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Opoka LM, Szturmowicz M, Oniszh K, Korzybski D, Podgajny Z, Błasińska-Przerwa K, Szołkowska M, Bestry I. CT imaging features of thin-walled cavitary squamous cell lung cancer. Adv Respir Med 2019; 87:114-117. [PMID: 31038723 DOI: 10.5603/arm.2019.0018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/10/2019] [Indexed: 11/25/2022]
Abstract
Primary lung cancer manifesting as a thin-walled solitary cavity, occurs relatively infrequently. The most common histologic type presenting such a pattern is squamous cell cancer, followed by adenocarcinoma, and finally - large cell cancer. Cavitation is typically not seen in small cell lung cancer. Entities indicating malignancy of such lesions include irregular cystic wall, wall nodule formation, nodular septa or increased standard uptake on positron emission tomography (PET). We are presenting a case of a squamous cell lung cancer manifesting on chest CT as a thin-walled septated cavity with irregular margins mimicking a cyst. The lesion was reported unchanged in a follow-up computed tomography after 3 months. A follow-up scan obtained 2 years after initial examination showed thickening of a cyst wall, solid structures within its lumen and thoracic lymph nodes enlargement.
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Szturmowicz M, Siemion-Szcześniak I, Wyrostkiewicz D, Klatt M, Brzezińska S, Zabost A, Lewandowska A, Filipczak D, Oniszh K, Skoczylas A, Augustynowicz-Kopeć E, Kuś J. Czynniki predysponujące do rozwoju mykobakteriozy płuc u chorych z obecnością prątków niegruźliczych w materiałach z dróg oddechowych. Adv Respir Med 2019. [DOI: 10.5603/arm.64961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Wstęp: W ostatnich latach w większości krajów Europy i w Stanach Zjednoczonych jest notowany wzrost częstości zakażeń układu oddechowego prątkami niegruźliczymi. Nie ma jednak zgodności opinii na temat wpływu różnych czynników na rozwój mykobakteriozy płuc w tej grupie chorych. Celem niniejszej pracy retrospektywnej było poszukiwanie czynników ryzyka mykobakteriozy płuc, w grupie chorych, u których wyhodowano prątki niegruźlicze z dróg oddechowych. Materiał i metody: Badaną grupę stanowiło 73 chorych, 23 mężczyzn i 50 kobiet, mediana wieku wyniosła 62.2 roku, z dodatnimi wynikami posiewów plwociny/wydzieliny oskrzelowej w kierunku prątków niegruźliczych, uzyskanymi w latach 2010–2015. Wyniki: Mykobakteriozę płuc (według American Thoracic Society/Infectious Diseases Society of America) rozpoznano u 36 chorych, kolonizację dróg oddechowych—w 37 przypadkach. Mykobakteriozę rozpoznawano istotnie częściej u chorych zakażonych M. kansasii, M. abscessus i M. avium/M. intracellulare w porównaniu z chorymi zakażonymi M. xenopi, M. gordonae i M. fortuitum (p < 0.0001). Wśród chorych na mykobakteriozę, w porównaniu z grupą z kolonizacją prątkami niegruźliczymi, było istotnie więcej kobiet niż mężczyzn (p < 0.007) oraz więcej chorych z wywiadem przebytej gruźlicy płuc lub mykobakteriozy (odpowiednio 28% i 8%, p = 0.038). Wykazano, że zakażenie M. kansasii, płeć żeńska oraz przebyta gruźlica lub mykobakterioza były istotnymi czynnikami predykcyjnymi aktualnego rozpoznania mykobakteriozy płuc. Wniosek: W badanej grupie chorych ryzyko zachorowania na mykobakteriozę było istotnie większe u kobiet, osób zakażonych M. kansasii oraz z przebytą gruźlicą lub mykobakteriozą płuc w przeszłości.
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Augustynowicz-Kopeć E, Siemion-Szcześniak I, Zabost A, Wyrostkiewicz D, Filipczak D, Oniszh K, Gawryluk D, Radzikowska E, Korzybski D, Szturmowicz M. Interferon Gamma Release Assays in Patients with Respiratory Isolates of Non-Tuberculous Mycobacteria - a Preliminary Study. Pol J Microbiol 2019; 68:15-19. [PMID: 31050249 PMCID: PMC7256814 DOI: 10.21307/pjm-2019-002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/07/2018] [Accepted: 10/25/2018] [Indexed: 12/30/2022] Open
Abstract
Interferon gamma releasing assays (IGRAs) are extensively used in the diagnosis of latent tuberculosis infections. Comparing to tuberculin skin test (TST) they lack false positive results in the populations vaccinated with BCG, and in most non-tuberculous mycobacteria (NTM) infections. Nevertheless, Mycobacterium kansasii, Mycobacterium marinum, and Mycobacterium szulgai may induce positive IGRAs due to RD1 homology with Mycobacterium tuberculosis. The aim of the study was to investigate the possible influence of NTM respiratory isolates on the results of IGRAs. 