Introduction
A powerful blood biomarker could assist surgeon in determining the factors affecting the surgery toxicity of the lung cancer patients. Here, we evaluate the activity of the indoleamine 2, 3-dioxygenase (IDO) 1, which was indicated by the ration of kyn and trp, in the blood and analyzed the association of the IDO1 activity with the post-surgery toxicity in patients with lung cancer. Hence, we aimed to investigate the IDO1 activity in different steps of surgery operation and its relationship with post-surgery toxicity in patients with lung cancer.
Methods
This is part of prospective cross-sectional study of treatment toxicity, quality of life and biomarker study. Patients aged 18-year old and above requiring Q were eligible. The post toxicity was evaluated by the treating physicians and graded according to NIH/NCI CTCAE v4.0. The variables of our interest included age, gender, Body mass index (can be calculated), weight/weight loss, KPS, comorbidity score, smoking history, tumor type, stage, size, histology. The high-performance chromatography (Waters) was used for assay of the IDO1 activity. Briefly, the Mobile phase A (2.5% acetonitrile in distilled water and mobile phase acetonitrile were delivered with Solvent pumps at the flow rate of 0.4 ml per minute (0 to 2.5 minutes 100% A, 2.5 to 4 minutes 100% A to 90% A linear gradient). Kynurenine was detected on an UV/vis channel at 360nm and tryptophan was detected at 285nm excitation. Data are presented as mean (95% confidence interval), OR (odds ratio) unless otherwise specified. Statistical significances were tested using the linear regression model. P < 0.05 were considered to be significant.
Results
A total of 105 patients scheduled to thoracic surgery enrolled this study. The blood samples of the patients were collected in five time-points: pre-anesthesia, post-anesthesia, before blood vessel cut, sample removal, 3 days of post-surgery. We found that the hiccups was closely associated with the IDO1 activity in blood taken before the step of blood vessel cut (OR = 1.34, CI: 1.15-1.58, p = 7E-04). Interesting, we also found that the hoarseness symptoms was closely associated with IDO1 activity in blood taken 3 days post-surgery (OR = 15.49, CI:2.09-114.89, p = 0.01). Furthermore, the constipation symptoms were associated with the blood taken when the samples were removed (OR = 1.349, CI:1.033-1.761, p = 0.03).
Conclusion
This study showed a close relationship between the IDO1 activity with the post surgery toxicity in patients with non-small cell lung cancer. Further validation study is warranted to validate our findings with large sample size of patients and further consideration of other confounding factors. This finding might reveal a potential role of IDO1 immune biomarker in defining approaches of surgery management to improve quality of life.
Keywords
IDO1, Surgery, lung cancer
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