Division of Human Nutrition, Stellenbosch University, Stellenbosch, 7600, South Africa.
Melanie Levy Dietician, Johannesburg, 2192, South Africa.
Support Care Cancer. 2024 May 14;32(6):349. doi: 10.1007/s00520-024-08549-5.
Quality of life (QoL), appetite, cachexia, and biomarkers [albumin, hemoglobin (Hb), neutrophils, lymphocytes, platelets, C-reactive protein (CRP), tumor necrosis factor alpha (TNFα), interleukin 6 (IL-6), interleukin 8 (IL-8), C-X-C motif chemokine ligand 5 (CXCL5) and citrullinated histoneH3 (H3Cit)] were compared for 40 cases with advanced cancer and 40 healthy controls. Baseline differences and significant relationships were explored for biomarkers with QoL, appetite, and cachexia.
In a prospective case-control, age and sex matched study, the European Organisation for the Research and Treatment of Cancer Quality of Life-C30 questionnaire (EORTC-QLQ-C30) for QoL, the Functional Assessment of Anorexia and Cachexia Therapy assessment (FAACT A/CS-12) for appetite, and a five-factor cachexia assessment tool for cachexia assessment were performed. Routine hematological measurements and blood chemistry analyses together with ELISA procedures and a Multiplex® bead array platform, were used for biomarker analysis. Descriptive statistics and regression analyses were undertaken. P < 0.05 defined statistical significance.
Global health status (QL-G), functional scales (QL-FS), and symptom scales (QL-SS) differed for cases and controls (p < 0.01). In cases, differences were observed for QL-G (p < 0.01), QL-FS (p < 0.01), and QL-SS (p = 0.01) compared to standardized references values. FAACT A/CS-12 scores differed significantly between cases and controls (p < 0.01) and 30% of cases scored "poor" appetites. Cachexia was present in 60% of cases. Albumin, lymphocytes, platelets, Hb, platelet to lymphocyte ratio (PLR), systemic immune-inflammation index (SII), CRP, TNFα, all at p < 0.01, neutrophil to lymphocyte ratio (NLR) (p = 0.02), IL-6 (p < 0.04), and IL-8 (p = 0.02) differed significantly between cases and controls. No difference was found for CXCL5 or H3Cit. Albumin NLR, Hb, PLR, SII, TNFα, IL-8, and CRP showed significant relationships with all aspects of QoL. QL-FS was significantly related to CXCL5 (p = 0.04), significant relationships with FAACT A/CS-12 included: NLR (p = 0.002), Hb (p < 0.001), and PLR (p < 0.01). NLR, PLR, SII, TNFα, IL-6, IL-8, and CRP correlated positively to cachexia and albumin while Hb and lymphocyte count correlated negatively to cachexia.
CXCL5 and H3Cit were not reliable biomarkers for cancer cachexia, nor significantly related to QoL, appetite or cachexia. Albumin, NLR, Hb, PLR, SII, TNFα, IL-8, and CRP were reliable indicators of QoL, appetite, and cachexia. Future research should include other novel biomarkers namely growth differentiation factor-15 (GDF-15), fibroblast growth factor 21 (FGF-21), fractakline, interferon gamma (IFN-y), IL-16, macrophage colony stimulating factor (M-CSF), and macrophage procoagulant-inducing factor (MPIF).
比较 40 例晚期癌症患者和 40 例健康对照者的生活质量（QoL）、食欲、恶病质和生物标志物[白蛋白、血红蛋白（Hb）、中性粒细胞、淋巴细胞、血小板、C-反应蛋白（CRP）、肿瘤坏死因子 alpha（TNFα）、白细胞介素 6（IL-6）、白细胞介素 8（IL-8）、C-X-C 基序趋化因子配体 5（CXCL5）和瓜氨酸化组蛋白 H3（H3Cit）]。探讨了生物标志物与 QoL、食欲和恶病质的基线差异和显著关系。
在一项前瞻性病例对照、年龄和性别匹配的研究中，采用欧洲癌症研究与治疗组织生活质量问卷（EORTC-QLQ-C30）评估 QoL，采用功能评估厌食和恶病质治疗评估（FAACT A/CS-12）评估食欲，采用五因素恶病质评估工具评估恶病质。进行常规血液学测量和血液化学分析，以及 ELISA 程序和 Multiplex®珠阵列平台的生物标志物分析。进行描述性统计和回归分析。p<0.05 定义为统计学意义。
病例组和对照组的总体健康状况（QL-G）、功能量表（QL-FS）和症状量表（QL-SS）存在差异（p<0.01）。与标准参考值相比，病例组的 QL-G（p<0.01）、QL-FS（p<0.01）和 QL-SS（p=0.01）存在差异。病例组和对照组的 FAACT A/CS-12 评分存在显著差异（p<0.01），30%的病例存在“较差”的食欲。60%的病例存在恶病质。白蛋白、淋巴细胞、血小板、Hb、血小板与淋巴细胞比值（PLR）、全身免疫炎症指数（SII）、CRP、TNFα，均为 p<0.01，中性粒细胞与淋巴细胞比值（NLR）（p=0.02），IL-6（p<0.04）和 IL-8（p=0.02）在病例组和对照组之间存在显著差异。CXCL5 或 H3Cit 无差异。白蛋白 NLR、Hb、PLR、SII、TNFα、IL-8 和 CRP 与 QoL 的所有方面均有显著关系。QL-FS 与 CXCL5 显著相关（p=0.04），与 FAACT A/CS-12 显著相关的包括：NLR（p=0.002）、Hb（p<0.001）和 PLR（p<0.01）。NLR、PLR、SII、TNFα、IL-6、IL-8 和 CRP 与恶病质和白蛋白呈正相关，而 Hb 和淋巴细胞计数与恶病质呈负相关。
CXCL5 和 H3Cit 不是癌症恶病质的可靠生物标志物，也与 QoL、食欲或恶病质无显著关系。白蛋白、NLR、Hb、PLR、SII、TNFα、IL-8 和 CRP 是 QoL、食欲和恶病质的可靠指标。未来的研究应包括其他新型生物标志物，即生长分化因子 15（GDF-15）、成纤维细胞生长因子 21（FGF-21）、分裂原激活蛋白激酶 1（MAPK1）、干扰素 gamma（IFN-y）、白细胞介素 16（IL-16）、巨噬细胞集落刺激因子（M-CSF）和巨噬细胞促凝诱导因子（MPIF）。
