The influence of COVID-19 severity on the local lung hormonal profile in patients with non-small cell lung cancer.

Abstract

e20047 Background: Lung cancer is a leading cause of cancer-related mortality, with pronounced sex differences. The COVID-19 pandemic, which has sex-specific characteristics, highlights the role of sex hormones in the immune response. Since lungs are a hormone-sensitive organ that expresses receptors for a range of hormones, the level of the hormones in normal and abnormal lung tissue in the context of previous COVID-19 requires further investigation. The aim of the research was to investigate the influence of previous COVID-19 of varying severity on the levels of sex hormones and cortisol in the lung tissue of patients with non-small cell lung cancer (NSCLC). Methods: The study included 60 patients (mean age 59.1±2.9 years) with stage I-IIIA NSCLC and a history of SARS-CoV-2 infection. Based on infection severity, two groups were formed: main (n=30, severe infection requiring hospitalization) and control (n=30, asymptomatic/mild infection), comparable in age and sex. Concentrations of estradiol (E2), testosterone (T), progesterone (P4), and cortisol were measured in lung tumor and adjacent normal resection margin tissue using ELISA. Statistical analysis used Student's t-test and Mann-Whitney U-test; only significant differences (p<0.05) are reported. Results: Severe COVID-19 leads to significant changes in the hormonal background in the resection line tissue, especially in women: there were an increase in the levels of E2 (1.7 times), P4 (4.1 times), and cortisol (1.5 times), while the levels of T decreased (1.3 times) compared to the control group. In the main group of men, the levels of T and P4 increased in the resection line tissue (1.8 times), while the levels of E2 and cortisol did not change. The effect of severe COVID-19 on tumor tissue parameters was less pronounced: in patients of both sexes in the main group, the E2 level was significantly higher by an average of 1.7 times, and in women, the cortisol content also increased by 1.8 times, compared to the control values. Conclusions: Result obtained indicates that the key target for hormonal changes induced by severe COVID-19 in patients with NSCLC is not so much the tumor as the relatively healthy lung tissue. This may indicate a systemic influence of the infectious disease on the hormonal homeostasis of the entire organ. The increased vulnerability of women (hyperestrogenism, hypercortisolemia) suggests an increased risk of more aggressive NSCLC, as estrogen stimulates proliferation as well as cortisol suppresses immunity. The data obtained suggest that COVID-19, by modulating the hormonal environment in the lungs, may affect the course and prognosis of lung cancer, which requires further study in the context of disease risks, response to therapy, and long-term outcomes.