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Marshall T, Chen J, Viloria-Petit AM. Adipocyte-Derived Adipokines and Other Obesity-Associated Molecules in Feline Mammary Cancer. Biomedicines 2023; 11:2309. [PMID: 37626804 PMCID: PMC10452835 DOI: 10.3390/biomedicines11082309] [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: 07/04/2023] [Revised: 07/30/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Obesity has been identified as a serious health concern in domestic cats. Feline mammary cancer (FMC) is also a concern, as it is highly prevalent and aggressive. Considering the identified connection between obesity and breast cancer, it is worthwhile to investigate the potential obesity-cancer relationship in FMC. This review investigated the association between adipokines and other obesity-associated molecules and FMC, with the aim of identifying gaps in the current literature for future research. Based on the reports to date, it was found that tissue concentrations of leptin, serum concentrations of leptin receptor, serum amyloid A, and estrogen correlate positively with FMC, and serum concentrations of leptin correlate negatively with FMC. The roles of adiponectin and prolactin in FMC development were also investigated, but the reports are either lacking or insufficient to suggest an association. Numerous research gaps were identified and could be used as opportunities for future research. These include the need for studies on additional cohorts to confirm the association of leptin/leptin receptor and serum amyloid A with FMC, and to address the role of adiponectin and prolactin in FMC. It is also important to investigate the genetic determinants of FMC, evaluate the use of molecular-targeted therapies in FMC, and exploit the enrichment of the triple-negative immunophenotype in FMC to address current clinical needs for both human triple-negative breast cancer and FMC. Finally, mechanistic studies with any of the molecules reviewed are scarce and are important to generate hypotheses and ultimately advance our knowledge and the outcome of FMC.
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Affiliation(s)
| | | | - Alicia M. Viloria-Petit
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada; (T.M.); (J.C.)
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Kimura T. Comparative evaluation of acute phase proteins by C-reactive protein (CRP) and serum amyloid A (SAA) in nonhuman primates and feline carnivores. ANIMAL DISEASES 2022. [DOI: 10.1186/s44149-022-00054-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AbstractThe feasibility of a commercially available assay for C-reactive protein (CRP, CRP for humans: hCRP, and CRP for dogs: vCRP) and a trial reagent of serum amyloid A (SAA, vSAA for animals) were applied to the measurement of acute phase proteins in zoo animals, particularly in nonhuman primates and feline carnivores was evaluate. Results showed that hCRP and vSAA methods were applicable to measure CRP and SAA in Haplorhini. There was a highly significant correlation between both parameters with remarkably high correlation coefficient. A higher proportion of Bonnet macaques in Haplorhini, and the linear regression with good correlation between hCRP and vSAA levels were observed. Reference values in healthy Bonnet macaques were hCRP (46.86 ± 30.97 nmol/L) and vSAA (9.06 ± 1.95 μg/mL). Although Ring-tailed lemur, which belonging to Strepsirrhini, showed low vSAA concentrations (reference values: 1.08 ± 0.47 μg/mL), vSAA in patients was apparently elevated. The vCRP and vSAA methods were applicable to measurements of CRP and SAA in feline carnivores for highly significant correlation between both parameters. Theses two methods were also been deteded in lions, tigers and cheetahs. vSAA assays can be applied to measure SAA levels in other carnivores and herbivores. In conclusion, vSAA systems have potential utility as diagnostic tools for health screening and prediction in zoo animals.
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Adjei‐Sowah EA, O'Connor SA, Veldhuizen J, Lo Cascio C, Plaisier C, Mehta S, Nikkhah M. Investigating the Interactions of Glioma Stem Cells in the Perivascular Niche at Single-Cell Resolution using a Microfluidic Tumor Microenvironment Model. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2201436. [PMID: 35619544 PMCID: PMC9313491 DOI: 10.1002/advs.202201436] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/25/2022] [Indexed: 05/03/2023]
Abstract
The perivascular niche (PVN) is a glioblastoma tumor microenvironment (TME) that serves as a safe haven for glioma stem cells (GSCs), and acts as a reservoir that inevitably leads to tumor recurrence. Understanding cellular interactions in the PVN that drive GSC treatment resistance and stemness is crucial to develop lasting therapies for glioblastoma. The limitations of in vivo models and in vitro assays have led to critical knowledge gaps regarding the influence of various cell types in the PVN on GSCs behavior. This study developed an organotypic triculture microfluidic model as a means to recapitulate the PVN and study its impact on GSCs. This triculture platform, comprised of endothelial cells (ECs), astrocytes, and GSCs, is used to investigate GSC invasion, proliferation and stemness. Both ECs and astrocytes significantly increased invasiveness of GSCs. This study futher identified 15 ligand-receptor pairs using single-cell RNAseq with putative chemotactic mechanisms of GSCs, where the receptor is up-regulated in GSCs and the diffusible ligand is expressed in either astrocytes or ECs. Notably, the ligand-receptor pair SAA1-FPR1 is demonstrated to be involved in chemotactic invasion of GSCs toward PVN. The novel triculture platform presented herein can be used for therapeutic development and discovery of molecular mechanisms driving GSC biology.
