From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.
University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
J Intern Med. 2020 Aug;288(2):207-218. doi: 10.1111/joim.13053. Epub 2020 May 5.
There is increasing recognition that heart failure (HF) and cancer are conditions with a number of shared characteristics.
To explore the association between tumour biomarkers and HF outcomes.
In 2,079 patients of BIOSTAT-CHF cohort, we measured six established tumour biomarkers: CA125, CA15-3, CA19-9, CEA, CYFRA 21-1 and AFP.
During a median follow-up of 21 months, 555 (27%) patients reached the primary end-point of all-cause mortality. CA125, CYFRA 21-1, CEA and CA19-9 levels were positively correlated with NT-proBNP quartiles (all P < 0.001, P for trend < 0.001) and were, respectively, associated with a hazard ratio of 1.17 (95% CI 1.12-1.23; P < 0.0001), 1.45 (95% CI 1.30-1.61; P < 0.0001), 1.19 (95% CI 1.09-1.30; P = 0.006) and 1.10 (95% CI 1.05-1.16; P < 0.001) for all-cause mortality after correction for BIOSTAT risk model (age, BUN, NT-proBNP, haemoglobin and beta blocker). All tumour biomarkers (except AFP) had significant associations with secondary end-points (composite of all-cause mortality and HF hospitalization, HF hospitalization, cardiovascular (CV) mortality and non-CV mortality). ROC curves showed the AUC of CYFRA 21-1 (0.64) had a noninferior AUC compared with NT-proBNP (0.68) for all-cause mortality (P = 0.08). A combination of CYFRA 21-1 and NT-proBNP (AUC = 0.71) improved the predictive value of the model for all-cause mortality (P = 0.0002 compared with NT-proBNP).
Several established tumour biomarkers showed independent associations with indices of severity of HF and independent prognostic value for HF outcomes. This demonstrates that pathophysiological pathways sensed by these tumour biomarkers are also dysregulated in HF.
越来越多的人认识到心力衰竭（HF）和癌症是具有许多共同特征的疾病。
探讨肿瘤标志物与 HF 结局之间的关系。
在 BIOSTAT-CHF 队列的 2079 名患者中，我们测量了六种已建立的肿瘤标志物：CA125、CA15-3、CA19-9、CEA、CYFRA 21-1 和 AFP。
在中位随访 21 个月期间，555 名（27%）患者达到了全因死亡率的主要终点。CA125、CYFRA 21-1、CEA 和 CA19-9 水平与 NT-proBNP 四分位数呈正相关（均 P<0.001，P 趋势<0.001），与危险比分别为 1.17（95%CI 1.12-1.23；P<0.0001）、1.45（95%CI 1.30-1.61；P<0.0001）、1.19（95%CI 1.09-1.30；P=0.006）和 1.10（95%CI 1.05-1.16；P<0.001）。在纠正 BIOSTAT 风险模型（年龄、BUN、NT-proBNP、血红蛋白和β受体阻滞剂）后，所有肿瘤标志物（AFP 除外）均与次要终点（全因死亡率和 HF 住院、HF 住院、心血管（CV）死亡率和非 CV 死亡率的复合终点）有显著相关性。ROC 曲线显示 CYFRA 21-1（AUC 为 0.64）的 AUC 与 NT-proBNP（AUC 为 0.68）相比，在全因死亡率方面无显著差异（P=0.08）。CYFRA 21-1 和 NT-proBNP 的组合（AUC 为 0.71）改善了模型对全因死亡率的预测价值（与 NT-proBNP 相比，P=0.0002）。
几种已建立的肿瘤标志物与 HF 严重程度指数独立相关，并对 HF 结局具有独立的预后价值。这表明这些肿瘤标志物感知的病理生理途径在 HF 中也失调。
