Investigating the Role of Leptin, Resistin, and Irisin Levels as Prognostic Indicators in Iraqi Lung Cancer Patients

Investigating the Role of Leptin, Resistin, and Irisin Levels as Prognostic Indicators in Iraqi Lung Cancer Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Investigating the Role of Leptin, Resistin, and Irisin Levels as Prognostic Indicators in Iraqi Lung Cancer Patients Noor Hanoush, Rashied Rashied, Abdul Rahman Mohammed This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4187821/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose Lung cancer is the most lethal malignancy and is often associated with a poor prognosis. However, limited studies have tested leptin, resistin, and irisin as biomarkers in lung cancers. Thus, this study aimed to determine whether irisin, resistin, and leptin could be useful biomarkers for lung cancer diagnosis. Methods The study is designed on 100 lung cancer patients at age rang (40–75) years, these patients divided in to (66) patients with non-small cell lung cancer (NSCLC) and (34) patients with small cell lung cancer (SCLC). For the purpose of comparison, (66) samples as control group with age range (40–70) years. Each patient and control had five milliliters of blood taken. Then the sera used to estimate the Leptin, Resistin, and Irisin by using ELISA technique. Results The results indicates the mean of Leptin was significant increase in NSCLC and SCLC groups (10.71 ± 0.30 and 10.13 ± 0.51)ng/ml respectively, in contrast to the control group (8.26 ± 0.47) ng/ml. The mean of Irisin significant increase in SCLC group (5.86 ± 0.13) pg/ml and NSCLC group(5.08 ± 0.09)pg/ml in contrast to the control group (4.13 ± 0.09) pg/ml. Resistin had been significant increase in SCLC group (7.25 ± 0.38)ng/ml followed by NSCLC group (6.35 ± 0.13)ng/ml compared with control group (3.96 ± 0.17) ng/ml. Conclusion The higher levels of leptin in NSCLC patients could serve as prognostic marker for NSCLC. The variations in Resistin and Irisin levels across different stages of lung cancer suggest that they might be useful in predicting the prognosis of lung cancer. Leptin Lung Cancer non-small cell lung cancer Prognostic Figures Figure 1 Introduction Lung cancer is one of the most pathogenic and fatal types of cancer in the world, affecting both men and women[ 1 ]. It starts in the cells of the lung organ and is referred to as primary lung cancer [ 2 ]. Every year, approximately 2 million people are diagnosed with lung cancer, with the majority of cases being detected in the late stages[ 1 ]. The total 5-year survival rate is still only 16%, despite improvements in outcomes and advancements in treatment[ 3 ]. The most significant factor in enhancing patient outcomes and survival rates is the discovery of accurate biomarkers to support early detection, diagnosis, and treatment monitoring [ 4 ]. Researchers have recently been examining the relationship between different physiological markers and the onset and spread of lung cancer, which can offer important insights into a person's physiological condition [ 3 , 5 ]. Leptin, Resistin, and Irisin are a few examples of the genetic, molecular, cellular, or biochemical components that may be included in these indicators and whose levels may change as cancer develops [ 4 , 5 ]. Gaining insight into the correlation between these markers and lung cancer may improve our comprehension of the fundamental mechanisms of the illness and pave the way for the development of tailored treatments [ 6 ]. The hormone leptin is non-glycosylated [ 7 ]. Elevated blood leptin levels have been found to be an independent risk factor for non-small-cell lung cancer (NSCLC) [ 8 ], despite one study suggesting a significant correlation between lower serum leptin levels and lung cancer prognosis 6 . Even after adjusting for BMI and recent weight reduction, the study by Bereda [ 7 ] found elevated leptin levels in NSCLC patients and identified leptin as a cancer risk factor. Resistin pro-inflammatory cytokine, which is mainly secreted from monocytes, dendritic cells, and macrophages in humans [ 9 ]. Resistin may be involved in many inflammatory and autoimmune processes, including cancer, inflammatory bowel disorders, and atherosclerosis, according to Increasing recent research [ 10 ]. There is still a dearth of information on resistin's relationship to various cancer types, despite prior research demonstration of this relationship [ 9 , 11 ]. According to one study, resistin and leptin might play a role in the development and spread of lung cancer [ 10 ]. Although resistin is less well studied and contentious in lung cancer, the amount of expression of this protein in cancer tissues has not been assessed in many papers [ 12 ]. One study found that higher circulating levels of resistin were associated with an increased risk of lung cancer [ 13 ]. Additionally, anti resistin antibody-treated mice have a lower incidence of lung tumors, indicating that resistin accelerates the progression of lung cancer. As a result, resistin may be a desirable target for the development of therapeutic approaches that target immune cells in the cancer microenvironment [ 14 , 15 ]. Irisin is an exercise-inducible myokine with a significant role in the regulation of body energy homeostasis [ 15 , 16 ]. Recent studies have documented that irisin is involved in the occurrence and development of a variety of tumors [ 16 , 17 ]. This study aims to investigate whether leptin, resistin, and irisin could be potential as a prognostic factor in lung cancer. Materials and methods Lung patients were collected from Anbar Cancer Center in AL-Ramadi city and the tumor Center in Baghdad Teaching Hospital. The Specimens collection were started from December, 2022 till end of November, 2023. The local Research Ethics Committee of the university of Anbar/ College of Medicine accepted the study protocol (Certificate No: 123 on November 23, 2023) in compliance with the Helsinki Declaration for Human Studies. A cross-sectional study was designed on 100 lung cancer patients at age rang (40–75) years, these patients divided in to (66) patients with non-small cell lung cancer (NSCLC) (41 males and 25 females) and (34) patients with small cell lung cancer (SCLC) (21 male and 13 females). The diagnosis was performed by medical oncologist. For the purpose of comparison, (66) samples as control group (34 males and 32 females) with age range (40–70) years included in the study. Sample selection Patients inclusion criteria they were newly diagnosed with lung cancer, and they were not initiating any therapeutic approach or receiving (1, 2, and 3) cycles of therapy. Patients exclusion criteria they had a history of other types of cancer or a family history of cancer, or received more than three cycles of therapy. Lung cancer patients with co-morbidities like HBsAg positivity. Controls Inclusion criteria controls were chosen from among participants who were in good health and were free of acute illness or infection at the time of sampling. Control Exclusion Criteria They have any endocrine abnormalities, are diabetic or hypertensive, and are comparatively similar in age and sex to the patient participants. Samples collection and laboratory measurements Before the collection of blood samples, a careful history was taken from each patient and control via interview: age, sex, duration of lung cancer, Height/weight, and Smoking, and written informed consent was obtained from each participant before to their involvement in the study. Each patient and control had five milliliters of blood taken. by disposable syringe after 12- hours fasting. The blood samples were placed in plain tubes and left 30 minutes to clot and centrifuged at 5000 round per minute (r.p.m) to obtained sera, which were placed in 1.5 mL Eppendorf tubes and kept cold until the analysis. In the lab, samples were examined using the enzyme-linked immunosorbent test (ELISA) using the Human Leptin (LEP) ELISA kit (Cat. No: ELK1160), the Human Resistin ELISA kit (Cat. No: ELK1225), and the Human Irisin ELISA kit (Cat. No: ELK6625). All ELISA kits were provided by ELK biotechnology company in China. The biomarkers were analyzed following the methods recommended by the kit manufacturer, and the color of the samples was measured spectrophotometrically at a wavelength of 450nm ± 10nm. By comparing the optical density (OD) of the samples to the standard curve, the quantities of these markers in the samples were ascertained. The information gathered was documented. Statistical Analysis: The SAS (2018) software was utilized to ascertain the impact of variance variables on the study parameters. The T-test