39 patients (23 females and 16 males) of median age 61 years, with negative medical history concerning tuberculosis, entered the study. Identification of NTM was performed using the niacin test and molecular method GenoType CM test (Hain Lifescience). QFT-Plus was performed in 17 patients, T-SPOT-Tb - in 23 patients. Chest X-rays and a high-resolution computed tomography of the chest have been reviewed by the experienced radiologist blinded to the results of IGRAs, in search of past tuberculosis signs. Positive IGRAs results were obtained in three out of 39 patients (8%): 22% of patients with M. kansasii isolates and 18% of patients with radiological signs on HRCT that might be suggestive of past tuberculosis. Positive IGRAs correlated with radiological signs suggestive of past tuberculosis (r = 0.32, p = 0.04), and on the borderline with isolation of M. kansasii (r = 0.29, p = 0.06). These findings may suggest that a positive IGRAs result, in our material, could depend mostly on asymptomatic past Tb infection. The cross-reactivity of M. kansasii isolates with IGRAs was less probable; nevertheless, it requires further investigations. Interferon gamma releasing assays (IGRAs) are extensively used in the diagnosis of latent tuberculosis infections. Comparing to tuberculin skin test (TST) they lack false positive results in the populations vaccinated with BCG, and in most non-tuberculous mycobacteria (NTM) infections. Nevertheless, Mycobacterium kansasii, Mycobacterium marinum, and Mycobacterium szulgai may induce positive IGRAs due to RD1 homology with Mycobacterium tuberculosis. The aim of the study was to investigate the possible influence of NTM respiratory isolates on the results of IGRAs. 39 patients (23 females and 16 males) of median age 61 years, with negative medical history concerning tuberculosis, entered the study. Identification of NTM was performed using the niacin test and molecular method GenoType CM test (Hain Lifescience). QFT-Plus was performed in 17 patients, T-SPOT-Tb – in 23 patients. Chest X-rays and a high-resolution computed tomography of the chest have been reviewed by the experienced radiologist blinded to the results of IGRAs, in search of past tuberculosis signs. Positive IGRAs results were obtained in three out of 39 patients (8%): 22% of patients with M. kansasii isolates and 18% of patients with radiological signs on HRCT that might be suggestive of past tuberculosis. Positive IGRAs correlated with radiological signs suggestive of past tuberculosis (r = 0.32, p = 0.04), and on the borderline with isolation of M. kansasii (r = 0.29, p = 0.06). These findings may suggest that a positive IGRAs result, in our material, could depend mostly on asymptomatic past Tb infection. The cross-reactivity of M. kansasii isolates with IGRAs was less probable; nevertheless, it requires further investigations.
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Szturmowicz M, Barańska I, Jędrych ME, Bartoszuk I, Radwan-Roehrenschef P, Roży A, Bestry I, Chorostowska-Wynimko J, Langfort R, Kuś J. Hypersensitivity pneumonitis recognised in a single pulmonary unit, between 2005 and 2015 — comparison with recently proposed diagnostic criteria. Adv Respir Med 2019; 87:83-89. [DOI: 10.5603/arm.2019.0014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/20/2019] [Indexed: 11/25/2022]
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Dybowska M, Szturmowicz M, Kuca P, Kazanecka B, Burakowski J, Czajka C, Grzegorczyk F, Langfort R, Burakowska B, Rudziński P, Tomkowski W. Wpływ skojarzonego leczenia cisplatyną podawaną doosierdziowo oraz kolchicyną doustnie na poprawę wyników leczenia wysięku osierdziowego w przebiegu raka nerki z przerzutami. Adv Respir Med 2019. [DOI: 10.5603/arm.62893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Wstęp: Wysięk do worka osierdziowego o etiologii nowotworowej (NPE) stanowi częstą przyczynę zachorowalności i umieralności u chorych onkologicznych. Często przebiega w postaci tamponady serca wymagającej pilnego odbarczenia: perikardiocentezy lub perikardiotomii wraz z drenażem płynu. Pomimo dużej skuteczności tych zabiegów, nawrót płynu w osierdziu występuje u 30–60% pacjentów. Cisplatyna podawana doosierdziowo jest skuteczną i uznaną metodą przeciwdziałania ponownemu gromadzeniu się płynu w osierdziu w przebiegu raka płuc i raka piersi. Natomiast jej efektywność w leczeniu tamponady serca u chorych na raka nerki pozostaje nieznana. Opis przypadku: Przedstawiono przypadek 82-letniego mężczyzny chorego na raka nerki, który został przyjęty na oddział intensywnej terapii z powodu zagrażającej tamponady serca. W trybie pilnym wykonano zabieg perikardiotomii podmostkowej i ewakuowano z osierdzia 1000 ml krwistego płynu. Na wewnętrznej powierzchni osierdzia zauważono kilka różowych guzków, które pobrano do badania histopatologicznego, gdzie stwierdzono komórki raka jasnokomórkowego nerki. W związku z utrzymującymi się dużymi drenażami z osierdzia zdecydowano o konieczności zastosowania cisplatyny doosierdziowo. Ponadto już w pierwszej dobie po zabiegu chory otrzymał kolchicynę doustnie w dawce 0,5 mg dziennie. Nie zaobserwowano skutków niepożądanych terapii. Pacjent zmarł po 12 miesiącach z powodu progresji nowotworu i wyniszczenia. Nie odnotowano nawrotu wysięku do worka osierdziowego. Wnioski: Jest to pierwszy opis przypadku prezentujący długotrwałą skuteczność w prewencji nawrotu płynu w osierdziu po doosierdziowym podaniu cisplatny w połączeniu z doustną kolchicyną w leczeniu NPE w przebiegu jasnokomórkowego raka nerki z przerzutami.
