https://doi.org/10.4081/monaldi.2025.3174
Significance of N-terminal pro-B-type natriuretic peptide levels in lung cancer
Submitted: August 5, 2024
Accepted: November 22, 2024
Published: January 27, 2025
Accepted: November 22, 2024
Abstract Views: 69
PDF_EARLY VIEW: 8
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
High blood levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) have been shown in various malignancies. In lung cancer, the importance of NT-proBNP is not clear. In this study, we aimed to investigate the significance of the correlation of NT-proBNP levels in lung cancer with tumor stage, tumor diameter, histopathology, and specific sites of mediastinal metastasis: lymphadenopathy; pericardial, cardiac, major vessel, other mediastinal organ or lymphatic involvement/invasion. A total of 105 lung cancer and 120 control patients (chronic obstructive lung disease, interstitial lung disease, pulmonary thromboembolism, and pneumonia; 30/subgroup) with measured NT-proBNP levels were included retrospectively. Demographics, comorbidities, and echocardiographic findings in all patients, as well as histologic subtype, diameter, stage, and radiologic and/or pathologic mediastinal involvement/invasion of the tumor to the mediastinum in patients with lung cancer, were studied with regards to blood NT-proBNP levels. When lung cancer and control groups were compared globally or as subgroups with comorbidities, NT-proBNP levels did not show meaningful differences. However, NT-proBNP levels were determined to be 249 pg/mL and 88 pg/mL in lung cancer (n=68) and control subgroups (n=58) without comorbidities, respectively (p=0.001). Among lung cancer patients without comorbidities and those with cardiac, pericardial, major vascular, or other mediastinal involvement/invasion (lymphadenopathy, lymphatic, or other organ invasion) (n=27), the NT-proBNP level was 303 pg/mL, whereas it was 166 pg/mL in those without these mediastinal invasions (n=41) (p=0.031). There is a need for much larger, randomized studies to obtain evidence for the potential role of NT-proBNP as a helpful diagnostic biomarker for lung cancer. Clinical suspicion of malignancy may be posed if high NT-proBNP levels cannot be explained by all other risk factors and disorders or diseases. Furthermore, pericardial, cardiac, major vessel, or other mediastinal invasion/involvement should be sought when high NT-proBNP levels are determined in lung cancer patients without any comorbidities or risk factors for high NT-proBNP levels.
Midthun DE, Lilenbaum RC, Schild SE, Vora SR. Overview of the initial treatment and prognosis of lung cancer. Available from: https://www.uptodate.com/contents/overview-of-the-initial-treatment-and-prognosis-of-lung-cancer.
Goldstraw P, Chansky K, Crowley J, et al. The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol 2016;11:39-51.
DOI: https://doi.org/10.1016/j.jtho.2015.09.009
Volpe M. Natriuretic peptides and cardio-renal disease. Int J Cardiol 2014;176:630-9.
DOI: https://doi.org/10.1016/j.ijcard.2014.08.032
Chen HH, Colucci WS. Natriuretic peptide measurement in non-heart failure settings. Available from: https://www.uptodate.com/contents/natriuretic-peptide-measurement-in-non-heart-failure-settings .
Luchner A, Hengstenberg C, Löwel H, et al. Effect of compensated renal dysfunction on approved heart failure markers: direct comparison of brain natriuretic peptide (BNP) and N-terminal pro-BNP. Hypertension 2005;46:118-23.
DOI: https://doi.org/10.1161/01.HYP.0000170140.36633.8f
Meaudre E, Jego C, Kenane N, et al. B-type natriuretic peptide release and left ventricular filling pressure assessed by echocardiographic study after subarachnoid hemorrhage: a prospective study in non-cardiac patients. Crit Care 2009;13:R76.
DOI: https://doi.org/10.1186/cc7891
Rudiger A, Gasser S, Fischler M, et al. Comparable increase of B-type natriuretic peptide and amino-terminal pro-B-type natriuretic peptide levels in patients with severe sepsis, septic shock, and acute heart failure. Crit Care Med 2006;34:2140-4.
DOI: https://doi.org/10.1097/01.CCM.0000229144.97624.90
McLean AS, Huang SJ, Hyams S, et al. Prognostic values of B- type natriuretic peptide in severe sepsis and septic shock. Crit Care Med 2007;35:1019-26.
