Respiratory insufficiency related to COPD accelerates systemic inflammation, under-nutrition, and angiogenesis in esophageal malignancies.
A number of esophageal cancer patients suffer from respiratory insufficiency due to the coexistence of chronic obstructive pulmonary disease (COPD).


OBJECTIVE
To test the hypothesis that COPD-related systemic hypoxemia may result in accelerated inflammation, malnutrition, and angiogenesis in esophageal cancer patients.


METHODS
Serum levels of C-reactive protein (CRP), albumin, transferrin, interleukin-1, interleukin-6, interleukin-8, TNF-alpha, platelet-derived growth factor (PDGF-BB), and midkine and patient BMI and weight-loss rate were determined and compared with blood oxygenation status (pO(2), SaO(2)) in 35 esophageal cancer patients and 42 controls.


RESULTS
The incidence of cachexia tended to be higher in patients with systemic hypoxemia (67% vs 40%, p = 0.169). Mean SaO(2) level was also significantly decreased in cachectic patients (90.3 vs 93.3%, p = 0.026) and pO(2) exhibited a similar trend (58.0 vs 63.4 mmHg, p = 0.120). Transferrin (234 vs 316 mg/dl, p = 0.005) and albumin (31.9 vs 37.1 mg/dl, p= 0.002) concentrations were reduced and CRP was elevated (129.9 vs 54.7 mg/l, p = 0.004) in hypoxemic patients and correlated with pO(2) (r = 0.47, p = 0.016; r= 0.48, p = 0.012; r = -0.37, p = 0.064) and SaO(2) (r = 0.52, p = 0.006; r = 0.53, p = 0.006; r = -0.40, p= 0.042). Interleukin-6 (9.97 vs 2.21 pg/ml, p = 0.005) and midkine (2101 vs 944 pg/ml, p < 0.001) were elevated and PDGF-BB was decreased (12.2 vs 17.3 pg x 10(-6)/PLT, p = 0.014) in hypoxemic compared with normoxemic patients. Interleukin-6 and midkine negatively correlated with pO(2) (r = -0.44, p = 0.016; r = -0.42, p = 0.011) and SaO(2) (r = -0.54, p = 0.003; r = -0.57, p < 0.0001) and PDGF-BB correlated positively (r = 0.53, p = 0.003; r = 0.44, p = 0.020). Interleukin-8 level was affected by pO(2) (r = -0.55, p = 0.015) and SaO(2) (r= -0.55, p = 0.018) only in hypoxemic patients.


CONCLUSIONS
COPD-related systemic hypoxemia negatively affects the status of esophageal cancer patients by accelerating inflammation, under-nutrition, and angiogenesis.
Krzystek-Korpacka
M
M
Department of Medical Biochemistry, Wroclaw Medical University, Wroclaw, Poland. krzystek@bioch.am.wroc.pl
Matusiewicz
M
M
Diakowska
D
D
Grabowski
K
K
Neubauer
K
K
Kustrzeba-Wojcicka
I
I
Terlecki
G
G
Gamian
A
A
D000209:Acute-Phase Proteins / Q000032:analysis; D000230:Adenocarcinoma / Q000097:blood / Q000150:complications / Q000473:pathology; D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000097:blood / Q000150:complications* / Q000473:pathology; D016022:Case-Control Studies; D016207:Cytokines / Q000097:blood; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000097:blood / Q000150:complications* / Q000473:pathology; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology*; D018836:Inflammation Mediators / Q000032:analysis / Q000097:blood; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000209:etiology*; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000097:blood / Q000209:etiology*; D009752:Nutritional Status / Q000502:physiology; D010100:Oxygen / Q000097:blood; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000150:complications*; D012131:Respiratory Insufficiency / Q000097:blood / Q000150:complications* / Q000209:etiology
D000209:Acute-Phase Proteins; D016207:Cytokines; D018836:Inflammation Mediators; D010100:Oxygen