and the least significant difference (LSD) test (ANOVA) were used to compare means statistically. The chi-square test was utilized to assess the different forms of lung cancer statistically (0.05 and 0.01 likelihood). Results The results shown a difference in patients and control according to age, sex, BMI, and smoking. Where the mean of age in lung cancer patients (66.15 ± 0.82) year no different from the mean of age in control (63.27 ± 1.60) year. While, the percentage of male (64%) is higher than the percentage of female (36%) in lung cancer group. Also in control group, high percent of male (51.5%) compared with female (48.5)%. The mean of BMI in lung cancer patients (26.30 ± 0.33) kg/m 2 is higher than the mean of BMI in control (24.52 ± 0.68) kg/m 2 . A larger percentage of lung cancer patients (67%) were smokers compared to non-smokers (33%). In contrast, the control group showed a high percentage of non-smokers (70%) compared to smokers (30%). A total of 100 sera from lung cancer, there are (30) patients with small cell lung cancer (SCLC) and (70) patients with non-small cell lung cancer (NSCLC). The present study found that significant higher percentage (70%) in patients with NSCLC compared with SCLC patients (30)% at level (P ≤ 0.01), as shown in table (1). Table (1): show clinical characteristics of patients and control. Characteristics Patients NO. (100) Control NO. (66) T-test P-value Age (year) Mean ± SE 66.15 ± 0.82 63.27 ± 1.60 3.346 0.061 Sex (M/F) No (%) 64/ 36 (64%) / (36%) 34/ 32 (51.5%)/(48.5%) - 0.0001 **/ 0.0166 ** BMI Mean ± SE 26.30 ± 0.33 24.52 ± 0.68 1.334 ** 0.0092 Smoking (smoker/no smoker) No (%) 67/33 (67%)/(33%) 12/28 (30%)/(70%) - 0.0001 **/ 0.0093 ** Lung cancer type SCLC (No / %) 30 / (30%) 0.0013 ** NSCLC (No / %) 70 / (70%) BMI = body mass index, M = male, F = female, SCLC = small cell lung cancer, NSCLC = non-small cell lung cancer. Stages of lung cancer The patients in this study are divided into four stages according to the staging or TNM system, which is based on the results of physical exams, biopsies, and other tests. The results show a significant difference at a level of p ≤ 0.05 in lung cancer stages among patients, with a high percentage (35%) of patients in stage IV, followed by stage III show a percentage (27%), while stage I and II shows a lower percentage (17% and 21%) respectively, as show in table (2). Table 2: Distribution of patients according to Stages in patients group . Factor No % Stages No (%) I 17 17.00 II 21 21.00 III 27 27.00 IV 35 35.00 Total 100 100% P-value --- 0.014 * * (P ≤ 0.05). Determination of Leptin, Irisin and Resistin hormone level between difference groups Table (3) indicates a significant different in leptin, irisin, and resistin hormone levels between study groups at (P ≤ 0.01). There was significant increase in mean of leptin in NSCLC and SCLC groups (10.51 ± 0.30 and 9.83 ± 0.51) ng/ml respectively, in contrast to the control group (8.26 ± 0.47) ng/ml. Resistin had been significant increase in SCLC group (7.25 ± 0.38) ng/ml compared with other groups. Also, resistin had been significant increase in NSCLC group (6.35 ± 0.13) ng/ml in contrast to the control group (3.96 ± 0.17) ng/ml at (p ≤ 0.01). While, mean of irisin significant increase in SCLC group (5.86 ± 0.13) pg/ml compared with other groups. Also, mean of irisin significant increase in NSCLC group (5.08 ± 0.09) pg/ml compared with control group was (4.13 ± 0.09) pg/ml. Table (3) Comparison between difference groups in leptin, resistin, and irisin. Group Mean ± S.E. Leptin (ng/ml) Resistin (ng/ml) Irisin (pg/ml) NSCLC 10.51 ± 0.30 a 6.35 ± 0.13 b 5.08 ± 0.09 b SCLC 9.83 ± 0.51 a 7.25 ± 0.38 a 5.86 ± 0.13 a Control 8.26 ± 0.47 b 3.96 ± 0.17 c 4.13 ± 0.09 c LSD value 1.163 ** 0.624 ** 0.298 ** P-value 0.0001 0.0001 0.0001 The means that had distinct letters in the same column varied significantly. ** (P ≤ 0.01). SCLC = small cell lung cancer, NSCLC = non-small cell lung cancer, LSD = the least significant difference, SE = stander error. Effect of Stage in Hormones level of Lung cancer patients: Table (4) indicate the levels of some hormones parameters in lung cancer stages. The mean of leptin show no significant different at all lung cancer stages. The mean of resistin showed a significant increase at Stage I (7.88 ± 0.56) ng/ml compared to the other stages, while there was no significant difference in the mean of resistin between Stages II (7.05 ± 0.29) and III (6.79 ± 0.34), significant decreased at Stage IV (5.67 ± 0.13). There were, a significant increase was observed in irsin level at Stage I (6.42 ± 0.13) pg/ml compared to the other stages, followed by stage II (5.86 ± 0.15). There were no significant different in irsin level between (III, and IV) stages (4.84 ± 0.15, and 4.57 ± 0.12) pg/ml respectively. Table (4): Effect of Stage in Hormones level of patients group Group Mean ± SE Leptin (ng/ml) Resistin (ng/ml) Irsin (pg/ml) I 10.12 ± 0.69 7.88 ± 0.56 a 6.42 ± 0.13 a II 9.21 ± 0.37 7.05 ± 0.29 b 5.86 ± 0.15 ab III 8.95 ± 0.59 6.79 ± 0.34 ab 4.84 ± 0.15 c IV 9.24 ± 0.47 5.67 ± 0.13 c 4.57 ± 0.12 c LSD value 1.712 NS 0.834 ** 0.461 ** P-value 0.9822 0.0001 0.0036 The means that had distinct letters in the same column varied significantly. ** (P ≤ 0.01). LSD = the least significant difference, SE = stander error. Correlation coefficient between study hormones and BMI in study groups As shown in the table (5) there are significant and positive correlations between BMI with resistin (r = 0.55, p = 0.0001; figure A), leptin with BMI (0.21, p = 0.038; figure F), irsin with BMI (0.31, p = 0.0001; figure D) in lung cancer patients. In control group all correlations were no significant except irsin with BMI show significant and positive correlations coefficient (r = 0.53, p = 0.0001). Table (5): Correlation coefficient between parameters study in patients and control groups. Parameters Correlation coefficient-r Patients group Control group Correlation coefficient-r P-value Correlation coefficient-r P-value Resistin and BMI 0.55 ** 0.0001 0.30 NS 0.081 Leptin and BMI 0.21 * 0.038 -0.17 NS 0.282 Irisin and BMI 0.31 ** 0.0001 0.53 ** 0.0001 * (P ≤ 0.05), ** (P ≤ 0.01), NS: Non-Significant. BMI = body mass index. Discussion The results show a higher percentage of males (64%) compared to females (36%) in the lung cancer group. The larger percentage in men may suggest that there are sex-specific risk factors for lung cancer development, as more men than women engage in risky behaviors like smoking or occupational exposures that are associated with the disease[ 18 , 19 ]. The variations in mean BMI between the control group and lung cancer patients could point to an association between a higher risk of developing lung cancer and an elevated BMI. While obesity is an established risk factor for several malignancies, it's vital to remember this. There are several factors that could contribute to the observed variation in BMI, including age, sex, and lifestyle choices [ 20 , 21 ]. Our results reported that the mean age of patients with lung cancer is 65.15 years. This suggests that the study's lung cancer patients are older than those in the control group. The variation in mean age suggests that being older might be a risk factor for lung cancer. This discovery is consistent with the well accepted notion that the risk of cancer rises with age [ 19 ]. The correlation between smoking and lung cancer is well-established, and this is supported by the higher percentage of smokers among patients with lung cancer. According to Hecht [ 22 ], tobacco smoke contains carcinogens that can harm lung cells and raise the risk of developing cancer. It is not always the case that lung cancer patients who smoke have a larger percentage of smoking among them [ 11 ]. A significant majority of individuals may be diagnosed with lung cancer at an advanced stage, as indicated by the increased percentage of patients in stage IV. This is problematic because advanced phases frequently present more difficult treatment and prognostic situations. Prognosis and treatment outcomes are typically better with early discovery (stages I and II) [ 23 ]. Large-scale research is needed to validate our findings, as serum leptin and resistin levels play a crucial role as pro-inflammatory cytokines in lung cancer. Nevertheless, their application as diagnostic or prognostic indicators is still viable. Leptin was detected high in our patients, particularly in patients with NSCLC. This might explain that leptin hormone is secreted from many adenomatous structures in the body, particularly from adipose tissue. Therefore, leptin secretion may be induced by paraneoplastic events