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Affiliation(s)
| | - Samantha A. O'Connor
- School of Biological and Health Systems EngineeringArizona State UniversityTempeAZ85287‐9709USA
| | - Jaimeson Veldhuizen
- School of Biological and Health Systems EngineeringArizona State UniversityTempeAZ85287‐9709USA
| | - Costanza Lo Cascio
- Ivy Brain Tumor Center, Barrow Neurological InstituteSt. Joseph's Hospital and Medical Center350 W Thomas RdPhoenixAZ85013USA
| | - Christopher Plaisier
- School of Biological and Health Systems EngineeringArizona State UniversityTempeAZ85287‐9709USA
| | - Shwetal Mehta
- Ivy Brain Tumor Center, Barrow Neurological InstituteSt. Joseph's Hospital and Medical Center350 W Thomas RdPhoenixAZ85013USA
| | - Mehdi Nikkhah
- School of Biological and Health Systems EngineeringArizona State UniversityTempeAZ85287‐9709USA
- Virginia G. Piper Biodesign Center for Personalized DiagnosticsArizona State UniversityTempeAZ85287‐9709USA
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Li Z, Hou Y, Zhao M, Li T, Liu Y, Chang J, Ren L. Serum amyloid a, a potential biomarker both in serum and tissue, correlates with ovarian cancer progression. J Ovarian Res 2020; 13:67. [PMID: 32517794 PMCID: PMC7285470 DOI: 10.1186/s13048-020-00669-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 05/27/2020] [Indexed: 12/24/2022] Open
Abstract
Background Ovarian cancer is the most fatal gynecologic malignancy worldwide due to its vagueness, delay in diagnosis, recurrence, and drug resistance. Therefore, a new type of ovarian cancer treatment prediction biomarker is urgently needed to supplement existing tools. A total of 230 people participated in this study. Out of this figure, 100 participants were patients who underwent an ovarian tumor operation, another 100 participants were ovarian benign patients, and the remaining 30 participants were healthy women. Cancer (experimental) group were 100 patients who underwent ovarian tumor operation, while the control groups were 130 participants consisting of 100 ovarian benign patients and 30 healthy women. Levels of SAA, carbohydrate antigen-125 (CA-125), and human epididymis protein 4 (HE4) were assessed using standard laboratory protocols. A total of 5 ovarian cancer tissues and paracancerous tissues were collected and then stored at − 80 °C until the qRT-PCR assay was conducted. Results The ROC curve of SAA concentration in ovarian cancer was plotted to obtain the area under the curve AUC = 0.889, the cut-off value 17.05 mg/L, the sensitivity 78.4% and specificity 86.5%. Compared with pretreatment, the level of serum SAA decreased significantly after treatment. The results revealed that there was a significant correlation between the level of serum SAA and advanced FIGO stage, histology subtype, lymphatic invasion, and distant metastasis (p = 0.003,0.002,0.000 and 0.001). The quantitative Reverse transcription polymerase chain reaction (qRT-PCR) assay revealed that the Messenger RNA (mRNA) of SAA-1 and SAA-4 was much higher in cancer tissues than in adjacent tissues, and MMPs was up-regulation including MMP-1, MMP-9 and MMP- 12 in OVCAR-3 cell stimulated by SAA. The transwell assay revealed that SAA could promote OVCAR-3 cell migration. Moreover, SAA can regulate EMT markers and promote AKT pathway activation. Conclusions In summary, our results demonstrated that SAA may be a potential diagnosis and treatment prediction biomarker. The SAA promotes OVCAR-3 cell migration by regulating MMPs and EMT which may correlate with AKT pathway activation.
