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Gwenzi T, Schrotz-King P, Anker SC, Schöttker B, Hoffmeister M, Brenner H. Prognostic value of post-operative iron biomarkers in colorectal cancer: population-based patient cohort. Br J Cancer 2024:10.1038/s41416-024-02814-4. [PMID: 39191894 DOI: 10.1038/s41416-024-02814-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 07/29/2024] [Accepted: 07/31/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Post-operative anaemia is linked to iron deficiency. We investigated the prognostic value of post-operative iron biomarkers in colorectal cancer (CRC). METHODS Ferritin, transferrin, iron, and transferrin saturation (TS%) were measured from blood collected at a single time-point post-surgery in 2769 CRC patients. Associations between iron biomarkers with cancer-specific survival (CSS) and overall survival (OS) were assessed using Cox regression with hazard ratios (HR), stratified by post-operative time of blood collection (<1-month/≥1-month). RESULTS After a median follow-up of 9.5 years, 52.6% of patients had died. For iron biomarkers assessed <1-month post-surgery, higher compared to normal TS% was associated with shorter CSS (HR [95% CI] = 2.36 [1.25-4.46]), and higher iron levels with better OS (upper vs. median tertile: HR [95% CI] = 0.79 [0.65-0.97]). When assessed ≥1-month post-surgery, elevated ferritin was associated with poor CSS (high vs. normal: HR [95% CI] = 1.44 [1.10-1.87]), and low TS% with worse CSS (low vs. normal: HR [95% CI] = 1.60 [1.24-2.06]). Similar but weaker associations were observed for OS. CONCLUSION Monitoring of serum ferritin and TS% beyond 1-month post-surgery may be relevant for risk stratification of patients with operable CRC. Future studies should validate our findings.
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Affiliation(s)
- Tafirenyika Gwenzi
- German Cancer Research Center (DKFZ) Heidelberg, Division of Preventive Oncology, Heidelberg, Germany
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Petra Schrotz-King
- German Cancer Research Center (DKFZ) Heidelberg, Division of Preventive Oncology, Heidelberg, Germany
| | - Sophie C Anker
- Department of Internal Medicine and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hermann Brenner
- German Cancer Research Center (DKFZ) Heidelberg, Division of Preventive Oncology, Heidelberg, Germany.
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Network Aging Research, Heidelberg University, Heidelberg, Germany.
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Urback AL, Martens K, McMurry HS, Chen EY, Citti C, Sharma A, Kardosh A, Shatzel JJ. Serum ferritin and the risk of early-onset colorectal cancer. World J Gastrointest Oncol 2024; 16:3496-3506. [PMID: 39171163 PMCID: PMC11334048 DOI: 10.4251/wjgo.v16.i8.3496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/14/2024] [Accepted: 06/11/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND The incidence of early-onset colorectal cancer (EO-CRC) is rising in the United States, and is often diagnosed at advanced stages. Low serum ferritin is often incidentally discovered in young adults, however, the indication for endoscopy in EO-CRC is unclear. AIM To compare serum ferritin between patients with EO-CRC and healthy controls (HCs), and examine the association of serum ferritin in EO-CRC with patient- and disease-specific characteristics. METHODS A retrospective study of patients < 50 years with newly-diagnosed EO-CRC was conducted from 1/2013-12/2023. Patients were included if serum ferritin was measured within 2 years prior to 1 year following CRC histologic diagnosis. To supplement the analysis, a cohort of HCs meeting similar inclusion and exclusion criteria were identified for comparison. A sensitivity analysis including only patients with serum ferritin obtained at or before diagnosis was separately performed to minimize risk of confounding. RESULTS Among 85 patients identified with EO-CRC (48 females), the median serum ferritin level was 26 ng/mL (range < 1-2759 ng/mL). Compared to HCs (n = 80211), there were a higher proportion of individuals with EO-CRC with serum ferritin < 20 ng/mL (female 65%, male 40%) versus HCs (female 32.1%, male 7.2%) age 29-39 years (P = 0.002 and P < 0.00001, respectively). Stage IV disease was associated with significantly higher serum ferritin compared to less advanced stages (P < 0.001). Serum ferritin obtained before or at the time of diagnosis was lower than levels obtained after diagnosis. Similar findings were confirmed in the sensitivity analysis. CONCLUSION Severe iron deficiency may indicate an increased risk of EO-CRC, particularly at earlier stages. Further studies defining the optimal serum ferritin threshold and routine incorporation of serum ferritin in screening algorithms is essential to develop more effective screening strategies for EO-CRC.
