The National Lung Cancer Screening Trial reported that three annual low-dose computed topography (LDCT) scans, in contrast to standard lung X-rays, can decrease lung cancer mortality by 20% and overall mortality by 7% in high risk individuals. However, the poor specificity of LDCT leads to a high rate of false positive results.
Lung cancer biomarkers have the potential to replace or complement current screening standards to reduce false positive cases. Over the last decade there has been intense research into identifying potential metabolic biomarkers for the diagnosis of lung cancer. Evidence suggests that cancer cell metabolism varies from that of noncancerous cells and that these changes may be useful for early detection and screening.
Metabolic phenotyping of blood plasma by proton nuclear magnetic resonance (H-NMR) identified unique metabolic biomarkers specific to lung cancer patients and allowed for the accurate identification of a cohort of patients with early and late-stage lung cancer.
The results published in the Journal of Thoracic Oncology identified increased levels of several metabolites in cancer versus non-cancer patients including glucose, N-acetylated glycoproteins, leucine, lysine, tyrosine, threonine, glutamine, valine, and aspartate, and decreased levels of alanine, lactate, sphingomyelin, phosphatidylcholine, citrate, and other phospholipids. Based on the metabolic variances observed, the model classified 78% of the lung cancer patients and 92% of the controls correctly with an AUC of 0.88. The model had a sensitivity of 71% and a specificity of 81% with an AUC of 0.84, however, was unable to discriminate between histological subtypes and tumor stages.
The authors comment that, "This paper validates H-NMR metabolic phenotyping of blood plasma as a complementary tool to discriminate between lung cancer patients and controls. Our findings indicate that while metabolic alterations can be detected at an early stage. Our intent is not to use the metabolome as a separate screening tool but to complement current risk models with additional parameters to better select high-risk individuals eligible for LDCT screening."