or cytokine effects in lung carcinoma [ 7 , 24 ]. Our results agree with [ 25 ] who indicated that mean of leptin increase in lung cancer group contrast with control. The results of present study disagree with results by Tas, [ 26 ]; Hong, [ 27 ] who they recorded that the mean of leptin decrease in lung cancer compared with control. In Chine, according to the meta-analysis, leptin levels in serum and tissue may have a role in the etiology of lung cancer and tumor metastasis [ 28 ]. An earlier investigation revealed that leptin stimulation increases the growth of lung cancer by stimulating the production of immunoinflammatory cytokines, such as TNF-a and IL-6, and by causing resistance to apoptosis [ 27 ]. In one study, increased leptin in lung tissue was found to be associated with impairment in lung tissue, along with increased risk of NSCLC [ 7 ]. Many studies have concluded that elevated blood leptin levels may be predictive of lung cancer diagnosis and progression, suggesting that leptin plays a significant role in the pathophysiology of lung cancer [ 28 , 29 ]. Additionally, the current study's findings along with those of earlier research may enable us to pinpoint a novel marker for the diagnosis of lung cancer as well as a therapeutic target. A large number of studies have suggested that leptin has potential as an anticancer drug target [ 30 , 31 ]. While, Resistin hormone had been significant increase in SCLC and NSCLC group compared with control group. These results agree with results by Demiray et al ., [ 11 ] who indicated that lung cancer Patients' serum resistin levels were noticeably elevated (6.3 ± 1.9) ng/ml at (P = .025) than the control group (4.4 ± 0.5) ng/ml. It was stated that tissue inflammation and organ failure were linked to this increase[ 14 ]. Study by Nigro et al ., [ 32 ] indicated that NSCLC patients showed significantly higher serum resistin levels than healthy volunteers and they found that resistin might be involved in the pathophysiology of weight reduction in NSCLC patients. Our results disagree with[ 14 ] when who indicated that no significant correlation between the resistin level in the lung cancer and control groups. There aren't many studies looking into the connection between resistin and cancer. Peripheral blood monocytes, macrophages and adipose tissue produce resistin in tumor tissues[ 13 ]. Lung cancer patients may have elevated resistin levels due to both adipose tissue involvement and monocyte activation as a component of the greater inflammatory process 33,34 . The results by Gong et al ., [ 13 ] implied that resistin could increase the migration and invasion of lung adenocarcinoma cells. In the borderline regions of human lung cancer tissue, there is more resistin than in the non-cancerous portions reported by Kuo et al . [ 35 ]. These results show mean of Irisin significant increase in SCLC and NSCLC groups compared with control group. These results agree with results by Nowinska et al ., [ 36 ] who indicated that the Irisin level increase in NSCLC patients (2.25 ± 0.09) ng/ml compared with in control (1 ± 0.97)ng/ml. The results by Tsiani et al ., [ 37 ] consistent with our results increase Irisin levels in NSCLC tissue and in stromal fibroblasts, and they suggest that Irisin expression in stromal fibroblasts may be a separate predictor of survival for NSCLC patients as well as a possible link to enhanced cancer cell proliferation. In China, study by Shao et al ., [ 38 ] found that Irisin dramatically reduced NSCLC cell proliferation at concentrations of 20–50 nM, and decreased the migration and invasiveness of NSCLC cells at values greater than 20 nM [ 15 , 39 ]. Irisin is expressed in the greatest energy-demanding cells in normal bodily tissues, such as hepatocytes, cardiac muscle cells, and skeletal muscle fibers [ 37 ]. Furthermore, irisin enhances glucose absorption and is linked to glucose homeostasis. This could account for the increased production of irisin in lung cancer cells, which also have a high glucose absorption need as a result of tumor growth [ 39 ]. Many researches have observed that increased irisin expression in fibroblasts may function as an independent prognostic factor and is linked to a worse patient prognosis [ 37 , 38 ]. Perhaps only lung cancer exhibits irisin expression in the malignant stromal. No other form of cancer has been shown to express irisin in the stromal cells. This may just be a feature of lung tumors[ 16 , 37 ]. In tumor cells, Irisin expression levels were decreased with higher grades of malignancy and in larger tumors (T)[ 39 ]. Conclusion Based on our results, the higher levels of leptin in NSCLC patients could serve as screening and independent prognostic factor for NSCLC. The significant variations in resistin and Irisin levels across different stages of lung cancer suggest their potential utility in predicting the prognosis or progression of lung cancer. However, further large-scale studies are required to confirm our results. Declarations Acknowledgements The authors would like to thank all participants in this study. Funding sources This research is self‑funded. Data availability Enquiries about data availability should be directed to the authors. Competing interests The authors declare that they have no competing interests . Ethical approval The local Research Ethics Committee of the university of Anbar/ College of Medicine accepted the study protocol (Certificate No: 123 on November 23, 2023) in compliance with the Helsinki Declaration for Human Studies. Consent to participate Best practices in informed consent were followed and all participants consented to participate in this study . Author Contributions All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [Noor], [Rashied] and [Abdul Rahman]. The first draft of the manuscript was written by [Noor] and all authors commented on previous versions of the manuscript. 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Tsiani E, Wang J, Zhang W (2021) Current evidence of the role of the myokine irisin in cancer, Cancers 13(11):2628. Shao L, Zhang H, Zhou Q (2017) Irisin Suppresses the Migration, Proliferation, and Invasion of Lung Cancer Cells via Inhibition of Epithelial-to-Mesenchymal Transition. Biochem Biophys Res Commun 485:598–605. Pinkowska A, Lukaszewicz M, Pluciennik E (2021) The role of irisin in cancer disease, Cells 10(6):1479. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4187821","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":285449939,"identity":"b11f6b1e-3538-40c4-a1da-347db9a81ec6","order_by":0,"name":"Noor Hanoush","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBUlEQVRIiWNgGAWjYLACxgYwZfgARBqA2WxgRFCLsQHJWswkULTgAubszcc+MO6wi+Znb95WzVNhl2fOfvYBw4eywwx87AlYtVj2HEuewXgmOXdmz7Gy2zxnkoste9INGGecO8zAxvMAqxaDGznGDIxtzLkbbuSY3eZtY07ccCCNgZm3DahFArstUC31ufvvvzEr5m2rT9xw/hkD81/CWg7nbpDgMQMZnrjhBtAWRnxazhxLZkhsO54740xaseScM8cTd854xnCw51w6D06/HG8+zPCxrTq3v/3wxg9vKqoTt/OnMT74UWYtJ9+O3RYwwJA6AMQ8WMQJAzK0jIJRMApGwXAEAE5FXcw+a0TEAAAAAElFTkSuQmCC","orcid":"","institution":"University of Anbar","correspondingAuthor":true,"prefix":"","firstName":"Noor","middleName":"","lastName":"Hanoush","suffix":""},{"id":285449940,"identity":"83e48901-fc49-4bc5-b04d-41c3ff853d9c","order_by":1,"name":"Rashied Rashied","email":"","orcid":"","institution":"University of Anbar","correspondingAuthor":false,"prefix":"","firstName":"Rashied","middleName":"","lastName":"Rashied","suffix":""},{"id":285449941,"identity":"a53c4518-635b-4f67-8fcb-77bad44284c7","order_by":2,"name":"Abdul Rahman Mohammed","email":"","orcid":"","institution":"University of Anbar","correspondingAuthor":false,"prefix":"","firstName":"Abdul","middleName":"Rahman","lastName":"Mohammed","suffix":""}],"badges":[],"createdAt":"2024-03-29 12:14:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4187821/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4187821/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54106389,"identity":"5155e946-b0f8-4fc8-a819-c20010b77106","added_by":"auto","created_at":"2024-04-04 17:22:17","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":403453,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e(A): \u003c/strong\u003eRelationship between resistin and BMI in control.\u003cstrong\u003e (B): \u003c/strong\u003eRelationship between resistin and BMI in lung cancer patients.\u003cstrong\u003e (C):\u003c/strong\u003e Relationship between irisin and BMI in control.\u003cstrong\u003e (D): Re\u003c/strong\u003elationship between irisin and BMI in lung cancer patients.\u003cstrong\u003e (E): \u003c/strong\u003eRelationship between leptin and BMI in control.