Neopterin: A prognostic variable in operations for lung cancer

Background. We studied the prognostic value of preoperatively measured neop terin to predict survival of lung cancer patients. Neopterin is produced an d secreted by interferon-gamma -stimulated monocytic cells. High urinary ne opterin concentrations are found in patients with viral infections, allogra ft rejection episodes, and some malignant diseases. In various tumor types high urinary neopterin concentrations are associated with a worse prognosis . Methods. Preoperative neopterin levels of 110 patients (29 women, 81 men) w ith lung cancer including 7 patients with small cell lung cancer were measu red and related to the time of survival after operation. Patients with clin ically suspected stage IIIB lung cancer were not operated and therefore not enrolled in this study. Infectious diseases were not apparent at the time of preoperative urine sampling. Median postoperative follow-up period was 1 7.4 months. Results. In a univariate analysis, patients with a preoperative neopterin c oncentration of more than 212 mu mol/mol creatinine (4th quartile) were det ermined to have a significantly lower survival probability. In a multivaria te analysis, a neopterin concentration of more than 212 mu mol/mol creatini ne (p < 0.01) and T-stage status (p < 0.005) were determined to be signific antly predictive variables for worse survival prognosis. Conclusions. Preoperative neopterin proved to be a reliable prognostic fact or for survival. Immunology may provide an accurate assessment of tumor agg ression and its clinical behavior. In this sense, neopterin can serve as an immunologically based estimation of malignant outgrowth. In patients who a re operable by clinical tumor stage but have a high risk for operation, ele vated preoperative neopterin may help in the decision for a nonoperative tr eatment. (Ann Thorac Surg 2000;70:1861-4) (C) 2000 by The Society of Thorac ic Surgeons.