Prognostic value of serum neutrophil gelatinase-associated lipocalin in metastatic and nonmetastatic colorectal cancer.

BACKGROUND: Neutrophil gelatinase-associated lipocalin (NGAL) expression is increased in epithelial cancer patients, but studies showing its relation to prognosis are scarce. We aimed to test the ability of preoperative serum NGAL levels (pNGAL) to predict recurrence in metastatic and nonmetastatic colorectal cancer (CRC) patients. METHODS: This retrospective study determined pNGAL levels in 60 healthy individuals, 47 patients with nonmetastatic CRC, and 70 patients with metastatic CRC undergoing curative neoplastic resection. Patients were divided into low- and high-pNGAL groups using a median series-based cutoff. RESULTS: The mean ± SD pNGAL in CRC patients (nonmetastatic and metastatic) was 102.3 ± 66.6 (median 91.4). Nonmetastatic CRC and metastatic CRC patients had higher pNGAL than healthy controls (88 ± 64 and 112 ± 67 vs. 0.6 ± 0.3, respectively, both p < 0.0001). Nonmetastatic CRC patients with deeper tumor invasion and metastatic CRC patients with shorter disease-free interval after CRC resection had higher pNGAL. pNGAL levels correlated with neoplastic tissue volume. CRC patients with recurrence had higher pNGAL than those without recurrence (118 ± 64 vs. 88 ± 66, p = 0.013), and high-pNGAL patients had a higher recurrence rate (59.3 vs. 36.2 %, p = 0.016). Median pNGAL-based risk classification had a sensitivity of 62.5 % for predicting neoplastic progression in CRC patients and 74.3 % for predicting neoplastic progression during the first year after metastatic CRC resection. CONCLUSIONS: pNGAL is higher in CRC patients than in the healthy population, which indicates a potential screening role. High-pNGAL levels are associated with higher neoplastic tissue volume, characteristics of neoplastic invasion, and recurrence, showing a prognostic utility mainly in metastatic CRC patients.

Serum neutrophil gelatinase-associated lipocalin in patients with colorectal liver metastases: preliminary results of an exploratory prospective study.

PURPOSE: To quantify preoperative serum neutrophil gelatinase-associated lipocalin (NGAL) levels in patients undergoing curative resection of colorectal liver metastases and to assess the relationship between NGAL levels and prognostic features in these patients. METHODS: From April 2005 to August 2007, 32 patients operated on for first curative resection of colorectal liver metastases underwent determination of preoperative serum NGAL. Patients were divided into four homogeneous clinical groups and into two risk groups based on their clinical risk scores. NGAL levels were corrected by simultaneous creatinine levels to avoid bias due to renal failure. RESULTS: Higher values of corrected NGAL levels (CNL) were found in patients of the high-risk group (94.53+/-56.18 vs 57.87+/-24.49, p=0.014). Patients with more than three tumor nodules had higher values of CNL compared to patients with three or fewer nodules (101.78+/-56.35 vs 58.57+/-27.24, p=0.008). Patients with disease involving both hepatic lobes had higher CNL levels than those with involvement of a single lobe (106.5+/-59.13 vs 59.01+/-26.69, p=0.005). Patients with higher clinical risk scores had significantly higher CNL. CONCLUSIONS: CNL are associated with the considered prognostic clinical factors and scores, suggesting a possible role for CNL as a prognosis-related indicator and a neoplastic tissue volume marker in patients with colorectal liver metastases.