\u003cstrong\u003e (F): \u003c/strong\u003eRelationship between leptin and BMI in lung cancer patients.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4187821/v1/699c172261173d21982f8d17.jpg"},{"id":54108724,"identity":"5bbb6891-d435-4ccc-b873-f65c45873f5b","added_by":"auto","created_at":"2024-04-04 17:38:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":656434,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4187821/v1/c07d0903-e315-4b06-b276-47e0e2740fd4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Investigating the Role of Leptin, Resistin, and Irisin Levels as Prognostic Indicators in Iraqi Lung Cancer Patients","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLung cancer is one of the most pathogenic and fatal types of cancer in the world, affecting both men and women[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It starts in the cells of the lung organ and is referred to as primary lung cancer [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Every year, approximately 2\u0026nbsp;million people are diagnosed with lung cancer, with the majority of cases being detected in the late stages[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The total 5-year survival rate is still only 16%, despite improvements in outcomes and advancements in treatment[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe most significant factor in enhancing patient outcomes and survival rates is the discovery of accurate biomarkers to support early detection, diagnosis, and treatment monitoring [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Researchers have recently been examining the relationship between different physiological markers and the onset and spread of lung cancer, which can offer important insights into a person's physiological condition [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Leptin, Resistin, and Irisin are a few examples of the genetic, molecular, cellular, or biochemical components that may be included in these indicators and whose levels may change as cancer develops [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Gaining insight into the correlation between these markers and lung cancer may improve our comprehension of the fundamental mechanisms of the illness and pave the way for the development of tailored treatments [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe hormone leptin is non-glycosylated [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Elevated blood leptin levels have been found to be an independent risk factor for non-small-cell lung cancer (NSCLC) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], despite one study suggesting a significant correlation between lower serum leptin levels and lung cancer prognosis\u003csup\u003e6\u003c/sup\u003e. Even after adjusting for BMI and recent weight reduction, the study by Bereda [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] found elevated leptin levels in NSCLC patients and identified leptin as a cancer risk factor.\u003c/p\u003e \u003cp\u003eResistin pro-inflammatory cytokine, which is mainly secreted from monocytes, dendritic cells, and macrophages in humans [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Resistin may be involved in many inflammatory and autoimmune processes, including cancer, inflammatory bowel disorders, and atherosclerosis, according to Increasing recent research [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. There is still a dearth of information on resistin's relationship to various cancer types, despite prior research demonstration of this relationship [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. According to one study, resistin and leptin might play a role in the development and spread of lung cancer [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Although resistin is less well studied and contentious in lung cancer, the amount of expression of this protein in cancer tissues has not been assessed in many papers [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. One study found that higher circulating levels of resistin were associated with an increased risk of lung cancer [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Additionally, anti resistin antibody-treated mice have a lower incidence of lung tumors, indicating that resistin accelerates the progression of lung cancer. As a result, resistin may be a desirable target for the development of therapeutic approaches that target immune cells in the cancer microenvironment [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Irisin is an exercise-inducible myokine with a significant role in the regulation of body energy homeostasis [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Recent studies have documented that irisin is involved in the occurrence and development of a variety of tumors [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This study aims to investigate whether leptin, resistin, and irisin could be potential as a prognostic factor in lung cancer.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eLung patients were collected from Anbar Cancer Center in AL-Ramadi city and the tumor Center in Baghdad Teaching Hospital. The Specimens collection were started from December, 2022 till end of November, 2023. The local Research Ethics Committee of the university of Anbar/ College of Medicine accepted the study protocol (Certificate No: 123 on November 23, 2023) in compliance with the Helsinki Declaration for Human Studies.\u003c/p\u003e \u003cp\u003eA cross-sectional study was designed on 100 lung cancer patients at age rang (40\u0026ndash;75) years, these patients divided in to (66) patients with non-small cell lung cancer (NSCLC) (41 males and 25 females) and (34) patients with small cell lung cancer (SCLC) (21 male and 13 females). The diagnosis was performed by medical oncologist. For the purpose of comparison, (66) samples as control group (34 males and 32 females) with age range (40\u0026ndash;70) years included in the study.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSample selection\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003ePatients inclusion criteria\u003c/strong\u003e \u003cp\u003ethey were newly diagnosed with lung cancer, and they were not initiating any therapeutic approach or receiving (1, 2, and 3) cycles of therapy.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePatients exclusion criteria\u003c/strong\u003e \u003cp\u003ethey had a history of other types of cancer or a family history of cancer, or received more than three cycles of therapy. Lung cancer patients with co-morbidities like HBsAg positivity.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eControls Inclusion criteria\u003c/strong\u003e \u003cp\u003e controls were chosen from among participants who were in good health and were free of acute illness or infection at the time of sampling.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eControl Exclusion Criteria\u003c/strong\u003e \u003cp\u003eThey have any endocrine abnormalities, are diabetic or hypertensive, and are comparatively similar in age and sex to the patient participants.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSamples collection and laboratory measurements\u003c/h2\u003e \u003cp\u003e Before the collection of blood samples, a careful history was taken from each patient and control via interview: age, sex, duration of lung cancer, Height/weight, and Smoking, and written informed consent was obtained from each participant before to their involvement in the study. Each patient and control had five milliliters of blood taken. by disposable syringe after 12- hours fasting. The blood samples were placed in plain tubes and left 30 minutes to clot and centrifuged at 5000 round per minute (r.p.m) to obtained sera, which were placed in 1.5 mL Eppendorf tubes and kept cold until the analysis. In the lab, samples were examined using the enzyme-linked immunosorbent test (ELISA) using the Human Leptin (LEP) ELISA kit (Cat. No: ELK1160), the Human Resistin ELISA kit (Cat. No: ELK1225), and the Human Irisin ELISA kit (Cat. No: ELK6625). All ELISA kits were provided by ELK biotechnology company in China. The biomarkers were analyzed following the methods recommended by the kit manufacturer, and the color of the samples was measured spectrophotometrically at a wavelength of 450nm\u0026thinsp;\u0026plusmn;\u0026thinsp;10nm. By comparing the optical density (OD) of the samples to the standard curve, the quantities of these markers in the samples were ascertained. The information gathered was documented.