The Impact of Acid-Base Homeostasis and Serum Parameters on Oncologic Outcome in Non-Small Cell Lung Cancer

Background A well known characteristic of tumor cells is the increased anaerobic metabolism through glycolysis leading to an acidic environment of the tumor. This acidity is linked to tumor progression, invasion and metastasis, besides stimulated survival pathways in the malignant cells.

Aim of our analysis is to investigate the role of systemic acid base parameters such as pH, bicarbonate, baseexcess and lactate. Furthermore, fluctuations in electrolytes as well as hemoglobin and their impact on overall survival was investigated.

Methods & Materials Data of 937 NSCLC patients who underwent anatomic VATS resection was collected in a prospectively maintained database and analyzed.

To minimize confounding effects and due to the retrospecrive study design we decided to use data of the first arterial blood gas analysis during surgery and the most recent lab results prior to surgery.

Results We found significant correlations between low systemic bicarbonate (<20mEq/l) and overall survival (31.7 vs. 62.3 %, p = 0.006). Low sodium levels (<135 mmol/l) were associated with a reduced 5-year overall survival (40.8% vs. 62.8%, p = 0.004), as well as reduced disease-free survival (49.4% vs. 63.5%, p = 0.017).

Hemoglobin under 12 g/dl for women and 13 g/dl for men was also linked to a poorer outcome (59% vs. 68.2%, p < 0.001), even when excluding patients who received neoadjuvant therapy.

Conclusion Systemic bicarbonate, sodium and hemoglobin levels were found as prognostic markers and possible therapeutic targets to improve overall survival. Further investigations are necessary to develop therapeutic strategies.

Publikationsverlauf

Artikel online veröffentlicht:
25. August 2025