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Szturmowicz M, Siemion-Szcześniak I, Wyrostkiewicz D, Klatt M, Brzezińska S, Zabost A, Lewandowska A, Filipczak D, Oniszh K, Skoczylas A, Augustynowicz-Kopeć E, Kuś J. Factors predisposing to non-tuberculous mycobacterial lung disease in the patients with respiratory isolates of non-tuberculous mycobacteria. Adv Respir Med 2018; 86:ARM.a2018.0043. [PMID: 30594992 DOI: 10.5603/arm.a2018.0043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/11/2018] [Accepted: 10/15/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION An increasing incidence rate of respiratory isolates of non-tuberculous mycobacteria (NTM) has been noted recently in most European countries as well as in the US. Despite many publications, there is no consensus concerning the importance of different factors in promoting NTM lung disease (NTMLD). The aim of the present retrospective study was to analyse patients with positive NTM respiratory isolates in search of factors predisposing to NTMLD. MATERIAL AND METHODS 73 patients, 23 males, 50 females, median age 62.2 years, in whom NTM have been cultured from respiratory specimen (sputum and/or bronchial washings), in the period 2010-2015, entered the study. RESULTS NTMLD (according to ATS/IDSA) has been recognised in 36 patients, airways colonisation by NTM - in 37 patients. NTMLD was diagnosed more often in the patients infected with M. kansasii, M. abscessus and M. avium/M. intracellulare comparing to those infected with M.xenopi, M. gordonae and M. fortuitum (p < 0.0001). The proportion of females to males was significantly higher in the NTMLD group comparing to the colonisation group (p < 0.007). Previous tuberculosis or mycobacteriosis were noted significantly more frequently in the group of patients with NTMLD comparing to the colonisation group (28% vs 8%, p = 0.038). Univariate regression analysis revealed M. kansasii, female gender, and previous tuberculosis or mycobacteriosis as significant predictors of NTMLD. CONCLUSIONS The risk factors of NTMLD recognition in the presented group of patients were the following: female gender, M. kansasii isolation, as well as past tuberculosis or mycobacteriosis.
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Kacprzak A, Szturmowicz M, Kus J. Respiratory system involvement in inflammatory bowel diseases. Adv Respir Med 2018; 85:161-168. [PMID: 28667659 DOI: 10.5603/arm.2017.0028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 02/28/2017] [Accepted: 04/12/2017] [Indexed: 11/25/2022]
Abstract
Inflammatory bowel diseases are systemic disorders that can manifest in any location. The problem of respiratory system involvement is very important form clinical point of view. In the article we try to systematize the current knowledge on this topic.
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Szturmowicz M, Kacprzak A, Szołkowska M, Burakowska B, Szczepulska E, Kuś J. Choroba zarostowa żył płucnych: patogeneza, czynniki ryzyka, cechy kliniczne i algorytm diagnostyczny—Aktualny stan wiedzy. Adv Respir Med 2018. [DOI: 10.5603/arm.60096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Choroba zarostowa żył płucnych (PVOD) i hemangiomatoza włośniczek płucnych (PCH) należą do rzadkich schorzeń—szacowana częstość występowania wynosi mniej niż jeden przypadek na milion mieszkańców. W PVOD/PCH patologia dotyczy małych żyłek—przedprzegrodowych i przegrodowych, włośniczek oraz tętniczek zaprzegrodowych i małych tętniczek płucnych. W klasyfikacji nadciśnienia płucnego (PH) według ERS/ESC z 2015 roku PVOD/PCH tworzy podgrupę 1’. Dane z niedawnych analiz wskazują jednak, że PVOD/PCH może być w rzeczywistości częstsze, z powodu błędnej kwalifikacji tych chorych do grupy 1. Problem ten może dotyczyć przypadków rozpoznanych jako tętnicze nadciśnienie płucne (PAH) występujące w przebiegu twardziny, spowodowane lekami, związane z zakażeniem wirusem HIV oraz około 10% pacjentów z idiopatycznym PAH (IPAH). Ostatnio zidentyfikowano dwuallelowe mutacje genu EIF2AK4 w dziedzicznej postaci PVOD/PCH i w 9% przypadków bez rodzinnego występowania choroby. Udowodniono ponadto zależność między zawodowym narażeniem na rozpuszczalniki organiczne a PVOD/PCH. Niniejszy przegląd jest próbą podsumowania aktualnych danych na temat patogenezy, czynników ryzyka, cech klinicznych i algorytmu diagnostycznego PVOD/PCH.
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Dybowska M, Szturmowicz M, Kuca P, Kazanecka B, Burakowski J, Czajka C, Grzegorczyk F, Langfort R, Burakowska B, Rudziński P, Tomkowski W. Intrapericardial cisplatin combined with oral colchicine resulted in long term control of malignant pericardial effusion in the course of metastatic renal cancer. Adv Respir Med 2018; 86:ARM.a2018.0030. [PMID: 30110119 DOI: 10.5603/arm.a2018.0030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/02/2018] [Accepted: 08/06/2018] [Indexed: 11/25/2022]
Abstract
Background Neoplastic pericardial effusion (NPE) represents a common cause of morbidity and mortality in patient with cancer. NPE presents frequently as cardiac tamponade, requiring urgent pericardiocentesis or pericardiotomy, with subsequent pericardial fluid drainage. Despite high effectiveness of such procedures, the recurrence of effusion is noted in 30- 60% of patients. Intrapericardial therapy with cisplatin was found to be effective in NPE due to lung and breast cancer. Its role in cardiac tamponade due to renal cancer is unknown. Case presentation We presented 82-year-old man with renal cancer who was admitted to the Intensive Care Unit because of threatening pericardial tamponade due to NPE . Urgent subxiphoid pericardiotomy was performed with subsequent evacuation of 1000ml of bloody fluid. On the inner surface of the pericardium several pink nodules were found. Histological examination revealed carcinoma clarocellulare. In view of the persistent high drainage of the pericardium, intrapericardial cisplatin therapy was performed. The first day after surgery colchicine 0.5 mg/day/po was also introduced. No side effects of this treatment were observed. The patient died 12- month later due to cancer progression and cachexia. No recurrence of pericardial effusion was observed. Conclusion This is the first case study demonstrating long-term efficacy and safety of intrapericardial cisplatin combined with oral colchicine in NPE due to metastatic renal cell carcinoma.