DOI: https://doi.org/10.1097/01.CCM.0000259469.24364.31
Phua J, Lim TK, Lee KH. B-type natriuretic peptide: issues for the intensivist and pulmonologist. Crit Care Med 2005;33:2094-13.
DOI: https://doi.org/10.1097/01.CCM.0000178351.03327.9F
Aujollet N, Meyer M, Cailliod R, et al. High N-terminal pro–B-type natriuretic peptide: A biomarker of lung cancer? Clin Lung Cancer 2010;11:341-5.
DOI: https://doi.org/10.3816/CLC.2010.n.043
Burjonroppa SC, Tong AT, Xiao LC, et al. Cancer patients with markedly elevated B-type natriuretic peptide may not have volume overload. Am J Clin Oncol 2007;30:287-93.
DOI: https://doi.org/10.1097/01.coc.0000256101.04404.b0
Lafaras C, Mandala E, Saratzis A, et al. Pro-brain natriuretic peptide is a sensitive marker for detecting cardiac metastases in patients with non- small cell lung cancer. Onkologie 2009;32:389-92.
DOI: https://doi.org/10.1159/000218368
Bando S, Soeki T, Matsuura T, et al. Plasma brain natriuretic peptide levels are elevated in patients with cancer. PLoS One 2017;12:e0178607.
DOI: https://doi.org/10.1371/journal.pone.0178607
Dautzenberg B, Arriagada R, Chammard AB, et al. A controlled study of postoperative radiotherapy for patients with completely resected nonsmall cell lung carcinoma. Groupe d’Etude et de Traitement des Cancers Bronchiques. Cancer 1999;86:265-73.
DOI: https://doi.org/10.1002/(SICI)1097-0142(19990715)86:2<265::AID-CNCR10>3.0.CO;2-B
Ohsaki Y, Gross AJ, Le PT, et al. Human small cell lung cancer cells produce brain natriuretic peptide. Oncology 1999;56:155-9.
DOI: https://doi.org/10.1159/000011957
Pavo N, Raderer M, Hülsmann M, et al. Cardiovascular biomarkers in patients with cancer and their association with all-cause mortality. Heart 2015;101:1874-80.
DOI: https://doi.org/10.1136/heartjnl-2015-307848
Law C, Glover C, Benson K, Guglin M. Extremely high brain natriuretic peptide does not reflect the severity of heart failure. Congest Heart Fail 2010;16:221-5.
DOI: https://doi.org/10.1111/j.1751-7133.2010.00178.x
Chovanec J, Chovanec M, Mego M. Levels of NT-proBNP and troponin T in cancer patients - mini-review. Klin Onkol 2020;33:171-6.
DOI: https://doi.org/10.14735/amko2020171
Burdett S, Parmar MKB, Stewart LA, et al. Postoperative radiotherapy in non-small-cell lung cancer: systematic review and meta-analysis of individual patient data from nine randomised controlled trials. PORT meta analysis trialist group. Lancet 1998;352:257-63.
DOI: https://doi.org/10.1016/S0140-6736(98)06341-7
Martinou M, Gaya A. Cardiac complications after radical radiotherapy. Semin Oncol 2013;40:178-85.
DOI: https://doi.org/10.1053/j.seminoncol.2013.01.007
Popat J, Rivero A, Pratap P, Guglin M. What is causing extremely elevated amino terminal brain natriuretic peptide in cancer patients? Congest Heart Fail 2013;19:143-8.
DOI: https://doi.org/10.1111/chf.12018
Refardt J, Winzeler B, Meienberg F, Christ-Crain M. Artificial syndrome of inappropriate antidiuresis model as potential use for diagnostic and therapeutic strategies. Horm Metab Res 2017;49:673-9.
DOI: https://doi.org/10.1055/s-0043-113450
Nikitenko LL, Fox SB, Kehoe S, et al. Adrenomedullin and tumour angiogenesis. Br J Cancer 2006;94:1-7.
DOI: https://doi.org/10.1038/sj.bjc.6602832
Nelson J, Bagnato A, Battistini B, Nisen P. The endothelin axis: emerging role in cancer. Nat Rev Cancer 2003;3:110-6.
