The impact of lung cancer resection surgery on fibrinogen and C-reactive protein and their relationship with patients outcomes: A prospective follow up study

Article type: Research Article

Authors: Araújo, Amanda Souza^b | Nogueira, Ingrid Correia^{a; b} | Neto, Antero Gomes^{a; b} | de Medeiros, Israel Lopes^b | Morano, Maria Tereza Aguiar Pessoa^{a; b; c} | da Silva, Guilherme Pinheiro Ferreira^{a; c} | Santos, Flávia Almeida^a | Filho, Manoel Odorico De Moraes^a | Pereira, Eanes Delgado Barros^{a; b; *}

Affiliations: [a] Universidade Federal do Ceará - UFC, Fortaleza, Brazil | [b] Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Brazil | [c] Universidade de Fortaleza - UNIFOR, Fortaleza, Brazil

Correspondence: [*] Corresponding author: Eanes Delgado Barros Pereira, Rua Barbara de Alencar 1401, zip code 60140000, Fortaleza, Brazil. Fax: +55 85 32610689; E-mail:[email protected]

Abstract: BACKGROUND: Major thoracic surgery is characterized by release of inflammatory markers.The objective of this study was to assess the preoperative and postoperative systemic inflammatory markers of patients undergoing lung cancer resection. METHODS: This is a prospective follow up study conducted with 48 patients submitted to lung cancer resection.All patients were assessed before and 1 month after surgery through measurement of fibrinogen and C-reative protein(CRP), pulmonary function tests, 6- minute Walk Test (6MWT), maximal inspiratory pressure (PImax) and maximal expiratory preasure (PEmax), anxiety and depression scale and karnofsky performance status scale. RESULTS: Both fibrinogen and CRP were higher 1 month after surgery, although only the change in CRP was statistically significant (p= 0.03). The following functional parameters: 6MWT, PImax, PEmax, FEV1(%) and FVC(%) decreased after surgery with p≤ 0.001 for all the parameters. Anxiety and depression improved and Karnofsky decrease after surgery (p= 0.03, p= 0.01 and p= 0.02; respectively). Change in CRP score following lung resection correlated significantly with changes in fibrinogen (r= 0.40; p= 0.003), change in Karnofsky scale (r= -0.50; p< 0.001) and a borderline significant trend with the 6MWT (r= -0.28; p= 0.05). With the exception of video-assisted thoracoscopic surgery (VATS), who had a significantly lower fibrinogen level 1 month after surgery compared with thoracotomy (p= 0.01), no significant differences in fibrinogen or CRP were noted in other subgroups of patients considered at increased risk for higher levels of inflammation compared with lower risk counterparts. CONCLUSION: Lung cancer resection surgery was associated with increased level of CRP, 1 month after surgery, and correlated directly with change in fibrinogen and inversely with measurement of performance status. VATS provided lower level of fibrinogen after surgery.

Keywords: Lung cancer, surgery, inflammatory mediators

DOI: 10.3233/CBM-150539

Journal: Cancer Biomarkers, vol. 16, no. 1, pp. 47-53, 2016