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Wyrostkiewicz D, Szturmowicz M, Bartoszuk I, Siemion-Szcześniak I, Jakubowska L, Augustynowicz-Kopeć E, Kuś J. Mykobakterioza Płuc u Chorego na Przewlekłą Obturacyjną Chorobę płuc i Rozstrzenie Oskrzeli, Przebiegająca z Obrazem Radiologicznym Guza Płuca. Adv Respir Med 2018. [DOI: 10.5603/arm.58534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mykobakteriozy to choroby wywoływane przez prątki niegruźlicze (NTM, nontuberculous mycobacteria), zwane również prątkami atypowymi. Prątki niegruźlicze występują powszechnie w środowisku, głównie w glebie i wodzie. Mogą kolonizować drogi oddechowe, przewód pokarmowy i układ moczowo-płciowy człowieka, nie wywołując objawów choroby. Do zachorowania dochodzi przede wszystkim w grupach ryzyka, między innymi u chorych na przewlekłe choroby płuc oraz z obniżoną odpornością. W ostatnich latach obserwuje się zwiększenie liczby przypadków mykobakteriozy u chorych na przewlekłą obturacyjną chorobę płuc (POChP), szczególnie w przypadku stosowania długotrwałej steroidoterapii wziewnej. W pracy opisano przypadek mykobakteriozy wywołanej przez Mycobacterium avium u chorego na POChP i rozstrzenie oskrzeli, u którego obraz kliniczny i radiologiczny sugerowały obecność guza płuca.
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Szturmowicz M, Tomkowski W, Fijalkowska A, Burakowski J, Sakowicz A, Filipecki S. The Role of Carcinoembryonic Antigen (CEA) and Neuron-Specific Enolase (NSE) Evaluation in Pericardial Fluid for the Recognition of Malignant Pericarditis. Int J Biol Markers 2018; 12:96-101. [PMID: 9479590 DOI: 10.1177/172460089701200302] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study was designed to assess the value of tumor marker evaluation in pericardial fluid for the recognition of malignant pericarditis. Thirty-six patients with signs and symptoms of large pericardial effusion entered the study. Pericardiocentesis with pericardial fluid drainage was performed in all of them. CEA and NSE levels were evaluated in the pericardial fluid and compared to pericardial fluid cytology. The median CEA value in malignant effusions was 80 ng/ml (range 0-305 ng/ml) and in non-malignant ones 1.26 ng/ml (range 0.2-18.4 ng/ml), p<0.01. The sensitivity of CEA elevation above 5 ng/ml for the recognition of malignant pericarditis was 73% and the specificity was 90%. Pericardial fluid cytology was positive in 22 of 26 patients with malignant pericarditis (85%). CEA exceeding 5 ng/ml or positive cytology were seen in 96% of the patients with malignant pericarditis. The median NSE value in malignant pericardial effusions was 41.8 μg/l (range 2-172 μg/l) and in non-malignant ones 5.85 μg/l (range 1-83.9 μg/l), p<0.3. For the differential diagnosis of large pericardial effusions we would recommend simultaneous cytologic examination of pericardial fluid and CEA assessment. NSE measurement in hemorrhagic pericardial fluid is of limited value.
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Szturmowicz M, Sakowicz A, Rudzinski P, Zych J, Wiatr E, Zaleska J, Rowinska-Zakrzewska E. The Clinical Value of Cyfra 21-1 Estimation for Lung Cancer Patients. Int J Biol Markers 2018; 11:172-7. [PMID: 8915713 DOI: 10.1177/172460089601100306] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cytokeratin-19, one of the cytoskeletal proteins, is expressed both in bronchial epithelium and in lung cancer cells. The aim of our study was to establish the value of serum cytokeratin-19 soluble fragment (Cyfra 21-1) measurement in lung cancer patients. Cyfra 21-1 levels were estimated in 35 patients (pts) with benign lung diseases and in 116 lung cancer patients: 55 pts with squamous cell lung cancer, 38 pts with small cell lung cancer and 23 pts with adenocarcinoma. The cutoff level was set at 4 ng/ml with a specificity of 94% and a sensitivity of 40%. Elevated Cyfra 21-1 values were found in 44% of squamous cell lung cancer, 39% of adenocarcinoma and 34% of small cell lung cancer pts (the difference was not significant). In squamous cell lung cancer and in adenocarcinoma elevated Cyfra 21-1 values were observed more often in patients with advanced disease than in patients with limited disease. There was no significant correlation between the initial Cyfra 21-1 level and the response to chemotherapy. Cyfra 21-1 was hot a prognostic indicator, although in operable squamous cell lung cancer the proportion of survivors in the second year of observation was higher among the patients with normal preoperative Cyfra 21-1 levels.