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Affiliation(s)
- Ze Li
- Department of Laboratory, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, National Human Genetic Resources Sharing Service Platform, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Yongwang Hou
- Department of Laboratory, the First Affiliated Hospital of Hebei North University, Hebei, China
| | - Meng Zhao
- Department of Laboratory, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, National Human Genetic Resources Sharing Service Platform, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Tianning Li
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China
| | - Yahui Liu
- Department of Laboratory, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, National Human Genetic Resources Sharing Service Platform, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Jiao Chang
- Department of Laboratory, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, National Human Genetic Resources Sharing Service Platform, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Li Ren
- Department of Laboratory, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, National Human Genetic Resources Sharing Service Platform, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
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A Clinical Investigation on Serum Amyloid A Concentration in Client-Owned Healthy and Diseased Cats in a Primary Care Animal Hospital. Vet Sci 2020; 7:vetsci7020045. [PMID: 32326517 PMCID: PMC7355685 DOI: 10.3390/vetsci7020045] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 02/06/2023] Open
Abstract
Although measurement of serum amyloid A (SAA) concentration in client-owned cats has already been shown to be clinically useful, limited data are available on common diseases at primary care hospitals. In this study, we measured the SAA concentration in cats with various diseases and investigated their clinical significance using a primary care hospital as a population. We measured the SAA concentrations in healthy cats (n = 98) and those with various clinical signs (n = 444). The SAA concentrations in healthy cats did not differ significantly by age, breed, sex, and presence/absence of neutering/spaying. The SAA concentrations were significantly higher in the diseased cat group than in the healthy cat group (p < 0.001). We observed significant increases in SAA concentrations in cats with confirmed diagnosis of inflammatory disease such as upper respiratory tract infections (p < 0.001), pneumonia (p < 0.001), pyometra (p = 0.001), and feline infectious peritonitis (p < 0.001), compared with those observed in healthy cats. Conversely, no increase was observed in cardiomyopathy, hyperthyroidism, and diabetes mellitus without systemic inflammation. In univariate analysis, survival at 30 days (p = 0.03) differed significantly between the low and high SAA concentration groups, but not at 180 days. In multivariate analysis, survival at 30 days did not significantly affect SAA concentration. Measurement of SAA concentration is a useful biomarker for detecting the presence or absence of inflammation in diseased cats. However, it may not be useful as a biomarker for determining the prognosis of the disease.
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Vilhena H, Tvarijonaviciute A, Cerón JJ, Figueira AC, Miranda S, Ribeiro A, Canadas A, Dias-Pereira P, Rubio CP, Franco L, Tecles F, Cabeças R, Pastor J, Silvestre-Ferreira AC. Acute phase proteins and biomarkers of oxidative status in feline spontaneous malignant mammary tumours. Vet Comp Oncol 2019; 17:394-406. [PMID: 31025532 DOI: 10.1111/vco.12486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 04/15/2019] [Accepted: 04/17/2019] [Indexed: 12/27/2022]
Abstract
Acute phase proteins (APP) and biomarkers of oxidative status change in human and canine mammary tumours, however, they have not been studied in feline mammary tumours. The aims of this study were to investigate the APP and antioxidant responses in feline malignant mammary tumours, to evaluate their relation with tumour features, and to assess their prognostic value. Serum amyloid A (SAA), haptoglobin (Hp), albumin, butyrylcholinesterase (BChE), insulin-like growth factor1 (IGF1), paraoxonase1 (PON1), total serum thiols (Thiol), glutathione peroxidase (GPox) and total antioxidant capacity determined by different assays, including trolox equivalent antioxidant capacity assessed by two different methodologies (TEAC1/2), ferric reducing ability of plasma (FRAP), and cupric reducing antioxidant capacity (CUPRAC), were determined in serum of 50 queens with spontaneous mammary carcinomas and of 12 healthy female cats. At diagnosis, diseased queens presented significantly higher SAA and Hp, and lower albumin, BChE, GPox, TEAC1, TEAC2 and CUPRAC than controls. Different tumour features influenced concentrations of APP and antioxidants. Increases in serum Hp, and decreases in albumin, Thiol and FRAP were significantly associated with neoplastic vascular emboli, metastasis in regional lymph nodes and/or in distant organs. Distant metastasis development during the course of the disease was associated with increases in SAA and TEAC1. At diagnosis, decreased albumin was associated with a longer survival, and BChE <1.15 μmoL/mL.minute was associated with a shorter survival time on multivariate analysis. Feline malignant mammary tumours are associated with an APP response and oxidative stress, and different tumour features influence the inflammatory response and the oxidative damage. Furthermore, some of these analytes proved to have prognostic value.
