Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Diveision of Hematology/Oncology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
J Geriatr Oncol. 2019 Sep;10(5):749-756. doi: 10.1016/j.jgo.2019.03.015. Epub 2019 Apr 2.
We aimed to explore serum biomarkers for predicting survival of older patients with metastatic solid tumors who received first line palliative chemotherapy.
Serum samples were prospectively collected before first-line chemotherapy at 11 academic centers in Korea. All patients were participants in a prospective cohort study of older patients with metastatic solid tumors. Serum levels of C-reactive protein (CRP), CXCL10, SIRT1, VEGF-A, activin A, C-terminal telopeptide of type I collagen (CTx), total 25-hydroxyvitamin D were measured by ELISA and interleukin-6 (IL-6), myostatin, irisin, FGF-19, FGF-21, FGF-23 by Luminex multiplex assay. Overall survival (OS) was determined.
Serum samples from 138 patients (median age: 75 years, range: 70-92 years) were collected from February 2014 to December 2016. During a median follow up time of 13.8 months, 73 (52.9%) patients died. Among 13 serum markers, CRP (log-rank, P = 0.009), activin A (P = 0.007), and myostatin (P = 0.047) were significantly correlated with OS in univariate analyses. Activin A (hazard ratio [HR] 2.22, 95% confidence interval [CI] 1.32-3.72; P = 0.003) and myostatin (HR 3.02, 95% CI 1.39-6.57; P = 0.005) were significantly associated with OS after adjustment for other clinical factors. In predicting early (6-month) mortality, two inflammatory markers, IL-6 and CRP, were included in the decision-tree model.
In older patients with cancer, high serum concentrations of activin A and myostatin were predictive of poor OS. IL-6 and CRP might be useful to select older patients at risk of early mortality. These markers could be incorporated into predictive tools for clinical decision-making and warrant further investigation.
我们旨在探索预测接受一线姑息化疗的老年转移性实体瘤患者生存的血清生物标志物。
在韩国 11 个学术中心前瞻性地收集了一线化疗前的血清样本。所有患者均为老年转移性实体瘤前瞻性队列研究的参与者。通过酶联免疫吸附试验（ELISA）测量 C 反应蛋白（CRP）、CXCL10、SIRT1、VEGF-A、激活素 A、I 型胶原 C 端肽（CTX）、总 25-羟维生素 D 的血清水平，通过 Luminex 多重分析测量白细胞介素-6（IL-6）、肌肉生长抑制素、鸢尾素、成纤维细胞生长因子-19（FGF-19）、成纤维细胞生长因子-21（FGF-21）和成纤维细胞生长因子-23（FGF-23）。确定总生存期（OS）。
从 2014 年 2 月至 2016 年 12 月，共收集了 138 例患者（中位年龄：75 岁，范围：70-92 岁）的血清样本。在中位随访时间 13.8 个月期间，73 例（52.9%）患者死亡。在 13 种血清标志物中，CRP（对数秩检验，P=0.009）、激活素 A（P=0.007）和肌肉生长抑制素（P=0.047）在单因素分析中与 OS 显著相关。在调整其他临床因素后，激活素 A（风险比 [HR]2.22，95%置信区间 [CI]1.32-3.72；P=0.003）和肌肉生长抑制素（HR3.02，95%CI1.39-6.57；P=0.005）与 OS 显著相关。在预测早期（6 个月）死亡率方面，两种炎症标志物 IL-6 和 CRP 被纳入决策树模型。
在老年癌症患者中，高血清浓度的激活素 A 和肌肉生长抑制素与较差的 OS 相关。IL-6 和 CRP 可能有助于选择有早期死亡风险的老年患者。这些标志物可以纳入临床决策的预测工具中，并需要进一步研究。