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Szturmowicz M, Burakowski J, Tomkowski W, Sakowicz A, Filipecki S. Neuron-Specific Enolase in Non-Neoplastic Lung Diseases, a Marker of Hypoxemia? Int J Biol Markers 2018; 13:150-3. [PMID: 10079389 DOI: 10.1177/172460089801300305] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neuron-specific enolase (NSE) is a glycolytic enzyme localized within neuronal and neuroendocrine tissues. Serum NSE is widely used as a marker of neuroendocrine tumors. Moderate serum NSE elevation has been reported in some patients with benign lung diseases. We decided to investigate whether the elevation of serum NSE in non-neoplastic lung diseases is connected with hypoxemia and to what extent the recovery of sufficient ventilation with a respirator may influence NSE concentrations. Serum NSE was estimated by means of radioimmunoassay in 83 patients with various non-neoplastic lung diseases. Serum NSE exceeding 12.5 μg/L was significantly more frequent in patients with marked hypoxemia (PaO2<6.67 kPa; p=0.03) than in others. The median NSE value in the group of patients without respiratory failure (Ro) was 7.2 μg/L (10% >12.5 μg/L), in the group of patients with respiratory failure not requiring mechanical ventilation (Rf) it was 8.5 μg/L (24%>12.5 μg/L), and in the group of patients with respiratory failure requiring mechanical ventilation (Rfv) 13.1 μg/L (60%>12.5 μg/L). The differences between the Rfv group and the other two groups (Rf and Ro) were significant (p=0.049 and p=0.0004, respectively). During successful mechanical ventilation elevated serum NSE decreased to values below the cutoff in 8/10 patients. We conclude that serum NSE elevation is a frequent event in patients with terminal hypoxemia in the course of benign lung diseases. Normalization of serum NSE is observed in the majority of patients during the first week of mechanical ventilation.
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Kacprzak A, Szturmowicz M, Burakowska B, Franczuk M, Kober J, Kurzyna M, Wilk M, Szmit S, Torbicki A, Kuś J. Nadciśnienie Płucne w Przebiegu Sarkoidozy Leczone Sildenafilem. Adv Respir Med 2018. [DOI: 10.5603/arm.57159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Rozwój nadciśnienia płucnego w przebiegu sarkoidozy (SAPH) istotnie pogarsza rokowanie. Niestety, nie ma metody leczenia o udokumentowanym korzystnym działaniu w tej postaci nadciśnienia płucnego. Duże zainteresowanie w tym zakresie budzą leki stosowane w terapii tętniczego nadciśnienia płucnego (PAH). W prezentowanej pracy przedstawiono opis przypadku chorej na sarkoidozę powikłaną ciężkim nadciśnieniem płucnym, która była leczona sildenafilem. Obserwowano istotną, choć zaledwie przejściową poprawę stanu czynnościowego. Pacjentka zmarła z powodu stopniowo postępującej niewydolności krążenia i oddychania, w trakcie oczekiwania na przeszczepienie płuc.
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Szturmowicz M, Kacprzak A, Kuś J. Nadciśnienie Płucne w Przebiegu śródmiąższowych Chorób Płuc—Czy Leczenie Ukierunkowane na PAH Przynosi Korzyści? Adv Respir Med 2018. [DOI: 10.5603/arm.57075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nadciśnienie płucne (PH) jest rozpoznawane u 40–50% chorych w końcowym stadium rozsianych śródmiąższowych chorób płuc (DPLD) i wiąże się ze znacznym pogorszeniem rokowania. Najnowsze wytyczne Europejskiego Towarzystwa Chorób Płuc i Europejskiego Towarzystwa Kardiologicznego zalecają w tej grupie chorych najbardziej optymalne leczenie DPLD oraz przewlekłą tlenoterapię u chorych z PaO2 poniżej 60 mm Hg. Leki stosowane w tętniczym nadciśnieniu płucnym (PAH) nie są rekomendowane chorym na PH-DPLD, ze względu na ryzyko zwiększenia przecieku krwi nieutlenowanej w płucach i w konsekwencji, pogorszenia hipoksemii. Jednak leczenie ukierunkowane na PAH może przynosić korzyść w wybranych sytuacjach klinicznych. Autorzy obecnej pracy próbują znaleźć odpowiedź na kilka ważnych pytań: czy terapia ukierunkowana na PAH może przynieść korzyści w PH-DPLD, kto powinien być poddany terapii ukierunkowanej na PAH, jaka grupa leków jest najbardziej obiecująca, w jaki sposób należy oceniać wyniki leczenia?