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis:\u003c/h2\u003e \u003cp\u003eThe SAS (2018) software was utilized to ascertain the impact of variance variables on the study parameters. The T-test and the least significant difference (LSD) test (ANOVA) were used to compare means statistically. The chi-square test was utilized to assess the different forms of lung cancer statistically (0.05 and 0.01 likelihood).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe results shown a difference in patients and control according to age, sex, BMI, and smoking. Where the mean of age in lung cancer patients (66.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82) year no different from the mean of age in control (63.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.60) year. While, the percentage of male (64%) is higher than the percentage of female (36%) in lung cancer group. Also in control group, high percent of male (51.5%) compared with female (48.5)%. The mean of BMI in lung cancer patients (26.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33) kg/m\u003csup\u003e2\u003c/sup\u003e is higher than the mean of BMI in control (24.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68) kg/m\u003csup\u003e2\u003c/sup\u003e. A larger percentage of lung cancer patients (67%) were smokers compared to non-smokers (33%). In contrast, the control group showed a high percentage of non-smokers (70%) compared to smokers (30%). A total of 100 sera from lung cancer, there are (30) patients with small cell lung cancer (SCLC) and (70) patients with non-small cell lung cancer (NSCLC). The present study found that significant higher percentage (70%) in patients with NSCLC compared with SCLC patients (30)% at level (P\u0026thinsp;\u0026le;\u0026thinsp;0.01), as shown in table (1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;(1): show clinical characteristics of patients and control.\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Taba\" border=\"1\"\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eCharacteristics\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePatients\u003c/p\u003e\n\u003cp\u003eNO. (100)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eControl\u003c/p\u003e\n\u003cp\u003eNO. (66)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eT-test\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP-value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eAge (year)\u003c/p\u003e\n\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SE\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e66.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e63.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.60\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e3.346\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e0.061\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eSex (M/F)\u003c/p\u003e\n\u003cp\u003eNo (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e64/ 36\u003c/p\u003e\n\u003cp\u003e(64%) / (36%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e34/ 32\u003c/p\u003e\n\u003cp\u003e(51.5%)/(48.5%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e0.0001 **/ 0.0166 **\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBMI\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SE\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e26.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e24.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e1.334 **\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.0092\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSmoking (smoker/no smoker)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNo (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e67/33\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(67%)/(33%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e12/28\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(30%)/(70%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.0001 **/ 0.0093 **\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eLung cancer type\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSCLC (No / %)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e30 / (30%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.0013 **\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNSCLC (No / %)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e70 / (70%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eBMI\u0026thinsp;=\u0026thinsp;body mass index, M\u0026thinsp;=\u0026thinsp;male, F\u0026thinsp;=\u0026thinsp;female, SCLC\u0026thinsp;=\u0026thinsp;small cell lung cancer, NSCLC\u0026thinsp;=\u0026thinsp;non-small cell lung cancer.\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n\u003ch2\u003eStages of lung cancer\u003c/h2\u003e\n\u003cp\u003eThe patients in this study are divided into four stages according to the staging or TNM system, which is based on the results of physical exams, biopsies, and other tests. The results show a significant difference at a level of p\u0026thinsp;\u0026le;\u0026thinsp;0.05 in lung cancer stages among patients, with a high percentage (35%) of patients in stage IV, followed by stage III show a percentage (27%), while stage I and II shows a lower percentage (17% and 21%) respectively, as show in table (2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: \u003c/strong\u003eDistribution of patients according to Stages in patients group\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eFactor\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e%\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"6\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eStages\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNo (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eII\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIII\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIV\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e100\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e100%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP-value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e---\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.014 *\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e* (P\u0026thinsp;\u0026le;\u0026thinsp;0.05).\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003eDetermination of Leptin, Irisin and Resistin hormone level between difference groups\u003c/h2\u003e\n\u003cp\u003eTable\u0026nbsp;(3) indicates a significant different in leptin, irisin, and resistin hormone levels between study groups at (P\u0026thinsp;\u0026le;\u0026thinsp;0.01). There was significant increase in mean of leptin in NSCLC and SCLC groups (10.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30 and 9.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51) ng/ml respectively, in contrast to the control group (8.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47) ng/ml. Resistin had been significant increase in SCLC group (7.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38) ng/ml compared with other groups. Also, resistin had been significant increase in NSCLC group (6.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13) ng/ml in contrast to the control group (3.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17) ng/ml at (p\u0026thinsp;\u0026le;\u0026thinsp;0.01). While, mean of irisin significant increase in SCLC group (5.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13) pg/ml compared with other groups. Also, mean of irisin significant increase in NSCLC group (5.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09) pg/ml compared with control group was (4.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09) pg/ml.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;(3)\u0026nbsp;\u003c/strong\u003eComparison between difference groups in leptin, resistin, and irisin.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tabb\" border=\"1\"\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eGroup\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;S.E.\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eLeptin (ng/ml)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eResistin (ng/ml)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eIrisin (pg/ml)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNSCLC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSCLC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eControl\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLSD value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.163 **\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.624 **\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.298 **\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP-value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eThe means that had distinct letters in the same column varied significantly. ** (P\u0026thinsp;\u0026le;\u0026thinsp;0.01).