Serum Metabolomic Profiles for Distinguishing Lung Cancer From Pulmonary Tuberculosis: Identification of Rapid and Noninvasive Biomarker

• Published in: The Journal of infectious diseases 2023-11, Vol.228 (9), p.1154-1165
• Main Authors: Chen, Siyu, Li, Chunyan, Qin, Zhonghua, Song, Lili, Zhang, Shiyuan, Sun, Chongxiang, Zhuang, Pengwei, Wang, Yuming, Yang, Bin, Ning, Li, Li, Yubo
• Format: Article
• Language: English
• Subjects: Biomarkers; Lung cancer; Medical diagnosis; Metabolites; Metabolomics; Tuberculosis
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1093/infdis/jiad175

Abstract Background Pulmonary tuberculosis (PTB) and lung cancer (LC) have similar clinical symptoms and atypical imaging findings, which are easily misdiagnosed. There is an urgent need for a noninvasive and accurate biomarker to distinguish LC from PTB. Methods A total of 694 subjects were enrolled and divided into discovery set (n = 122), identification set (n = 214), and validation set (n = 358). Metabolites were identified by multivariate and univariate analyses. Receiver operating characteristic curve were used to evaluate the diagnostic efficacy of biomarkers. Results Seven metabolites were identified and validated. Phenylalanylphenylalanine for distinguishing LC from PTB yielded an area under the curve of 0.89, sensitivity of 71%, and specificity of 92%. It also showed good diagnostic abilities in discovery set and identification set. Compared with that in healthy volunteers (median [interquartile range], 1.57 [1.01, 2.34] μg/mL), it was elevated in LC (4.76 [2.74, 7.08] μg/mL; ratio of median, [ROM] = 3.03, P < .01) and reduced in PTB (1.06 [0.51, 2.09] μg/mL; ROM = 0.68, P < .05). Conclusions The metabolomic profile of LC and PTB was described and a key biomarker identified. We produced a rapid and noninvasive method to supplement existing clinical diagnostic examinations for distinguishing LC from PTB. Untargeted and targeted metabolomic analysis was performed to describe the metabolomic profile of LC and PTB. A key biomarker, phenylalanylphenylalanine, was identified. This provides a noninvasive, rapid, accurate, easy-to-use method for diagnosis and to prevent misdiagnosis of LC and PTB.