Tao Yuewei, Lang Chim C, Petty Russell D, Hall Peter S, Baxter Mark A
Dundee Medical School, Ninewells School of Medicine, University of Dundee, Dundee DD1 9SY, UK.
Department of Cardiology, Ninewells Hospital, Dundee DD1 9SY, UK.
Cancers (Basel). 2025 Feb 10;17(4):601. doi: 10.3390/cancers17040601.
Better prognostic biomarkers are needed in older adults with cancer. There are established links between N-terminal pro-B-type Natriuretic Peptide (NT-proBNP) and sarcopenia, and sarcopenia is associated with poorer cancer survival. However, there are limited data regarding baseline NT-proBNP as a biomarker of cancer outcome. The GO2 trial recruited older and/or frail United Kingdom (UK) patients with advanced gastroesophageal cancer and investigated the role of chemotherapy dose de-escalation. Using the GO2 database, we sought to investigate the prognostic role of NT-proBNP as well as the interaction between NT-proBNP and frailty. This was a post-hoc analysis of a completed clinical trial. Frailty measures included ECOG performance status (PS) and GO2 frailty grouping (based on an assessment of nine geriatric domains). A corrected NT-proBNP (cBNP) was calculated for each patient, adjusting for the upper limit of normal (ULN) reference from each centre. A total of 241 patients were eligible to be included in the analysis. The median age was 76 (range 52-89), 187 (77.6%) were male and 211 (87.6%) had adenocarcinoma. Eighty (33.2%) patients had a baseline NT-proBNP above the local ULN. There was no association between cBNP and ECOG PS ( = 0.36) or the GO2 frailty group ( = 0.58). Those with the highest cBNP ( = 59) had significantly inferior median overall survival: 5.3 months (mos.) vs. 6.8 mos. (medium, = 120) vs. 8.2 mos. (low, = 61); HR 1.57 (95% CI; 1.04-2.37), = 0.031. This was maintained on a Cox regression analysis (HR 1.69, = 0.01) accounting for the GO2 trial stratification factors. There was no clear association between frailty and NT-proBNP. In this study, NT-proBNP appeared to be prognostic-independent of other factors. Further investigation and validation are needed to confirm our findings and to determine the potential beneficial role of cardioprotective therapy in at-risk patients with cancer identified in this manner.
老年癌症患者需要更好的预后生物标志物。N端前脑钠肽（NT-proBNP）与肌肉减少症之间存在既定联系，且肌肉减少症与癌症患者较差的生存率相关。然而，关于基线NT-proBNP作为癌症预后生物标志物的数据有限。GO2试验招募了英国的老年和/或体弱的晚期食管癌患者，并研究了化疗剂量递减的作用。利用GO2数据库，我们试图研究NT-proBNP的预后作用以及NT-proBNP与体弱之间的相互作用。这是一项对已完成临床试验的事后分析。体弱的衡量指标包括东部肿瘤协作组（ECOG）体能状态（PS）和GO2体弱分组（基于对九个老年领域的评估）。为每位患者计算校正后的NT-proBNP（cBNP），并根据各中心正常上限（ULN）参考值进行调整。共有241名患者符合纳入分析的条件。中位年龄为76岁（范围52 - 89岁），187名（77.6%）为男性，211名（87.6%）患有腺癌。80名（33.2%）患者的基线NT-proBNP高于当地ULN。cBNP与ECOG PS（P = 0.36）或GO2体弱分组（P = 0.58）之间无关联。cBNP最高组（n = 59）的中位总生存期显著较差：5.3个月（月），而中等组为6.8个月（n = 120），低组为8.2个月（n = 61）；风险比（HR）为1.57（95%置信区间；1.04 - 2.37），P = 0.031。在考虑GO2试验分层因素的Cox回归分析中（HR 1.69，P = 0.01），这一结果依然成立。体弱与NT-proBNP之间无明确关联。在本研究中，NT-proBNP似乎是独立于其他因素的预后指标。需要进一步的研究和验证来证实我们的发现，并确定心脏保护治疗对以此方式识别出的癌症高危患者的潜在有益作用。