\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eSCLC\u0026thinsp;=\u0026thinsp;small cell lung cancer, NSCLC\u0026thinsp;=\u0026thinsp;non-small cell lung cancer, LSD\u0026thinsp;=\u0026thinsp;the least significant difference, SE\u0026thinsp;=\u0026thinsp;stander error.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n\u003ch2\u003eEffect of Stage in Hormones level of Lung cancer patients:\u003c/h2\u003e\n\u003cp\u003eTable\u0026nbsp;(4) indicate the levels of some hormones parameters in lung cancer stages. The mean of leptin show no significant different at all lung cancer stages. The mean of resistin showed a significant increase at Stage I (7.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56) ng/ml compared to the other stages, while there was no significant difference in the mean of resistin between Stages II (7.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29) and III (6.79\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34), significant decreased at Stage IV (5.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13). There were, a significant increase was observed in irsin level at Stage I (6.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13) pg/ml compared to the other stages, followed by stage II (5.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15). There were no significant different in irsin level between (III, and IV) stages (4.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15, and 4.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12) pg/ml respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;(4): Effect of Stage in Hormones level of patients group\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tabc\" border=\"1\"\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eGroup\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SE\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eLeptin (ng/ml)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eResistin (ng/ml)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eIrsin (pg/ml)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eII\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.37\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15 \u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIII\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.79\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34 \u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIV\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLSD value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.712 \u003csup\u003eNS\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.834 **\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.461 **\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP-value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.9822\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0036\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eThe means that had distinct letters in the same column varied significantly. ** (P\u0026thinsp;\u0026le;\u0026thinsp;0.01).\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eLSD\u0026thinsp;=\u0026thinsp;the least significant difference, SE\u0026thinsp;=\u0026thinsp;stander error.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n\u003ch2\u003eCorrelation coefficient between study hormones and BMI in study groups\u003c/h2\u003e\n\u003cp\u003eAs shown in the table (5) there are significant and positive correlations between BMI with resistin (r\u0026thinsp;=\u0026thinsp;0.55, p\u0026thinsp;=\u0026thinsp;0.0001; figure A), leptin with BMI (0.21, p\u0026thinsp;=\u0026thinsp;0.038; figure F), irsin with BMI (0.31, p\u0026thinsp;=\u0026thinsp;0.0001; figure D) in lung cancer patients. In control group all correlations were no significant except irsin with BMI show significant and positive correlations coefficient (r\u0026thinsp;=\u0026thinsp;0.53, p\u0026thinsp;=\u0026thinsp;0.0001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;(5): Correlation coefficient between parameters study in patients and control groups.\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tabd\" border=\"1\"\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eParameters\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eCorrelation coefficient-r\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003ePatients group\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eControl group\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCorrelation coefficient-r\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP-value\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCorrelation coefficient-r\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP-value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eResistin and BMI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.55 **\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.30 NS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.081\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eLeptin and BMI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.21 *\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.038\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.17 NS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.282\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eIrisin and BMI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.31 **\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.53 **\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e* (P\u0026thinsp;\u0026le;\u0026thinsp;0.05), ** (P\u0026thinsp;\u0026le;\u0026thinsp;0.01), NS: Non-Significant.\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eBMI\u0026thinsp;=\u0026thinsp;body mass index.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe results show a higher percentage of males (64%) compared to females (36%) in the lung cancer group. The larger percentage in men may suggest that there are sex-specific risk factors for lung cancer development, as more men than women engage in risky behaviors like smoking or occupational exposures that are associated with the disease[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe variations in mean BMI between the control group and lung cancer patients could point to an association between a higher risk of developing lung cancer and an elevated BMI. While obesity is an established risk factor for several malignancies, it's vital to remember this. There are several factors that could contribute to the observed variation in BMI, including age, sex, and lifestyle choices [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur results reported that the mean age of patients with lung cancer is 65.15 years. This suggests that the study's lung cancer patients are older than those in the control group. The variation in mean age suggests that being older might be a risk factor for lung cancer. This discovery is consistent with the well accepted notion that the risk of cancer rises with age [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The correlation between smoking and lung cancer is well-established, and this is supported by the higher percentage of smokers among patients with lung cancer. According to Hecht [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], tobacco smoke contains carcinogens that can harm lung cells and raise the risk of developing cancer. It is not always the case that lung cancer patients who smoke have a larger percentage of smoking among them [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. A significant majority of individuals may be diagnosed with lung cancer at an advanced stage, as indicated by the increased percentage of patients in stage IV. This is problematic because advanced phases frequently present more difficult treatment and prognostic situations. Prognosis and treatment outcomes are typically better with early discovery (stages I and II) [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLarge-scale research is needed to validate our findings, as serum leptin and resistin levels play a crucial role as pro-inflammatory cytokines in lung cancer. Nevertheless, their application as diagnostic or prognostic indicators is still viable. Leptin was detected high in our patients, particularly in patients with NSCLC. This might explain that leptin hormone is secreted from many adenomatous structures in the body, particularly from adipose tissue. Therefore, leptin secretion may be induced by paraneoplastic events or cytokine effects in lung carcinoma [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Our results agree with [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] who