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Affiliation(s)
- Hugo Vilhena
- Department of Veterinary Medicine, Center for Investigation Vasco da Gama (CIVG), Vasco da Gama Universitary School, Coimbra, Portugal.,Baixo Vouga Veterinary Hospital, Águeda, Portugal.,Animal and Veterinary Research Centre (CECAV), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - Asta Tvarijonaviciute
- Interdisciplinary Laboratory of Clinical Analysis of University of Murcia (Interlab-UMU), University of Murcia, Murcia, Spain
| | - José J Cerón
- Interdisciplinary Laboratory of Clinical Analysis of University of Murcia (Interlab-UMU), University of Murcia, Murcia, Spain
| | - Ana C Figueira
- Department of Veterinary Medicine, Center for Investigation Vasco da Gama (CIVG), Vasco da Gama Universitary School, Coimbra, Portugal.,University Veterinary Hospital of Coimbra, Coimbra, Portugal
| | - Sónia Miranda
- Baixo Vouga Veterinary Hospital, Águeda, Portugal.,Animal and Veterinary Research Centre (CECAV), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - Ana Ribeiro
- Veterinary Policlinic of Aveiro, Aveiro, Portugal
| | - Ana Canadas
- Department of Pathology and Molecular Immunology, Institute for the Biomedical Sciences Abel Salazar, Porto University (ICBAS-UP), Porto, Portugal
| | - Patrícia Dias-Pereira
- Department of Pathology and Molecular Immunology, Institute for the Biomedical Sciences Abel Salazar, Porto University (ICBAS-UP), Porto, Portugal
| | - Camila P Rubio
- Interdisciplinary Laboratory of Clinical Analysis of University of Murcia (Interlab-UMU), University of Murcia, Murcia, Spain
| | - Lorena Franco
- Interdisciplinary Laboratory of Clinical Analysis of University of Murcia (Interlab-UMU), University of Murcia, Murcia, Spain
| | - Fernando Tecles
- Interdisciplinary Laboratory of Clinical Analysis of University of Murcia (Interlab-UMU), University of Murcia, Murcia, Spain
| | - Ricardo Cabeças
- Department of Veterinary Medicine, Center for Investigation Vasco da Gama (CIVG), Vasco da Gama Universitary School, Coimbra, Portugal
| | - Josep Pastor
- Department of Animal Medicine and Surgery, Autonomous University of Barcelona, Barcelona, Spain
| | - Ana C Silvestre-Ferreira
- Animal and Veterinary Research Centre (CECAV), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal.,Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
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Involvement of serum amyloid A1 in the rupture of fetal membranes through induction of collagen I degradation. Clin Sci (Lond) 2019; 133:515-530. [PMID: 30683734 DOI: 10.1042/cs20180950] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/03/2019] [Accepted: 01/25/2019] [Indexed: 12/22/2022]
Abstract
The de novo synthesis of serum amyloid A1 (SAA1) is augmented in human fetal membranes at parturition. However, its role in parturition remains largely unknown. Here, we investigated whether SAA1 was involved in the rupture of fetal membranes, a crucial event in parturition accompanied with extensive degradation of collagens. Results showed that SAA1 decreased both intracellular and extracellular COL1A1 and COL1A2 abundance, the two subunits of collagen I, without affecting their mRNA levels in human amnion fibroblasts. These reductions were completely blocked only with inhibition of both matrix metalloproteases (MMPs) and autophagy. Consistently, SAA1 increased MMP-2/9 abundance and the markers for autophagic activation including autophagy related (ATG) 7 (ATG7) and the microtubule-associated protein light chain 3 β (LC3B) II/I ratio with the formation of LC3 punctas and autophagic vacuoles in the fibroblasts. Moreover, the autophagic degradation of COL1A1/COL1A2 and activation of MMP-2/9 by SAA1 were blocked by inhibitors for the toll-like receptors 2/4 (TLR2/4) or NF-κB. Finally, reciprocal corresponding changes of SAA1 and collagen I were observed in the amnion following spontaneous rupture of membranes (ROM) at parturition. Conclusively, SAA1 may participate in membrane rupture at parturition by degradating collagen I via both autophagic and MMP pathways. These effects of SAA1 appear to be mediated by the TLR2/4 receptors and the NF-κB pathway.
