yeh K, Hsueh S, Hung C, Lu C, Tsang N . Impact of early nutrition counseling in head and neck cancer patients with normal nutritional status. Support Care Cancer. 2020; 29(5):2777-2785. DOI: 10.1007/s00520-020-05804-3. View

Chen H, Luo M, Wang X, Liang T, Huang C, Huang C . Inhibition of PAD4 enhances radiosensitivity and inhibits aggressive phenotypes of nasopharyngeal carcinoma cells. Cell Mol Biol Lett. 2021; 26(1):9. PMC: 7962337. DOI: 10.1186/s11658-021-00251-2. View

Zhao Q, Ji J, Cai Q, Wang C, Shi M, Zhou C . Low expression of transferrin receptor 2 predict poor prognosis in gastric cancer patients. Kaohsiung J Med Sci. 2020; 36(12):1014-1020. DOI: 10.1002/kjm2.12278. View

Lei G, Zhang Y, Koppula P, Liu X, Zhang J, Lin S . The role of ferroptosis in ionizing radiation-induced cell death and tumor suppression. Cell Res. 2020; 30(2):146-162. PMC: 7015061. DOI: 10.1038/s41422-019-0263-3. View

Chua A, Knuiman M, Trinder D, Divitini M, Olynyk J . Higher concentrations of serum iron and transferrin saturation but not serum ferritin are associated with cancer outcomes. Am J Clin Nutr. 2016; 104(3):736-42. DOI: 10.3945/ajcn.115.129411. View

Ma X, Zhou J, Liu J, Wu G, Yu Y, Zhu H . LncRNA ANCR promotes proliferation and radiation resistance of nasopharyngeal carcinoma by inhibiting PTEN expression. Onco Targets Ther. 2018; 11:8399-8408. PMC: 6267624. DOI: 10.2147/OTT.S182573. View

Busk M, Horsman M, Overgaard J, Jakobsen S . Dual-tracer PET of viable tumor volume and hypoxia for identification of necrosis-containing radio-resistant Sub-volumes. Acta Oncol. 2019; 58(10):1476-1482. DOI: 10.1080/0284186X.2019.1648864. View

Yamane T, Sawayama H, Yoshida N, Morinaga T, Akiyama T, Eto K . Preoperative transferrin level is a novel indicator of short- and long-term outcomes after esophageal cancer surgery. Int J Clin Oncol. 2021; 27(1):131-140. DOI: 10.1007/s10147-021-02031-6. View

Salem A, Mistry H, Hatton M, Locke I, Monnet I, Blackhall F . Association of Chemoradiotherapy With Outcomes Among Patients With Stage I to II vs Stage III Small Cell Lung Cancer: Secondary Analysis of a Randomized Clinical Trial. JAMA Oncol. 2018; 5(3):e185335. PMC: 6439849. DOI: 10.1001/jamaoncol.2018.5335. View

10.

Wang Z, Mao J, Liu G, Wang F, Ju Z, Zhou D . MicroRNA-372 enhances radiosensitivity while inhibiting cell invasion and metastasis in nasopharyngeal carcinoma through activating the PBK-dependent p53 signaling pathway. Cancer Med. 2019; 8(2):712-728. PMC: 6382924. DOI: 10.1002/cam4.1924. View

11.

Hui E, Li W, Ma B, Lam W, Chan K, Mo F . Integrating postradiotherapy plasma Epstein-Barr virus DNA and TNM stage for risk stratification of nasopharyngeal carcinoma to adjuvant therapy. Ann Oncol. 2020; 31(6):769-779. DOI: 10.1016/j.annonc.2020.03.289. View

12.

He Y, Jing Y, Wei F, Tang Y, Yang L, Luo J . Long non-coding RNA PVT1 predicts poor prognosis and induces radioresistance by regulating DNA repair and cell apoptosis in nasopharyngeal carcinoma. Cell Death Dis. 2018; 9(2):235. PMC: 5833381. DOI: 10.1038/s41419-018-0265-y. View

13.

Harrison L, Blackwell K . Hypoxia and anemia: factors in decreased sensitivity to radiation therapy and chemotherapy?. Oncologist. 2004; 9 Suppl 5:31-40. DOI: 10.1634/theoncologist.9-90005-31. View

14.

Melsens E, De Vlieghere E, Descamps B, Vanhove C, Kersemans K, de Vos F . Hypoxia imaging with F-FAZA PET/CT predicts radiotherapy response in esophageal adenocarcinoma xenografts. Radiat Oncol. 2018; 13(1):39. PMC: 5842657. DOI: 10.1186/s13014-018-0984-3. View

15.

Hong J, Hua Y, Su L, Zhang H, Lv W, Chen X . Modified-Nutrition Index is a Significant Prognostic Factor for the Overall Survival of the Nasopharyngeal Carcinoma Patients who Undergo Intensity-modulated Radiotherapy. Nutr Cancer. 2017; 69(7):1011-1018. DOI: 10.1080/01635581.2017.1359311. View

16.

Pan J, Ng W, Zong J, Chan L, OSullivan B, Lin S . Proposal for the 8th edition of the AJCC/UICC staging system for nasopharyngeal cancer in the era of intensity-modulated radiotherapy. Cancer. 2015; 122(4):546-58. PMC: 4968037. DOI: 10.1002/cncr.29795. View

17.

Tian Y, Tian Y, Tu Y, Zhang G, Zeng X, Lin J . microRNA-124 inhibits stem-like properties and enhances radiosensitivity in nasopharyngeal carcinoma cells via direct repression of expression of JAMA. J Cell Mol Med. 2020; 24(17):9533-9544. PMC: 7520313. DOI: 10.1111/jcmm.15177. View

18.

Kono T, Sakamoto K, Shinden S, Ogawa K . Pre-therapeutic nutritional assessment for predicting severe adverse events in patients with head and neck cancer treated by radiotherapy. Clin Nutr. 2016; 36(6):1681-1685. DOI: 10.1016/j.clnu.2016.10.021. View

19.

Guo S, Liang Y, Liu L, Chen Q, Wen Y, Liu S . Increased Angiogenin Expression Correlates With Radiation Resistance and Predicts Poor Survival for Patients With Nasopharyngeal Carcinoma. Front Pharmacol. 2021; 12:627935. PMC: 8427601. DOI: 10.3389/fphar.2021.627935. View

20.

Lin F, Ren H, Lin F, Pan Z, Wu L, Yang N . Evaluation of the Effect of Nutritional Intervention on Patients with Nasopharyngeal Carcinoma. J Healthc Eng. 2022; 2022:2531671. PMC: 8933072. DOI: 10.1155/2022/2531671. View