indicated that mean of leptin increase in lung cancer group contrast with control. The results of present study disagree with results by Tas, [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]; Hong, [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] who they recorded that the mean of leptin decrease in lung cancer compared with control. In Chine, according to the meta-analysis, leptin levels in serum and tissue may have a role in the etiology of lung cancer and tumor metastasis [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. An earlier investigation revealed that leptin stimulation increases the growth of lung cancer by stimulating the production of immunoinflammatory cytokines, such as TNF-a and IL-6, and by causing resistance to apoptosis [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn one study, increased leptin in lung tissue was found to be associated with impairment in lung tissue, along with increased risk of NSCLC [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Many studies have concluded that elevated blood leptin levels may be predictive of lung cancer diagnosis and progression, suggesting that leptin plays a significant role in the pathophysiology of lung cancer [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Additionally, the current study's findings along with those of earlier research may enable us to pinpoint a novel marker for the diagnosis of lung cancer as well as a therapeutic target. A large number of studies have suggested that leptin has potential as an anticancer drug target [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. While, Resistin hormone had been significant increase in SCLC and NSCLC group compared with control group. These results agree with results by Demiray \u003cem\u003eet al\u003c/em\u003e., [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] who indicated that lung cancer Patients' serum resistin levels were noticeably elevated (6.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9) ng/ml at (P\u0026thinsp;=\u0026thinsp;.025) than the control group (4.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5) ng/ml. It was stated that tissue inflammation and organ failure were linked to this increase[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Study by Nigro \u003cem\u003eet al\u003c/em\u003e., [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] indicated that NSCLC patients showed significantly higher serum resistin levels than healthy volunteers and they found that resistin might be involved in the pathophysiology of weight reduction in NSCLC patients. Our results disagree with[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] when who indicated that no significant correlation between the resistin level in the lung cancer and control groups. There aren't many studies looking into the connection between resistin and cancer. Peripheral blood monocytes, macrophages and adipose tissue produce resistin in tumor tissues[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Lung cancer patients may have elevated resistin levels due to both adipose tissue involvement and monocyte activation as a component of the greater inflammatory process\u003csup\u003e33,34\u003c/sup\u003e. The results by Gong \u003cem\u003eet al\u003c/em\u003e., [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] implied that resistin could increase the migration and invasion of lung adenocarcinoma cells. In the borderline regions of human lung cancer tissue, there is more resistin than in the non-cancerous portions reported by Kuo \u003cem\u003eet al\u003c/em\u003e. [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThese results show mean of Irisin significant increase in SCLC and NSCLC groups compared with control group. These results agree with results by Nowinska \u003cem\u003eet al\u003c/em\u003e., [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] who indicated that the Irisin level increase in NSCLC patients (2.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09) ng/ml compared with in control (1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97)ng/ml. The results by Tsiani \u003cem\u003eet al\u003c/em\u003e., [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] consistent with our results increase Irisin levels in NSCLC tissue and in stromal fibroblasts, and they suggest that Irisin expression in stromal fibroblasts may be a separate predictor of survival for NSCLC patients as well as a possible link to enhanced cancer cell proliferation. In China, study by Shao \u003cem\u003eet al\u003c/em\u003e., [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] found that Irisin dramatically reduced NSCLC cell proliferation at concentrations of 20\u0026ndash;50 nM, and decreased the migration and invasiveness of NSCLC cells at values greater than 20 nM [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Irisin is expressed in the greatest energy-demanding cells in normal bodily tissues, such as hepatocytes, cardiac muscle cells, and skeletal muscle fibers [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Furthermore, irisin enhances glucose absorption and is linked to glucose homeostasis. This could account for the increased production of irisin in lung cancer cells, which also have a high glucose absorption need as a result of tumor growth [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Many researches have observed that increased irisin expression in fibroblasts may function as an independent prognostic factor and is linked to a worse patient prognosis [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Perhaps only lung cancer exhibits irisin expression in the malignant stromal. No other form of cancer has been shown to express irisin in the stromal cells. This may just be a feature of lung tumors[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. In tumor cells, Irisin expression levels were decreased with higher grades of malignancy and in larger tumors (T)[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBased on our results, the higher levels of leptin in NSCLC patients could serve as screening and independent prognostic factor for NSCLC. The significant variations in resistin and Irisin levels across different stages of lung cancer suggest their potential utility in predicting the prognosis or progression of lung cancer. However, further large-scale studies are required to confirm our results.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all participants in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding sources\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research is self‑funded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEnquiries about data availability should be directed to the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe local Research Ethics Committee of the university of Anbar/ College of Medicine accepted the study protocol (Certificate No: 123 on November 23, 2023) in compliance with the Helsinki Declaration for Human Studies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBest practices in informed consent were followed and all participants consented to participate in this study\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [Noor], [Rashied] and [Abdul Rahman]. The first draft of the manuscript was written by [Noor] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eThandra KC, Barsouk A, Saginala K, Aluru JS, Barsouk A (2021) Epidemiology of lung cancer, Contemp Oncol (Pozn) 25(1):45-52.\u003c/li\u003e\n\u003cli\u003eParma B (2023) Identification of the mitochondrial HSPD1 as metabolic vulnerability in non-small cell lung cancer [Ph.D. dissertation]. 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\u003c/li\u003e\n\u003cli\u003eBereda G (2023) Application of Leptin in Enhancing Immunity and Maintaining Obesity, J Clin Case Stud Rev Reports 5(1):2-2.\u003c/li\u003e\n\u003cli\u003eCaruso A, Di Noia V, Grasso V, et al (2023) Leptin: A Heavyweight Player in Obesity-Related Cancers, Biomolecules 13(7):1084.\u003c/li\u003e\n\u003cli\u003eAbdalla MMI (2023) Serum resistin and the risk for hepatocellular carcinoma in diabetic patients, World J Gastroenterol 29(27):4271.\u003c/li\u003e\n\u003cli\u003eAshour MA, Elarabi AM, Al-Hussaini H, et al (2023) Insulin Resistance, Resistin Hormone and Hepatocellular Carcinoma Interplay: A Review Article, Egypt J Hosp Med 90(2):2041-2044.\u003c/li\u003e\n\u003cli\u003eDemiray G, Ulasli M, Alp E, et al (2017) Effects of serum leptin and resistin levels on cancer cachexia in patients with advanced-stage non\u0026ndash;small cell lung cancer, Clin Med Insights Oncol 11:1179554917690144.