Johansen Julia S, Bojesen Stig E, Mylin Anne K, Frikke-Schmidt Ruth, Price Paul A, Nordestgaard Børge G
Department of Rheumatology, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, Denmark.
J Clin Oncol. 2009 Feb 1;27(4):572-8. doi: 10.1200/JCO.2008.18.8367. Epub 2008 Dec 15.
Elevated plasma YKL-40 is a biomarker of poor prognosis in cancer patients. We tested the hypotheses that elevated plasma YKL-40 predicts risk of cancer as well as survival after a cancer diagnosis in the general population.
A prospective cohort study of 8,899 subjects (20 to 95 years) from the Danish general population, the Copenhagen City Heart Study, observed for 11 years for cancer incidence and 14 years for death: 1,432 participants had a first incident cancer, 968 of these died. Hazard ratios (HRs) for cancer events and death after events according to plasma YKL-40 in sex and 10 years age percentile categories: 0% to 33%, 34% to 66%, 67% to 90%, 91% to 95%, and 96% to 100%.
The cumulative incidence of gastrointestinal cancer increased with increasing YKL-40 (trend P < .0001). Multifactorially adjusted HRs for gastrointestinal cancer were 1.0 (95% CI, 0.7 to 1.5) for YKL-40 in category 34% to 66%, 1.5 for 67% to 90% (95% CI, 1.0 to 2.3), 2.4 for 91% to 95%, (95% CI, 1.3 to 4.6), and 3.4 for 96% to 100% (95% CI, 1.9 to 6.1) versus YKL-40 category 0% to 33% (P < .0001). Participants with any cancer event and YKL-40 category 91% to 100% had a median survival time after the diagnosis of 1 year versus 4 years in participants with YKL-40 category 0% to 33% (P < .0001). Corresponding values for gastrointestinal cancer were 6 months versus 1 year (P = .007). Multifactorially adjusted HRs for early death were 1.8 (95% CI, 1.3 to 2.5; P < .0001) after any cancer and 2.4 (95% CI, 1.3 to 4.3; P = .005) after gastrointestinal cancer in participants with YKL-40 category 91% to 100% versus 0% to 33%.
In the general population, elevated plasma YKL-40 predicts increased risk of gastrointestinal cancer and decreased survival after any cancer diagnosis.
血浆YKL-40升高是癌症患者预后不良的生物标志物。我们检验了以下假设：血浆YKL-40升高可预测普通人群患癌风险以及癌症诊断后的生存率。
对来自丹麦普通人群的哥本哈根城市心脏研究中的8899名受试者（20至95岁）进行前瞻性队列研究，观察11年的癌症发病率和14年的死亡率：1432名参与者首次发生癌症，其中968人死亡。按性别和10岁年龄百分位数类别，根据血浆YKL-40得出癌症事件及事件后死亡的风险比（HRs）：0%至33%、34%至66%、67%至90%、91%至95%和96%至100%。
胃肠道癌的累积发病率随YKL-40升高而增加（趋势P<.0001）。血浆YKL-40处于34%至66%类别时，胃肠道癌的多因素调整HR为1.0（95%CI，0.7至1.5）；67%至90%类别时为1.5（95%CI，1.0至2.3）；91%至95%类别时为2.4（95%CI，1.3至4.6）；96%至100%类别时为3.4（95%CI，1.9至6.1），而YKL-40处于0%至33%类别时（P<.0001）。发生任何癌症事件且YKL-40处于91%至100%类别的参与者诊断后的中位生存时间为1年，而YKL-40处于0%至33%类别的参与者为4年（P<.0001）。胃肠道癌的相应数值为6个月对1年（P=.007）。YKL-40处于91%至100%类别的参与者与0%至33%类别的参与者相比，多因素调整后任何癌症后的早期死亡HR为1.8（95%CI，1.3至2.5；P<.0001），胃肠道癌后为2.4（95%CI，1.3至4.3；P=.005）。
在普通人群中，血浆YKL-40升高预示着胃肠道癌风险增加以及任何癌症诊断后的生存率降低。
