Prognostic Significance of Urine N1,N12-Diacetylspermine in Patients with Non-small Cell Lung Cancer

Background: Recently N-1,N-12-diacetylspermine, a diacetylated polyamine derivative, was recognized as a tumor marker in patients with several kinds of cancers. However, the significance of its levels in urine as a prognostic factor has not been elucidated. In the present study, we examined whether the urine N-1,N-12-diacetylspermine levels can be used as a prognostic factor in patients with NSCLC. Patients and Methods: Urine samples from 251 patients with NSCLC were collected prior to surgery and the urinary N-1,N-12-diacetylspermine concentration was measured. Thereafter, all 251 patients underwent curative surgery and the analysis of prognosis was performed for over 10 years. Out of the 251 patients, 91 had recurrent disease. The significance of the urinary N-1,N-12-diacetylspermine level as a prognostic factor among all 251 patients and among the 91 patients with recurrence was evaluated. Results: Univariate analysis of all 251 patients showed that the level of urinary N-1,N-12-diacetylspermine was a significant prognostic factor for disease-free survival and overall survival; however, multivariate analysis showed it had no significance. Conversely, the univariate and multivariate analyses of post-recurrent survival of the 91 patients with recurrence showed that urinary N-1,N-12-diacetylspermine was an independent prognostic factor for post-recurrent survival. Conclusion: Patients with recurrence with positive urinary N-1,N-12-diacetylspermine should undergo more intensive care and determination of urinary N-1,N-12-diacetylspermine may contribute to improvement of prognosis of NSCLC.