Tuñón José, Pello Ana, Aceña Álvaro, Ramos-Cillán Sergio, Martínez-Milla Juan, González-Lorenzo Óscar, Fuentes-Antras Jesús, Tarín Nieves, Cristóbal Carmen, Blanco-Colio Luis M, Martín-Ventura José Luis, Huelmos Ana, Gutiérrez-Landaluce Carlos, López-Castillo Marta, Alonso Joaquín, Bescós Lorenzo López, Egido Jesús, Mahíllo-Fernández Ignacio, Lorenzo Óscar
Department of Cardiology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain.
Department of Medicine, School of Medicine, Autónoma University, 28040 Madrid, Spain.
J Clin Med. 2021 Sep 7;10(18):4042. doi: 10.3390/jcm10184042.
N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma levels are increased in patients with cancer. In this paper, we test whether NT-proBNP may identify patients who are going to receive a future cancer diagnosis (CD) in the intermediate-term follow-up. We studied 962 patients with stable coronary artery disease and free of cancer and heart failure at baseline. This sample represents a re-analysis of a previous work expanding the sample size and the follow-up. NT-proBNP, galectin-3, monocyte chemoattractant protein-1, high-sensitivity C-reactive protein, high-sensitivity cardiac troponin I (hsTnI), and calcidiol (vitamin D) plasma levels were assessed. The primary outcome was new CD. After 5.40 (2.81-6.94) years of follow-up, 59 patients received a CD. NT-proBNP [HR 1.036 CI (1.015-1.056) per increase in 100 pg/mL; = 0.001], previous atrial fibrillation (HR 3.140 CI (1.196-8.243); = 0.020), and absence of previous heart failure (HR 0.067 CI (0.006-0.802); = 0.033) were independent predictors of receiving a CD in the first three years of follow-up. None of the variables analyzed predicted a CD beyond this time. The number of patients developing heart failure during follow-up was 0 (0.0%) in patients receiving CD in the first three years of follow-up, 2 (6.9%) in those receiving a CD diagnosis beyond this time, and 40 (4.4%) in patients not developing cancer ( = 0.216). These numbers suggest that future heart failure was not a confounding factor. In patients with coronary artery disease, NT-proBNP was an independent predictor of CD in the first three years of follow-up but not later, suggesting that it could be detecting subclinical undiagnosed cancers.
癌症患者血浆N末端脑钠肽前体（NT-proBNP）水平升高。在本文中，我们测试NT-proBNP是否可以识别在中期随访中未来会被诊断出患有癌症（CD）的患者。我们研究了962例基线时患有稳定冠状动脉疾病且无癌症和心力衰竭的患者。该样本是对先前一项工作的重新分析，扩大了样本量并延长了随访时间。评估了NT-proBNP、半乳糖凝集素-3、单核细胞趋化蛋白-1、高敏C反应蛋白、高敏心肌肌钙蛋白I（hsTnI）和骨化二醇（维生素D）的血浆水平。主要结局是新发CD。经过5.40（2.81 - 6.94）年的随访，59例患者被诊断出患有癌症。NT-proBNP[每增加100 pg/mL，风险比（HR）为1.036，置信区间（CI）为（1.015 - 1.056）；P = 0.001]、既往心房颤动（HR为3.140，CI为（1.196 - 8.243）；P = 0.020）以及既往无心力衰竭（HR为0.067，CI为（0.006 - 0.802）；P = 0.033）是随访前三年接受癌症诊断的独立预测因素。在这段时间之后，所分析的变量均未预测到癌症诊断。随访期间发生心力衰竭的患者数量在随访前三年被诊断出患有癌症的患者中为0（0.0%），在这段时间之后被诊断出患有癌症的患者中为2（6.9%），在未患癌症的患者中为40（4.4%）（P = 0.216）。这些数字表明未来发生心力衰竭并非混杂因素。在冠状动脉疾病患者中，NT-proBNP是随访前三年癌症诊断的独立预测因素，但之后则不是，这表明它可能检测到了亚临床未诊断的癌症。
