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J Geriatr Oncol. 2019 Apr 2. pii: S1879-4068(18)30386-2. doi: 10.1016/j.jgo.2019.03.015. [Epub ahead of print]

Serum biomarkers for predicting overall survival and early mortality in older patients with metastatic solid tumors.

Author information

1
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
2
Diveision of Hematology/Oncology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
3
Departmenet of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.
4
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
5
Center for Colorectal Cancer, National Cancer Center, Goyang, Republic of Korea.
6
Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Republic of Korea.
7
Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Republic of Korea.
8
Department of Internal Medicine, Soonchunhyang University Hospital, Bucheon, Republic of Korea.
9
Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.
10
Department of Oncology, Asan Medical Center, Seoul, Republic of Korea.
11
Department of Internal Medicine, Yeouido St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
12
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. Electronic address: jhkimmd@snu.ac.kr.

Abstract

OBJECTIVES:

We aimed to explore serum biomarkers for predicting survival of older patients with metastatic solid tumors who received first line palliative chemotherapy.

MATERIALS AND METHODS:

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.

RESULTS:

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.

CONCLUSION:

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.

KEYWORDS:

Activin a; Cancer; Frailty; Mortality; Prognostic

PMID:
30952517
DOI:
10.1016/j.jgo.2019.03.015

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