\u003c/li\u003e\n\u003cli\u003eZhao CC, Xue L, Zhang J, et al (2018) Increased resistin suggests poor prognosis and promotes development of lung adenocarcinoma, Oncol Rep 40(6):3392-3404.\u003c/li\u003e\n\u003cli\u003eGong WJ, Zheng W, Xiao L, et al (2018) Resistin facilitates metastasis of lung adenocarcinoma through the TLR 4/Src/EGFR/PI 3K/NF‐\u0026kappa;B pathway, Cancer Sci 109(8):2391-2400.\u003c/li\u003e\n\u003cli\u003eG\u0026ouml;ktepe M, Selvi A, Eroglu A, et al (2020) Evaluation of serum resistin, visfatin, and chemerin levels in patients with lung cancer and chronic obstructive pulmonary disease, Turk Thorac J 21(3):169.\u003c/li\u003e\n\u003cli\u003eAbd Temur A, Rashid FA (2022) The relationship between circulating irisin and oxidative stress in gastric and colorectal cancer patients, Asian Pac J Cancer Prev 23(8):2649.\u003c/li\u003e\n\u003cli\u003eTemur AA, Rashid FA (2021) Irisin and Carcinoembryonic Antigen (CEA) as Potential Diagnostic Biomarkers in Gastric and Colorectal Cancers, Rep Biochem Mol Biol 10:488\u0026ndash;494.\u003c/li\u003e\n\u003cli\u003eLiu S, Cui F, Ning K, Wang Z, Fu P, Wang D, Xu H (2022) Role of irisin in physiology and pathology, Front Endocrinol 13:962\u0026ndash;968.\u003c/li\u003e\n\u003cli\u003eStapelfeld C, Dammann C, Maser E (2020) Sex-specificity in lung cancer risk, Int J Cancer 146(9):2376\u0026ndash;2382.\u003c/li\u003e\n\u003cli\u003eMederos N, Friedlaender A, Peters S, Addeo A (2020) Gender-specific aspects of epidemiology, molecular genetics and outcome: lung cancer, ESMO Open 5:e000796.\u003c/li\u003e\n\u003cli\u003eArdesch FH, Ruiter R, Mulder M, Lahousse L, Stricker BHC, Kiefte-de Jong JC (2020) The obesity paradox in lung cancer: associations with body size versus body shape, Front Oncol 10:591110.\u003c/li\u003e\n\u003cli\u003eLi M, Cao SM, Dimou N, Wu L, Li JB, Yang J (2024) Association of metabolic syndrome with risk of lung cancer: a population-based prospective cohort study, Chest 165(1):213\u0026ndash;223.\u003c/li\u003e\n\u003cli\u003eHecht SS (2012) Lung carcinogenesis by tobacco smoke, Int J Cancer 131(12):2724\u0026ndash;2732.\u003c/li\u003e\n\u003cli\u003eBlandin Knight S, Crosbie PA, Balata H, Chudziak J, Hussell T, Dive C (2017) Progress and prospects of early detection in lung cancer, Open Biol 7(9):170070.\u003c/li\u003e\n\u003cli\u003eVita E, Pozzi V, Pisano C, Barresi S, Scambia G, Ferrandina G (2023) Leptin-mediated meta-inflammation may provide survival benefit in patients receiving maintenance immunotherapy for extensive-stage small cell lung cancer (ES-SCLC), Cancer Immunol Immunother 72(11):3803\u0026ndash;3812.\u003c/li\u003e\n\u003cli\u003eSong CH, Yang JH, Park JH, Lee JH, Kim HJ (2014) Is leptin a predictive factor in patients with lung cancer, Clin Biochem 47:230\u0026ndash;232.\u003c/li\u003e\n\u003cli\u003eTas F, Duranyildiz D, Argon A, Oguz H, Camlica H, Yasasever V (2015) Serum levels of leptin and proinflammatory cytokines in advanced-stage non-small cell lung cancer, Med Oncol 22:353\u0026ndash;358.\u003c/li\u003e\n\u003cli\u003eHong X, Xu Q, Yang Z, Huang Z, Chen X, Zhang X (2013) Expression of serum leptin in small cell lung cancer and its clinical significance (Chinese), J Oncol 427\u0026ndash;430.\u003c/li\u003e\n\u003cli\u003eTong X, Liang Z, Zhuang J, Zhu J, Chen J, Yuan W (2017) Serum and tissue leptin in lung cancer: A meta-analysis, Oncotarget 8(12):19699.\u003c/li\u003e\n\u003cli\u003eBocian-Jastrzębska A, Malczewska-Herman A, Kos-Kudła B (2023) Role of leptin and adiponectin in carcinogenesis, Cancers 15(17):4250.\u003c/li\u003e\n\u003cli\u003eGreco M, Chiefari E, Montalcini T, Accattato F, Costanzo FS, Pujia A (2021) Leptin-activity modulators and their potential pharmaceutical applications, Biomolecules 11(7):1045.\u003c/li\u003e\n\u003cli\u003eWang J, Lou Y, Jiang Y, Liu Y, Zhang H, Li X, et al (2021) Autocrined leptin promotes proliferation of non-small cell lung cancer (NSCLC) via PI3K/AKT and p53 pathways, Ann Transl Med 9(7).\u003c/li\u003e\n\u003cli\u003eNigro E, Daniele M, Nigro E, Ciccodicola A (2020) Implications of the adiponectin system in non-Small cell lung cancer patients: A case-control study, Biomolecules 10(6):926.\u003c/li\u003e\n\u003cli\u003eSacher AG, Marrone KA, Iafrate AJ, Heist RS, Sequist LV (2016) Prospective validation of rapid plasma genotyping for the detection of EGFR and KRAS mutations in advanced lung cancer, JAMA Oncol 2:1014\u0026ndash;22.\u003c/li\u003e\n\u003cli\u003eSudan SK, Kumar A, Kumar Y, Bhatt MLB (2020) Resistin: An inflammatory cytokine with multi-faceted roles in cancer, Biochim Biophys Acta - Rev Cancer 1874(2):188419.\u003c/li\u003e\n\u003cli\u003eKuo C-H, Liu Y-C, Wu S-Y (2013) Lung tumor‐associated dendritic cell‐derived resistin promoted cancer progression by increasing Wolf\u0026ndash;Hirschhorn syndrome candidate 1/Twist pathway, Carcinogenesis 34:2600\u0026ndash;2609.\u003c/li\u003e\n\u003cli\u003eNowinska K, Staszewicz B, Bednarek AK, Sarnowska E, Mlak R (2019) Expression of Irisin/FNDC5 in Cancer Cells and Stromal Fibroblasts of Non-Small Cell Lung Cancer, Cancers 11:1538.\u003c/li\u003e\n\u003cli\u003eTsiani E, Wang J, Zhang W (2021) Current evidence of the role of the myokine irisin in cancer, Cancers 13(11):2628.\u003c/li\u003e\n\u003cli\u003eShao L, Zhang H, Zhou Q (2017) Irisin Suppresses the Migration, Proliferation, and Invasion of Lung Cancer Cells via Inhibition of Epithelial-to-Mesenchymal Transition. Biochem Biophys Res Commun 485:598\u0026ndash;605.\u003c/li\u003e\n\u003cli\u003ePinkowska A, Lukaszewicz M, Pluciennik E (2021) The role of irisin in cancer disease, Cells 10(6):1479.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Leptin, Lung Cancer, non-small cell lung cancer, Prognostic","lastPublishedDoi":"10.21203/rs.3.rs-4187821/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4187821/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eLung cancer is the most lethal malignancy and is often associated with a poor prognosis. However, limited studies have tested leptin, resistin, and irisin as biomarkers in lung cancers. Thus, this study aimed to determine whether irisin, resistin, and leptin could be useful biomarkers for lung cancer diagnosis.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe study is designed on 100 lung cancer patients at age rang (40\u0026ndash;75) years, these patients divided in to (66) patients with non-small cell lung cancer (NSCLC) and (34) patients with small cell lung cancer (SCLC). For the purpose of comparison, (66) samples as control group with age range (40\u0026ndash;70) years. Each patient and control had five milliliters of blood taken. Then the sera used to estimate the Leptin, Resistin, and Irisin by using ELISA technique.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe results indicates the mean of Leptin was significant increase in NSCLC and SCLC groups (10.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30 and 10.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51)ng/ml respectively, in contrast to the control group (8.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47) ng/ml. The mean of Irisin significant increase in SCLC group (5.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13) pg/ml and NSCLC group(5.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09)pg/ml in contrast to the control group (4.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09) pg/ml. Resistin had been significant increase in SCLC group (7.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38)ng/ml followed by NSCLC group (6.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13)ng/ml compared with control group (3.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17) ng/ml.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe higher levels of leptin in NSCLC patients could serve as prognostic marker for NSCLC. The variations in Resistin and Irisin levels across different stages of lung cancer suggest that they might be useful in predicting the prognosis of lung cancer.\u003c/p\u003e","manuscriptTitle":"Investigating the Role of Leptin, Resistin, and Irisin Levels as Prognostic Indicators in Iraqi Lung Cancer Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-04 17:22:11","doi":"10.21203/rs.3.rs-4187821/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e5071c3a-a38e-4b21-be13-e873409133c0","owner":[],"postedDate":"April 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-04T17:22:13+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-04 17:22:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4187821","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4187821","identity":"rs-4187821","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}