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Szturmowicz M, Tomkowski W, Fijalkowska A, Kupis W, Cieślik A, Demkow U, Langfort R, Wiechecka A, Orlowski T, Torbicki A. Diagnostic Utility of Cyfra 21-1 and Cea Assays in Pericardial Fluid for the Recognition of Neoplastic Pericarditis. Int J Biol Markers 2018. [DOI: 10.1177/172460080502000107] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A positive cytology result in pericardial fluid is the gold standard for recognition of malignant pericardial effusion. Unfortunately, in 30–50% of patients with malignant pericardial effusion cytological examination of the pericardial fluid is negative. Tumor marker assessment in pericardial fluid may help to recognize malignant pericardial effusion. The aim of our study was to estimate the value of CYFRA 21-1 and CEA measurement in pericardial fluid for the recognition of malignant pericardial effusion. To our knowledge this is the first study on CYFRA 21-1 assessment in pericardial effusion. The examined group consisted of 50 patients with malignant pericardial effusion and 34 patients with non-malignant pericardial effusion. Median CEA concentrations in malignant pericardial effusion and non-malignant pericardial effusion were 80 ng/mL (0–317) and 0.5 ng/mL (0–18.4), respectively (p<0.001). Median CYFRA 21-1 concentrations in malignant pericardial effusion and non-malignant pericardial effusion were 260 ng/mL (5.3–10080) and 22.4 ng/mL (1.87–317.6), respectively (p<0.001). The optimal cutoff value for CYFRA 21-1 in pericardial effusion was 100 ng/mL. CYFRA 21-1 >100 ng/mL or CEA >5 ng/mL were found in 14/15 patients with malignant pericardial effusion and negative pericardial fluid cytology. We therefore strongly recommend the use of CYFRA 21-1 and/or CEA in addition to pericardial fluid cytology for the recognition of malignant pericardial effusion.
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Kacprzak A, Szturmowicz M, Burakowska B, Franczuk M, Kober J, Kurzyna M, Wilk M, Szmit S, Torbicki A, Kuś J. Sarcoidosis-associated pulmonary hypertension treated with sildenafil - a case report. Adv Respir Med 2017; 85:258-263. [PMID: 29083021 DOI: 10.5603/arm.a2017.0042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/28/2017] [Accepted: 09/23/2017] [Indexed: 11/25/2022]
Abstract
Development of sarcoidosis-associated pulmonary hypertension (SAPH) significantly worsens prognosis in sarcoidosis patients. Unfortunately, there is no treatment of proven benefit for this condition. Medications used for treatment of pulmonary arterial hypertension are of great interest in this respect. Here, we report a case of a patient with severe SAPH treated with sildenafil. A significant, but only temporary improvement in functional status was observed, and the patient died of gradually progressing heart and respiratory failure while awaiting for lung transplantation.
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Szturmowicz M, Kacprzak A, Kuś J. Pulmonary hypertension in diffuse parenchymal lung diseases - is there any benefit of PAH-specific therapy? Adv Respir Med 2017; 85:216-223. [PMID: 28871590 DOI: 10.5603/arm.2017.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/09/2017] [Accepted: 08/10/2017] [Indexed: 11/25/2022]
Abstract
Pulmonary hypertension (PH) is diagnosed in 40-50% of the patients with end-stage diffuse parenchymal lung diseases (DPLD), and it is associated with significant worsening of life expectancy. Latest ERS/ESC guidelines recommend best available treatment of DPLD, and long-term oxygen therapy in the patients with PaO2 less than 60 mm Hg. Pulmonary arterial hypertension (PAH)-targeted drugs are not recommended in PH-DPLD patients, due to the risk of increasing the ventilation-perfusion mismatch, and consequently worsening of hypoxaemia. Nevertheless, PAH-oriented treatment may be beneficial to selected groups of patients. The authors try to find the answer to several important questions: is there any benefit of PAH-specific therapy in PH-DPLD, who should be the candidate for PAH-specific therapy, what class of drugs is most promising, and what outcome measures should be employed?
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Kacprzak A, Szturmowicz M, Kuś J. Zajęcie układu oddechowego w przebiegu nieswoistych zapaleń jelit. Adv Respir Med 2017. [DOI: 10.5603/arm.54812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nieswoiste zapalenia jelit to choroby systemowe z możliwością manifestacji w praktycznie każdej lokalizacji. Zagadnienie zajęcia układu oddechowego jest bardzo ważne z klinicznego punktu widzenia. W artykule próbujemy usystematyzować dotychczasową wiedzę na ten temat.
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Szturmowicz M, Kacprzak A, Franczuk M, Burakowska B, Kurzyna M, Fijałkowska A, Skoczylas A, Wesołowski S, Kuś J, Torbicki A. Low DLCO in idiopathic pulmonary arterial hypertension - clinical correlates and prognostic significance. PNEUMONOLOGIA I ALERGOLOGIA POLSKA 2017; 84:87-94. [PMID: 27238166 DOI: 10.5603/piap.2016.0006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Decreased diffusing capacity of the lung for carbon monoxide (DLCO) is observed in some idiopathic pulmonary arterial hypertension (IPAH) patients, but its clinical significance is uncertain. We aimed to assess clinical correlates and prognostic significance of low DLCO in IPAH patients. MATERIAL AND METHODS In the group of 65 IPAH patients the cut off value for low DLCO was set up based on histogram as < 55% of predicted value. Demographic data, exercise capacity, lung function tests, hemodynamic parameters and survival of the patients were compared depending on DLCO value. RESULTS Low DLCO was found in 18% of the patients, and it was associated with male sex, older age, worse functional status and exercise capacity, and higher prevalence of coronary artery disease. Low DLCO carried a 4-fold increase of death risk in 5-year perspective. CONCLUSIONS Low DLCO was a marker of worse functional capacity and increased risk of death in studied IPAH patients.
