Value of combined assessment of serum transforming growth factor-β1, interleukin-6, toll-like receptor-4, and nuclear factor-κb in evaluating the severity of radiation pneumonitis in non-small cell lung cancer

Objective To explore the value of combined assessment of serum transforming growth factor-β1(TGF-β1), interleukin-6(IL-6), Toll-like receptor-4(TLR-4), and nuclear factor-κB (NF-κB) in evaluating the severity of radiation pneumonitis (RP) in non-small cell lung cancer (NSCLC) patients.

Methods A total of 104 NSCLC patients with secondary RP after radiotherapy were selected as study group, and 52 NSCLC patients without secondary RP after radiotherapy were selected as control group.Serum levels of TGF-β1, IL-6, TLR-4, and NF-κB before and after radiotherapy were compared between the two groups.The levels of these serum markers in RP patients with different severity in the study group were also compared.The value of each serum marker alone and their combination for assessing the severity of RP after NSCLC radiotherapy was analyzed.

Results After radiotherapy, the serum levels of TGF-β1, IL-6, TLR-4, and NF-κB in the study group were significantly higher than those in the control group (P < 0.05).After radiotherapy, with the increase in the severity of RP, the serum levels of TGF-β1, IL-6, TLR-4, and NF-κB in the study group showed an increasing trend (P < 0.05).Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) for assessing grade 1 RP was 0.787 for TGF-β1, 0.718 for IL-6, 0.783 for TLR-4, and 0.801 for NF-κB, while the AUC for assessing ≥ grade 2 RP was 0.729, 0.740, 0.793, and 0.825, respectively.The risk of developing ≥ grade 2 RP in patients with positive expression of serum TGF-β1, IL-6, TLR-4, and NF-κB was 2.473, 2.275, 2.610, and 5.267 times higher than that in patients with negative expression, respectively (P < 0.05).The AUC for combined assessment of ≥ grade 2 RP using serum TGF-β1, IL-6, TLR-4, and NF-κB was 0.939, with a sensitivity of 76.00% and a specificity of 97.47%.

Conclusion The serum levels of TGF-β1, IL-6, TLR-4, and NF-κB in NSCLC patients after radiotherapy are positively correlated with the severity of RP.The combined assessment of these four markers has significant value in evaluating ≥ grade 2 RP and can provide a reference for clinical control of RP.