Truong Ngoc Uyen, deB Edwardes Michael D, Papavasiliou Vasilios, Goltzman David, Kremer Richard
Department of Medicine, Royal Victoria Hospital, Montreal, Canada.
Am J Med. 2003 Aug 1;115(2):115-21. doi: 10.1016/s0002-9343(03)00310-3.
Parathyroid hormone-related peptide (PTHrP) is the predominant cause of malignancy-associated hypercalcemia. However, its prognostic utility is unclear. We aimed to determine the prognostic value of serum PTHrP levels in patients who had hypercalcemia associated with malignancy.
In this prospective case series, we evaluated 76 patients with a diagnosis of cancer and hypercalcemia (serum calcium level >/=10.3 mg/dL on at least two occasions). PTHrP levels >/=1 pmol/L were considered elevated. We used multivariate Cox regression analysis to identify factors associated with mortality.
Fifty patients (66%) died during follow-up. In a multivariate analysis, higher pretreatment calcium levels and elevated PTHrP levels were associated with increased mortality, with effects of PTHrP varying by age (P = 0.03). Survival was associated with pretreatment calcium levels both in patients over 65 years of age (hazard ratio [HR] per mg/dL = 1.5; 95% confidence interval [CI]: 1.2 to 1.8; P <0.001) and in patients aged 65 years or less (HR = 1.3; 95% CI: 1.1 to 1.5; P = 0.003). Adjusted for pretreatment calcium levels, elevated PTHrP levels were associated with increased mortality in patients aged </=65 years (HR = 3.8; 95% CI: 1.6 to 8.8; P = 0.002), but not in older patients (HR = 0.7; 95% CI: 0.3 to 1.9; P = 0.51).
PTHrP is a useful prognostic factor in malignancy-associated hypercalcemia, at least in patients aged </=65 years.
甲状旁腺激素相关肽（PTHrP）是恶性肿瘤相关性高钙血症的主要病因。然而，其预后价值尚不清楚。我们旨在确定血清PTHrP水平在恶性肿瘤相关性高钙血症患者中的预后价值。
在这个前瞻性病例系列中，我们评估了76例诊断为癌症并伴有高钙血症（至少两次血清钙水平≥10.3mg/dL）的患者。PTHrP水平≥1pmol/L被认为升高。我们使用多变量Cox回归分析来确定与死亡率相关的因素。
50例患者（66%）在随访期间死亡。在多变量分析中，较高的治疗前钙水平和升高的PTHrP水平与死亡率增加相关，PTHrP的影响因年龄而异（P = 0.03）。65岁以上患者（每mg/dL的风险比[HR]=1.5；95%置信区间[CI]：1.2至1.8；P<0.001）和65岁及以下患者（HR = 1.3；95%CI：1.1至1.5；P = 0.003）的生存均与治疗前钙水平相关。校正治疗前钙水平后，PTHrP水平升高与65岁及以下患者的死亡率增加相关（HR = 3.8；95%CI：1.6至8.8；P = 0.002），但在老年患者中不相关（HR = 0.7；95%CI：0.3至1.9；P = 0.51）。
PTHrP是恶性肿瘤相关性高钙血症的一个有用的预后因素，至少在65岁及以下的患者中如此。
