The impact of lung cancer resection surgery on fibrinogen and C-reactive protein and their relationship with patients outcomes: A prospective follow up study.
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 (6 MWT), maximal inspiratory pressure (PImax) and maximal expiratory pressure (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: 6 MWT, 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 6 MWT (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.


CONCLUSIONS
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.
Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Brazil.
Amanda Souza
AS
Araújo
Universidade Federal do Ceará - UFC, Fortaleza, Brazil.|Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Brazil.
Ingrid Correia
IC
Nogueira
Universidade Federal do Ceará - UFC, Fortaleza, Brazil.|Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Brazil.
Antero
A
Gomes Neto
Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Brazil.
Israel Lopes
IL
de Medeiros
Universidade Federal do Ceará - UFC, Fortaleza, Brazil.|Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Brazil.|Universidade de Fortaleza - UNIFOR, Fortaleza, Brazil.
Maria Tereza Aguiar Pessoa
MT
Morano
Universidade Federal do Ceará - UFC, Fortaleza, Brazil.|Universidade de Fortaleza - UNIFOR, Fortaleza, Brazil.
Guilherme Pinheiro Ferreira
GP
da Silva
Universidade Federal do Ceará - UFC, Fortaleza, Brazil.
Flávia Almeida
FA
Santos
Universidade Federal do Ceará - UFC, Fortaleza, Brazil.
Manoel Odorico
MO
De Moraes Filho
Universidade Federal do Ceará - UFC, Fortaleza, Brazil.|Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Brazil.
Eanes Delgado Barros
ED
Pereira
D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein; D003131:Combined Modality Therapy; D015897:Comorbidity; D016207:Cytokines / Q000097:blood; D005260:Female; D005340:Fibrinogen; D005500:Follow-Up Studies; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D008175:Lung Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012129:Respiratory Function Tests; D016896:Treatment Outcome
D015415:Biomarkers; D016207:Cytokines; D018836:Inflammation Mediators; D005340:Fibrinogen; D002097:C-Reactive Protein
Lung cancer; inflammatory mediators; surgery