Telomerase activity in transthoracic fine-needle biopsy aspirates from non-small cell lung cancer as prognostic factor of patients' survival

PURPOSE: Evaluation of the relationship between telomerase activity in transthoracic fine-needle biopsy (TFNB) aspirates collected from peripheral non-small cell lung cancer (NSCLC), cancer advancement, risk of death and free of cancer recurrence survival. MATERIAL AND METHODS: The study group consisted of 93 patients with peripheral infiltration of the lung. All of them had TFNB of the focal pulmonary lesion performed. The aspirates were subjected to standard cytological evaluation. Telomerase activity in the specimens was determined with the PCR-ELISA PLUS method. Cancer advancement, manner of treatment and survival were assessed in patients with NSCLC. RESULTS: A benign lesion of the lung was recognised in 14 cases. NSCLC was newly diagnosed in 79 subjects. Nobody with benign infiltration had a detectable level of telomerase in lung infiltration. Increased telomerase activity was observed in 56 (70.9%) patients with lung cancer. It was significantly more often detected in patients with non-operable NSCLC (clinical stage IIIB plus IV) and patients with distant metastases (stage IV alone). Cox hazard analysis revealed that presence of telomerase activity in primary NSCLC is an independent prognostic factor of survival. Increased telomerase activity in TFNB aspirates was related to 7 times higher relative risk of death during the study [RR=6.9 (CI: 1.8-26.8); p<0.05] and 2.5 times higher risk of cancer recurrence after radical treatment [RR=2.5 (CI: 0.3-9.3); p<0.05]. CONCLUSION: Telomerase activity in aspirates collected through TFNB of primary peripheral NSCLC could be a helpful independent prognostic factor of distant metastases and risk of death or cancer recurrence.