Details
Category: Volume 06 Issue 02 February 2018
Hits: 1883

Title: Alteration of Serum Albumin Globulin Ratio in Patients with Lung Cancer

Authors: Raseela Karunakaran, Mithun Harold Thomas, Athul Santhosh, Meera Madhusudan

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i2.170

Abstract

Introduction: Recent studies have demonstrated that hypoalbuminemia and low albumin globulin ratio are important predictors of long term mortality in several cancers. To the best of our knowledge, studies on albumin globulin ratio in lung cancer patients has not been carried out in our population.

Aim: To study the alteration in serum albumin, globulin and albumin globulin ratio in patients with histologically diagnosed lung cancer.

Materials and methods: This was a retrospective analysis conducted in the department of pulmonary medicine in a tertiary care centre in Kerala. The case records of 21 patients histologically diagnosed as lung cancer were analysed. Blood samples were collected for testing of total protein and albumin before starting treatment. Patients with comorbidities that could alter albumin globulin ratio such as chronic liver disease, renal disease and other chronic inflammatory diseases were excluded from the study. Albumin-globulin ratio (AGR) was calculated using the equation AGR=Albumin (Total protein-albumin).

Results: The total number of patients included in the study was 21. The most common histopathological type of lung cancer observed in the study was adenocarcinoma (14/21). Other types were squamous cell (3), small cell (1), carcinoid tumor (1) and poorly differentiated cancer (2). Albumin globulin ratio was < 1 in 14 patients. In another 3 patients the ratio was 1.03.  Serum globulin was elevated (>3.5) in nine patients. Serum albumin was low (<3.5) in fourteen patients. Total protein was increased above normal (>7) in two patients in whom globulin was very high (>5).

Conclusion: Cancer related inflammation has been a subject of interest in the field of cancer research.  This study supports the recently changed concept that cancer cells are capable of producing immunoglobulins as against the older concept that immunoglobulins are produced by B cells alone.

Keywords: Lung cancer, Immunoglobulin, Albumin, Globulin.

References

  1. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010 Oct;60(5):277–300.
  2. Jiang C, Huang T, Wang Y, Huang G, Wan X, Gu J. Immunoglobulin G expression in lung cancer and its effects on metastasis. PloS One. 2014;9(5):e97359.
  3. Azab B, Kedia S, Shah N, Vonfrolio S, Lu W, Naboush A, et al. The value of the pretreatment albumin/globulin ratio in predicting the long-term survival in colorectal cancer. Int J Colorectal Dis. 2013 Dec;28(12):1629–36.
  4. Jafri SH, Shi R, Mills G. Advance lung cancer inflammation index (ALI) at diagnosis is a prognostic marker in patients with metastatic non-small cell lung cancer (NSCLC): a retrospective review. BMC Cancer. 2013 Mar 27;13:158.
  5. Duran AO, Inanc M, Karaca H, Dogan I, Berk V, Bozkurt O, et al. Albumin-globulin ratio for prediction of long-term mortality in lung adenocarcinoma patients. Asian Pac J Cancer Prev APJCP. 2014;15(15):6449–53.
  6. Busher JT. Walker HK, Hall WD,  Hurst JW. Serum albumin and globulin, Clinical Methods: the History, Physical, and Laboratory Examinations, 19903rd edition Boston, MAButterworths(pg. 497-499).
  7. Kyle RA. Sequence of testing for monoclonal gammopathies. Arch Pathol Lab Med. 1999 Feb;123(2):114–8.
  8. Dispenzieri A, Gertz MA, Therneau TM, Kyle RA. Retrospective cohort study of 148 patients with polyclonal gammopathy. Mayo Clin Proc. 2001 May;76(5):476–87.
  9. Zhou T, He X, Fang W, Zhan J, Hong S, Qin T, et al. Pretreatment Albumin/Globulin Ratio Predicts the Prognosis for Small-Cell Lung Cancer. Medicine (Baltimore). 2016 Mar;95(12):e3097.
  10. Suh B, Park S, Shin DW, Yun JM, Keam B, Yang H-K, et al. Low albumin-to-globulin ratio associated with cancer incidence and mortality in generally healthy adults. Ann OncolOff J EurSoc Med Oncol. 2014 Nov;25(11):2260–6.
  11. Heidland A, Klassen A, Rutkowski P, Bahner U. The contribution of Rudolf Virchow to the concept of inflammation: what is still of importance? J Nephrol. 2006 Jun;19Suppl 10:S102-109.
  12. Lux A, Aschermann S, Biburger M, Nimmerjahn F. The pro and anti-inflammatory activities of immunoglobulin G. Ann Rheum Dis. 2010 Jan;69Suppl 1:i92-96.
  13. Giat E, Ehrenfeld M, Shoenfeld Y. Cancer and autoimmune diseases. Autoimmun Rev. 2017 Oct;16(10):1049–57.
  14. Hu F, Zhang L, Zheng J, Zhao L, Huang J, Shao W, et al. Spontaneous Production of Immunoglobulin M in Human Epithelial Cancer Cells. PLOS ONE. 2012 Dec 12;7(12):e51423.
  15. Wang J, Lin D, Peng H, Huang Y, Huang J, Gu J. Cancer-derived immunoglobulin G promotes tumor cell growth and proliferation through inducing production of reactive oxygen species. Cell Death Dis. 2013 Dec;4(12):e945.
  16. Chen Z, Huang X, Ye J, Pan P, Cao Q, Yang B, et al. Immunoglobulin G is present in a wide variety of soft tissue tumors and correlates well with proliferation markers and tumor grades. Cancer. 2010 Apr 15;116(8):1953–63.

Corresponding Author

Mithun Harold Thomas

Senior Resident, Department of General Medicine,

Government Medical College, Kozhikode, Kerala, India

Phone number: 9809587773, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.