DOI: https://doi.org/10.1038/nrc990
Wigle DA, Campling BG, Sarda IR, et al. ANP secretion from small cell lung cancer cell lines: a potential model of ANP release. Am J Physiol 1995;268:H1869-74.
DOI: https://doi.org/10.1152/ajpheart.1995.268.5.H1869
GOLD. Global strategy for the diagnosis, management and prevention of COPD. 2017. Available from: https://goldcopd.org/gold-2017-global-strategy-diagnosis-management-%20prevention-copd/.
Hildebrandt P, Collinson PO. Amino-terminal pro-B-type natriuretic peptide testing to assist the diagnostic evaluation of heart failure in symptomatic primary care patients. Am J Cardiol 2008;101:25-8.
DOI: https://doi.org/10.1016/j.amjcard.2007.11.016
Chovanec J, Jr, Chovanec J Sr, Chovanec M, Mego M. Levels of NT‑proBNP in patients with cancer. Levels of NT‑proBNP in patients with cancer. Oncol Lett 2023;26:280.
DOI: https://doi.org/10.3892/ol.2023.13866
Otsuka T, Nojiri T, Minami S, et al. Evaluation of natriuretic peptide in non-small cell lung cancer patients treated with bevacizumab together with carboplatin–paclitaxel: a prospective study. Anticancer Res 2017;37:3505-12.
DOI: https://doi.org/10.21873/anticanres.11718
Munagala VK, Burnett JC Jr, Redfield MM. The natriuretic peptides in cardiovascular medicine. Curr Probl Cardiol 2004;29:707-69.
DOI: https://doi.org/10.1016/j.cpcardiol.2004.07.002
Kapoun AM, Liang F, O'Young G, et al. B-type natriuretic peptide exerts broad functional opposition to transforming growth factor-beta in primary human cardiac fibroblasts: fibrosis, myofibroblast conversion, proliferation, and inflammation. Circ Res 2004;94:453-61.
DOI: https://doi.org/10.1161/01.RES.0000117070.86556.9F
Masago K, Fujita S, Togashi Y, et al. Association between brain natriuretic peptide and distant metastases in advanced non-small cell lung cancer patients. Oncol Lett 2011;2:253-6.
DOI: https://doi.org/10.3892/ol.2011.247
Komarnicki P, Gut P, Musiałkiewicz J, et al. NT-proBNP as a neuroendocrine tumor biomarker: beyond heart failure. Endocr Connect 2023;12:e230249.
DOI: https://doi.org/10.1530/EC-23-0249
Srour B, Kaaks R, Johnson T, et al. Ageing-related markers and risks of cancer and cardiovascular disease: a prospective study in the EPIC-Heidelberg cohort. Eur J Epidemiol 2022;37:49-65.
DOI: https://doi.org/10.1007/s10654-021-00828-3
Geng C, Yang G, Zhou H, et al. Characteristics and risk factors of ultra-high-risk patients with newly diagnosed multiple myeloma. J Pers Med 2023;13:666.
DOI: https://doi.org/10.3390/jpm13040666
Romano S, Fratini S, Ricevuto E, et al. Serial measurements of NT-proBNP are predictive of not-high-dose anthracycline cardiotoxicity in breast cancer patients. Br J Cancer 2011;105:1663‑8.
DOI: https://doi.org/10.1038/bjc.2011.439
Semeraro GC, Cipolla CM, Cardinale D M. Role of cardiac biomarkers in cancer patients. Cancers 2021;13:5426.
DOI: https://doi.org/10.3390/cancers13215426
Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature 2008;454:436-44.
DOI: https://doi.org/10.1038/nature07205
Ethics Approval
The study protocol was approved by the institutional Ethical Review Committee of the Health Sciences University, İzmir Dr. Suat Seren Training and Research Hospital for Thoracic Medicine and Surgery (protocol no: 5840, dated: 21/08/2017).How to Cite
İnan, Sinem, Semra Bilaçeroğlu, and Burcu Uludağ Artun. 2025. “Significance of N-Terminal Pro-B-Type Natriuretic Peptide Levels in Lung Cancer”. Monaldi Archives for Chest Disease, January. https://doi.org/10.4081/monaldi.2025.3174.
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