title: Serum toll-like receptors are potential biomarkers of radiation pneumonia in locally advanced NSCLC.
abstract: OBJECTIVE
  Toll-like receptors (TLRs) are highly or lowly expressed in a wide variety of tumors and exhibit either pro-tumor or anti-tumor activities. In the present study, we investigate whether there are relationships between the expressions of TLRs and the occurrence of radiation pneumonia in advanced NSCLC patients treated with radiotherapy.
  
  
  METHODS
  76 patients diagnosed with NSCLC and 50 healthy controls were recruited from Oct 2012 to Jan 2014. The expressions of serum TLR1, TLR2, TLR3, TLR4, TLR5, TLR6, TLR7, TLR8, and TLR9 were detected by ELISA techniques. Fisher exact test, χ(2) test, ROC working curve and Cox regression model were applied to analyze all data.
  
  
  RESULTS
  serum TLR1, TLR2, TLR4, and TLR9 exhibited a relative high expression level in NSCLC patients compared with healthy controls. Importantly, pre-neutrophil granulocyte ratio was associated with the expression of TLR1, TLR2, and TLR4. Moreover, the patients with high ratio of neutrophil granulocyte significantly increased the occurrence of fever in comparison to normal neutrophil ratio in NSCLC patients during the course of radiotherapy. We further evaluated the containing of TLRs when patients had temperatures and found serum TLR1, TLR2 and TLR4 were over-expressed. Finally, 26 of 76 patients were diagnosed with different stages of radiation induced pneumonia; as a result, the contents of TLR1 and TLR4 before radiotherapy were identified as independent significances with pneumonia occurrence.
  
  
  CONCLUSIONS
  The pretreatment levels of TLR1 and TLR4 have the predictive value to be clinically potential biomarkers of pneumonia risk in locally advanced NSCLC.
authors.affiliation: Department of Radiation Oncology, PLA Airforce General Hospital Beijing 100142, China ; Department of Radiation Oncology, Tianjin Hospital Tianjin 300190, China.
authors.forename: Fengming
authors.initials: F
authors.lastname: Lan
authors.affiliation: Tianjin Huanhu Hospital, Tianjin Neurosurgery Institute Tianjin 300060, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Yue
authors.affiliation: Department of Radiation Oncology, PLA Airforce General Hospital Beijing 100142, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Ren
authors.affiliation: Department of Radiation Oncology, PLA Airforce General Hospital Beijing 100142, China.
authors.forename: Yingjie
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Radiation Oncology, PLA Airforce General Hospital Beijing 100142, China.
authors.forename: Tingyi
authors.initials: T
authors.lastname: Xia
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002289:Carcinoma, Non-Small-Cell Lung / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017564:Radiation Pneumonitis / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D051193:Toll-Like Receptors / Q000097:blood*
chemical_list: D015415:Biomarkers; D051193:Toll-Like Receptors
keywords: NSCLC; clinical biomarkers; radiation pneumonia risk; serum toll-like receptors