Clinical relevance of circulating activin A and follistatin in small cell lung cancer

Barany, Nandor and Rozsas, Anita and Megyesfalvi, Zsolt and Grusch, Michael and Hegedus, Balazs and Lang, Christian and Boettiger, Kristiina and Schwendenwein, Anna and Tisza, Anna and Renyi-Vamos, Ferenc and Schelch, Karin and Hoetzenecker, Konrad and Hoda, Mir Alireza and Paku, Sandor and Laszlo, Viktoria and Dome, Balazs (2021) Clinical relevance of circulating activin A and follistatin in small cell lung cancer. Lung Cancer, 161. pp. 128-135. ISSN 0169-5002

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Abstract

Objectives Circulating levels of activin A (ActA) and follistatin (FST) have been investigated in various disorders including malignancies. However, to date, their diagnostic and prognostic relevance is largely unknown in small cell lung cancer (SCLC). Our aim was to evaluate circulating ActA and FST levels as potential biomarkers in this devastating disease. Methods Seventy-nine Caucasian SCLC patients and 67 age- and sex-matched healthy volunteers were included in this study. Circulating ActA and FST concentrations were measured by ELISA and correlated with clinicopathological parameters and long-term outcomes. Results Plasma ActA and FST concentrations were significantly elevated in SCLC patients when compared to healthy volunteers (p < 0.0001). Furthermore, extensive-stage SCLC patients had significantly higher circulating ActA levels than those with limited-stage disease (p = 0.0179). Circulating FST concentration was not associated with disease stage (p = 0.6859). Notably, patients with high (≥548.8 pg/ml) plasma ActA concentration exhibited significantly worse median overall survival (OS) compared to those with low (<548.8 pg/ml) ActA levels (p = 0.0009). Moreover, Cox regression analysis adjusted for clinicopathological parameters revealed that high ActA concentration is an independent predictor of shorter OS (HR: 1.932; p = 0.023). No significant differences in OS have been observed with regards to plasma FST levels (p = 0.1218). Conclusion Blood ActA levels are elevated and correlate with disease stage in SCLC patients. Measurement of circulating ActA levels might help in the estimation of prognosis in patients with SCLC.

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