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Szturmowicz M, Pawlak-Cieślik A, Fijałkowska A, Gątarek J, Skoczylas A, Dybowska M, Błasińska-Przerwa K, Langfort R, Tomkowski W. The value of the new scoring system for predicting neoplastic pericarditis in the patients with large pericardial effusion. Support Care Cancer 2017; 25:2399-2403. [PMID: 28258502 DOI: 10.1007/s00520-017-3645-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 02/17/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Early recognition of neoplastic pericarditis (npe) is crucial for the planning of subsequent therapy. The aim of the present study was to construct the scoring system assessing the probability of npe, in the patients requiring pericardial fluid (pf) drainage due to large pericardial effusion. METHODS One hundred forty-six patients, 74 males and 72 females, entered the study. Npe based on positive pf cytology and/or pericardial biopsy specimen was recognised in 66 patients, non-npe in 80. Original scoring system was constructed based on parameters with the highest diagnostic value: mediastinal lymphadenopathy on chest CT scan, increased concentration of tumour markers (cytokeratin 19 fragments-Cyfra 21-1 and carcinoembryonic antigen-CEA) in pf, bloody character of pf, signs of imminent cardiac tamponade on echocardiography and tachycardia exceeding 90 beats/min on ECG. Each parameter was scored with positive or negative points depending on the positive and negative predictive values (PPV, NPV). RESULTS The area under curve (AUC) for the scoring system was 0.926 (95%CI 0.852-0.963) and it was higher than AUC for Cyfra 21-1 0.789 (95%CI 0.684-0.893) or CEA 0.758 (95%CI 0.652-0.864). The score optimally discriminating between npe and non-npe was 0 points (sensitivity 0.84, specificity 0.91, PPV 0.9, NPV 0.85). CONCLUSION Despite chest CT and tumour marker evaluation in pericardial fluid were good discriminators between npe and non-npe, the applied scoring system further improved the predicting of neoplastic disease in the studied population.
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Jędrych ME, Szturmowicz M, Bestry I, Kuś J. [Hypersensitivity pneumonitis: Diagnostic criteria, treatment, prognosis and prevention]. Med Pr 2017; 67:517-27. [PMID: 27623832 DOI: 10.13075/mp.5893.00406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Hypersensitivity pneumonitis (HP) is caused by inhalation of environmental antigens. Farmers and bird keepers are most frequently affected by this desease. The HP diagnosis is based on clinical symptoms (cough, dyspnea) in a person exposed to environmental antigens, and the presence of characteristic changes in high resolution chest computed tomography (HRCT) (bilateral, mosaic, ground glass opacities in the middle and lower lung zones, ill-defined centrilobular nodules and the sign of air-trapping on expiration). This type of HRCT pattern is most frequently found in the patients with subacute HP. Bronchioloalveolar lavage fluid (BALF) examination is helpful in establishing the HP diagnosis, when the increased total number of cells, with the predominance of T lymphocytes (> 50%), and the increased number of neutrophils (> 3%) and mastocytes (> 1%) are found. The presence of specific serum precipitins increases the likelihood of HP. In case of atypical clinical presentation, lung biopsy is recommended. The diagnostic criterion of HP is the presence of ill-defined non-necrotising granulomas, after excluding other granulomatous lung diseases. The prevention and treatment of HP is based on the elimination of the antigen from the environment. Corticosteroids may contribute to the improvement in the acute and sub-acute form of the disease but their long term effectiveness is uncertain. The prognosis of HP patients is generally perceived as good, especially in those patients in whom antigen avoidance is possible. Nevertheless, in some patients progressive pulmonary fibrosis and development of severe respiratory insufficiency is observed. Med Pr 2016;67(4):517-527.
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Wilińska E, Oniszh K, Augustynowicz-Kopeć E, Zabost A, Fijałkowska A, Kurzyna M, Wieteska M, Torbicki A, Kuś J, Szturmowicz M. Non-tuberculous mycobacterial lung disease (NT MLD ) in patients with chronic thromboembolic pulmonary hypertension and idiopathic pulmonary arterial hypertension. PNEUMONOLOGIA I ALERGOLOGIA POLSKA 2016; 82:495-502. [PMID: 25339559 DOI: 10.5603/piap.2014.0066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Non-tuberculous mycobacterial lung diseases (NTMLD) occur rarely and are diagnosed mainly in patients belonging to risk groups. Pulmonary hypertension (PH) has not been recognised as a risk factor for NTMLD yet. The aim of the study was to analyse the clinical course and predisposing factors of NTMLD recognised in our centre between 2002 and 2012 in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and idiopathic pulmonary arterial hypertension (IPAH). MATERIAL AND METHODS Thirteen patients (10 - CTEPH, 3 - IPAH) entered the study. PH was recognised during right heart catheterisation. Median value of mean pulmonary artery pressure (mPAP) was 49 mm Hg (39-65 mm Hg). NTMLD was diagnosed according to ATS guidelines (2007). RESULTS M. kansasii was the most frequent pathogen. Most patients complained of the exaggeration of dyspnoea and productive cough. Computed tomography of the chest with angiography revealed infiltrations with cavitation in seven patients and cavities surrounded by micronodules in six patients. In all CTEPH patients, NTMLD developed in the hypoperfused lung areas. No parenchymal abnormalities preceded the development of NTMLD. After diagnosis all of the patients received antituberculous treatment; in 12/13 improvement was achieved. By the end of March 2014 seven patients died due to right heart insufficiency, no deaths due to NTMLD were noted. CONCLUSIONS NTMLD should be suspected in patients with CTEPH or IPAH, presenting with productive cough and a new pulmonary infiltrate with cavitation. In patients with CTEPH, special attention should be paid to a new cavitary lesions without accompanying thrombus in the artery supplying the area. High mPAP (CTEPH/IPAH) and hypoperfusion (CTEPH) are predisposing to NTMLD.
