Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2020; 8(10): 1916-1922
Published online May 26, 2020. doi: 10.12998/wjcc.v8.i10.1916
Serum von Willebrand factor for early diagnosis of lung adenocarcinoma in patients with type 2 diabetes mellitus
Ying-Yi Zhou, Xuan Du, Jia-Li Tang, Qiu-Ping Wang, Ke Chen, Bi-Min Shi
Ying-Yi Zhou, Xuan Du, Jia-Li Tang, Qiu-Ping Wang, Bi-Min Shi, Department of Endocrinology, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
Ke Chen, Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
Author contributions: Zhou YY and Du X contributed equally to this study and should be regarded as the co-first authors; Shi BM and Chen K should be regarded as the co-corresponding authors; Shi BM and Chen K conceived the study; Zhou YY, Chen K, Wang QP, and Tang JL assembled the data; Zhou YY and Du X analyzed the data, and contributed to the discussion of the article; Shi BM reviewed and edited the article; all authors read and approved the submitted manuscript.
Institutional review board statement: All procedures were performed in accordance with the ethical standards of the Medical Ethics Committee of The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (2019-061) and with the Helsinki Declaration of 1975, as revised in 2000 (5).
Informed consent statement: Informed consent was obtained from all patients and volunteers.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: The data used to support the findings of this study are available from the corresponding author upon request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Bi-Min Shi, MD, Academic Research, Department of Endocrinology, The First Affiliated Hospital of Soochow University, No. 188, Shizi Road, Suzhou 215000, Jiangsu Province, China. gtmake144523@163.com
Received: February 10, 2020
Peer-review started: February 10, 2020
First decision: March 27, 2020
Revised: April 18, 2020
Accepted: April 24, 2020
Article in press: April 24, 2020
Published online: May 26, 2020
Processing time: 105 Days and 0.7 Hours
ARTICLE HIGHLIGHTS
Research background

Type 2 diabetes mellitus (T2DM) and lung cancer are the two major chronic non-communicable diseases worldwide. Previous evidence has indicated an increased cancer risk among patients with T2DM. However, early diagnosis of lung adenocarcinoma in situ (AIS) in T2DM patients is difficult, resulting in a lost opportunity for curative-intent surgery in almost 70%‒80% of lung cancer patients. T2DM causes endothelial activation, resulting in the secretion of plasma von Willebrand factor (vWF). The elevation of plasma vWF has been proposed to be a predictor of lung cancer. However, the role of vWF in patients with T2DM complicated with lung cancer remains unclear.

Research motivation

Since the early diagnosis of AIS in T2DM patients is difficult, which currently results in a lost opportunity for surgery in 70%-80% of patients with lung cancer, we were motivated to examine whether the plasma vWF could be a useful biomarker to diagnose lung AIS among patients with T2DM. If vWF could serve as a useful biomarker, then it could save additional 70%-80% of T2DM patients with lung cancer for the opportunity in treatment and therapy.

Research objectives

We aimed to examine whether vWF could serve as a useful biomarker to diagnose patients with T2DM combined with AIS. Specifically, we aimed to assess whether vWF levels were elevated among patients with T2D combined with AIS compared to patients with T2DM only, patients with AIS only, and patients without T2DM and AIS.

Research methods

We conducted a cross-sectional case-control study. The study enrolled 43 patients with T2DM combined with lung AIS (T2DM + AIS group), 43 patients with T2DM alone (T2DM group), 43 patients with lung AIS alone (AIS group), and 43 healthy volunteers (control group). The serum levels of vWF were measured using an enzyme-linked immunoassay (Elabscience Biotechnology Co. Ltd, Wuhan, China), and compared among the four groups.

Research results

Serum concentrations of vWF in the T2DM + AIS group were significantly higher than those in the T2DM, AIS, and control groups (P < 0.05). Serum vWF levels in the T2DM and AIS groups were significantly higher than those in the control group (both P < 0.05). There was no significant difference in serum vWF level between the T2DM and AIS groups.

Research conclusions

For the first time, we have found that serum levels of vWF in patients with T2DM combined with lung AIS were significantly higher than those in patients with T2DM only, patients with AIS only, and healthy individuals. Therefore, serum vWF level may serve as a novel biomarker for the early diagnosis of lung AIS among T2DM patients. This provides an important implication for the clinical practice and public health intervention that vWF could be introduced as a new test to diagnose or screen T2DM patients with lung cancer.

Research perspectives

Since the current study is the first to examine the clinical utility of vWF for the diagnosis of lung cancer among patients with T2DM patients, the temporal relationship cannot be determined. Future studies with larger sample sizes and prospective study design are warranted to validate our findings, and further examine if vWF could predict the risk of lung cancer among T2DM patients. Studies regarding the cost-effectiveness of measuring this biomarker in clinical practice or in large-scale public health screening programs are also needed.