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Effects of serum amyloid A on matrix metalloproteinase-9 production in feline lymphoma-derived cell lines. Vet Immunol Immunopathol 2017; 187:10-13. [PMID: 28494923 DOI: 10.1016/j.vetimm.2017.03.002] [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: 12/06/2016] [Revised: 03/10/2017] [Accepted: 03/11/2017] [Indexed: 11/21/2022]
Abstract
Serum amyloid A (SAA) concentration and plasma matrix metalloproteinase-9 (MMP-9) levels are increased in cats with lymphoma. In the present study, the association between SAA and MMP-9 production was evaluated using recombinant feline SAA (rfSAA) and three feline lymphoma-derived cell lines: 3201, MS4, and MCC. MMP-9 mRNA expression was significantly increased by rfSAA stimulation only in MCC cells. Secreted MMP-9 protein in culture media was confirmed by gelatin zymography, with clear bands of MMP-9 detected in MCC cells following rfSAA stimulation. A significant increase in semi-quantified MMP-9 levels was observed with 5 and 25μg/ml of rfSAA stimulation. The infiltrative activities of feline lymphoma cells, assessed by the matrigel transwell assay, showed that rfSAA stimulated cell infiltration in MCC cells, in addition to MMP-9 expression. Although the response to rfSAA stimulation varied between cell lines, the results showed that rfSAA can stimulate MMP-9 production and infiltration of feline lymphoma-derived cells. The findings of this study have identified a novel role for SAA in the progression of some forms of feline lymphoma.
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Biaoxue R, Hua L, Wenlong G, Shuanying Y. Increased serum amyloid A as potential diagnostic marker for lung cancer: a meta-analysis based on nine studies. BMC Cancer 2016; 16:836. [PMID: 27809798 PMCID: PMC5093952 DOI: 10.1186/s12885-016-2882-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 10/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies have disclosed that serum amyloid A (SAA) is likely involved in the lung cancer pathogenesis and progression. We performed a systematic evaluation and meta-analysis to disclose the correlation between the expression of SAA and lung cancer and to evaluate its value for lung cancer diagnosis. METHODS We searched the relevant articles from the databases of Medline, Embase, Cochrance Library and Web of Science and calculated the standardized mean difference (SMD) with 95 % confidence interval (CI) to assess the expression difference of SAA between lung cancer and normal patients. Moreover, we counted the positive rate, sensitivity and specificity and drew a summary receiver operating characteristic curve (SROC) to evaluate the diagnostic value of SAA for lung cancer. RESULTS A total of nine studies with 1392 individuals were included in this analysis. The results showed an increased SAA was correlated with the incidence of lung cancer (P < 0.001), especially with the lung squamous cell carcinoma (LSCC) (p = 0.012). The overall sensitivity and specificity of SAA for discerning lung cancer was 0.59 (95 % CI: 0.54-0.63) and 0.92 (95 % CI: 0.88-0.95), respectively. The area under the SROC curve was 0.9066 (SE = 0.0437). CONCLUSIONS Increased SAA in lung cancer was intimately correlated with the development and progression of lung cancer. A higher specificity of SAA suggested that it should be a significant biomarker for discerning lung cancer from normal individuals, especially for LSCC (p = 0.012).
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Affiliation(s)
- Rong Biaoxue
- Department of Respiratory Medicine, First Affiliated Hospital, Xi’an Medical University, 48 Fenghao West Road, Xi’an, 710077 China
- Research Center of Prevention and Treatment of Respiratory Disease, Xi’an, Shaanxi Province 710077 China
| | - Liu Hua
- Department of Respiratory Medicine, Gansu Provincial Hospital, Lanzhou, China
| | - Gao Wenlong
- Department of Statistics and Epidemiology, Medical College, Lanzhou University, Lanzhou, China
| | - Yang Shuanying
- Department of Respiratory Medicine, Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, China
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