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Szturmowicz M, Kacprzak A, Burakowska B, Skoczylas A, Bestry I, Kuś J, Fijałkowska A, Torbicki A, Kurzyna M. Guzki środkowej części zrazika w tomografii komputerowej płuc o wysokiej rozdzielczości u chorych na IPAH—Wstępne korelacje kliniczno-radiologiczne. Adv Respir Med 2016. [DOI: 10.5603/arm.47555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Wstęp: Zmiany miąższowe w tomografii komputerowej płuc o wysokiej rozdzielczości (TKWR) obserwowane są u niektórych chorych na idiopatyczne tętnicze nadciśnienie płucne (IPAH), pomimo że nie mają oni śródmiąższowej choroby płuc. Najczęściej opisuje się: słabo odgraniczone guzki środkowej części zrazika (CN, centrilobular nodules) albo ogniskowe zacienienia typu matowej szyby (FGGO, focal ground glass opacities). Nie wiadomo czy obecność tych zmian wskazuje na odmienny typ IPAH czy też na zarostową chorobę żył płucnych (PVOD, pulmonary venoocclusive disease). Celem pracy była ocena częstości występowania i znaczenia klinicznego zmian miąższowych w płucach stwierdzanych w TKWR u chorych na IPAH. Materiał i metody: Do badania zakwalifikowano 52 chorych na IPAH (38 kobiet, 14 mężczyzn, średni wiek 41 ± 15 lat). Wszystkie dostępne badania TKWR zostały poddane retrospektywnej analizie doświadczonego radiologa, nieposiadającego wiedzy na temat danych klinicznych. Wyniki: U 10 chorych (19%) stwierdzono CN, u 12(23%) FGGO. U badanych chorych nie występowały cechy PVOD, takie jak powiększenie węzłów chłonnych czy też pogrubienie przegród międzyzrazikowych. Wykazano, że chorzy z CN w porównaniu z pozostałymi byli istotnie młodsi (średnie wieku wynosiły 31 lat oraz 43.5 roku, p = 0.02), nie posiadali drożnego otworu owalnego (0% oraz 43%, p = 0.03), mieli istotnie wyższe średnie ciśnienie w prawym przedsionku (12.5 mm Hg oraz 7.94 mm Hg, p = 0.01). Nie wykazano jednak istotnych różnic dotyczących rokowania. Wnioski: Chorzy na IPAH, u których stwierdzono w TKWR guzki środkowej części zrazika, charakteryzowali się nieobecnością PFO, młodszym wiekiem i wyższym ciśnieniem w prawym przedsionku w porównaniu z pozostałymi chorymi.
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Szturmowicz M, Rudziński P, Kacprzak A, Langfort R, Bestry I, Broniarek-Samson B, Orłowski T. Prognostic value of serum C-reactive protein (CRP) and cytokeratin 19 fragments (Cyfra 21-1) but not carcinoembryonic antigen (CEA) in surgically treated patients with non-small cell lung cancer. PNEUMONOLOGIA I ALERGOLOGIA POLSKA 2016; 82:422-9. [PMID: 25133810 DOI: 10.5603/piap.2014.0055] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 08/18/2014] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The aim of the study was to assess the prognostic value of cytokeratin 19 fragments (Cyfra 21-1), carcinoembryonic antigen (CEA) and C-reactive protein (CRP) in surgically treated NSCLC patients. MATERIAL AND METHODS 50 NSCLC patients (25 adenocarcinoma, 21 squamous cell and 4 adenosquamous), clinical stages I and II, age 42-89 years, entered the study. CEA, Cyfra 21-1 and CRP concentrations were measured in serum taken before surgery, CEA and Cyfra 21-1 in 50 patients, CRP - in 46 patients. The survival was calculated from the date of surgical treatment until death or until the end of the observation time. The results were expressed as medians (95%CI). RESULTS Cyfra 21-1 concentration was 2.1 (0.7-14.5) ng/mL. Survival time in the patients with Cyfra 21-1 ≤ 2 ng/mL, and > 2 ng/ /mL was 79 (14.85-88.2) and 29 (5.7-87.6) months, (p < 0.026). CEA concentration was 2.68 (0.87-72.7) ng/mL, significantly higher in adenocarcinoma than in squamous cell lung cancer - 4.38 ng/mL (1.67-41.35) vs. 2.2 ng/mL (1.0-6.1), p = 0.002. CRP concentration was 5.45 (0-122.6) mg/L. Significant dependence was found between CRP and pathological tumour size (pT). Median CRP values in pT1, pT2 and pT3+4 tumours were: 2.8 mg/L, 6.9 mg/L and 23.5 mg/L, respectively. Survival time of the patients with CRP ≤ 10 mg/L and CRP > 10 mg/L was 79 (14.85-88.2) and 29.5 (5.7-87.6) months, respectively (p = 0.045). CRP > 10 mg/L and Cyfra 21-1 > 2 ng/mL were the only significant preoperative prognostic indicators (HR 2.08 and 2.04, respectively). Among the postoperative parameters, pathological stage of disease (p-stage) and pT were the significant prognostic indicators (HR 2.1 and 2.42, respectively). CONCLUSIONS In the present study, concerning surgically treated NSCLC patients, preoperative CRP > 10 mg/L and Cyfra 21-1 > 2 ng/mL were the only negative prognostic indicators, while pT and p-stage were significant postoperative prognostic indicators.
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