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Affiliation(s)
- Adam L Urback
- Division of Internal Medicine, Oregon Health & Science University, Portland, OR 97239, United States
| | - Kylee Martens
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, United States
| | - Hannah Stowe McMurry
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, United States
| | - Emerson Y Chen
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, United States
| | - Caitlin Citti
- Division of Gastroenterology & Hepatology, Oregon Health & Science University, Portland, OR 97239, United States
| | - Anil Sharma
- Division of Gastroenterology & Hepatology, Oregon Health & Science University, Portland, OR 97239, United States
| | - Adel Kardosh
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, United States
| | - Joseph J Shatzel
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, United States
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Zhang W, Chen Q, Cheng Y, Wang M, Tong J, Tang R, Pan Y, Yang J. Can serum ferritin serve as a biomarker for the prognosis of gynecological malignant tumors? A retrospective cohort study. Cancer Biomark 2024; 39:127-136. [PMID: 38160345 PMCID: PMC11002721 DOI: 10.3233/cbm-230040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 11/03/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE It is widely accepted that there is a strong relationship between iron levels and cancer. This study aimed to investigate the relationship between serum ferritin levels and the severity and prognosis of gynecological malignant tumors. METHODS This retrospective study included patients with gynecological malignant tumors at Sir Run Run Shaw Hospital in the Department of Obstetrics and Gynecology from January 2013 to June 2019. Patients were grouped according to their serum ferritin level: low (< 13 μg/L), normal (13-150 μg/L), and high (> 150 μg/L). Correlation analyses were performed between serum ferritin level and other factors. Cox univariable and multivariable analysis and Kaplan-Meier survival curves were used to assess the impact of ferritin on survival in patients with gynecologic tumors. RESULTS The 402 total patients were divided into a low (n= 37), normal (n= 182), and high (n= 183) ferritin level group. Correlation analyses were performed that WBC, MCV, CRP, CA125, and CA153 were significantly positively correlated with serum ferritin level. The Kaplan-Meier survival curves revealed that of the three groups analyzed, the high serum ferritin level group had a significantly shorter survival time versus the normal and low serum ferritin level groups (log-rank P= 0.003). Univariable Cox regression analysis identified that patients with high serum ferritin levels had a significant correlation with risk of death compared to the patients with lower and normal serum ferritin levels. Serum ferritin was not found to be significant (HR = 0.792, 95% CI: 0.351-1.787, P= 0.574) in the multivariable Cox analysis. CONCLUSION Although this study did not find serum ferritin to be a significant independent prognosis indicator in gynecological malignant tumors, this study did identify that gynecological malignant tumor patients with high serum ferritin levels have significantly less survival time than patients with low or normal serum ferritin levels.
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Affiliation(s)
- Weidan Zhang
- Department of Obstetrics and Gynecology, Taizhou Hospital of Zhejiang Province, Zhejiang University, Taizhou, Zhejiang, China
- School of Medicine, Zhejiang University, Hangzhou, China
| | - Qiaoqiao Chen
- Department of Obstetrics and Gynecology, Taizhou Hospital of Zhejiang Province, Zhejiang University, Taizhou, Zhejiang, China
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, China
| | - Yali Cheng
- Department of Obstetrics and Gynecology, Taizhou Hospital of Zhejiang Province Affiliate to Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Miao Wang
- Department of Obstetrics and Gynecology, Taizhou Maternal and Child Health Hospital, Taizhou, Zhejiang, China
| | - Jinfei Tong
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Hangzhou, China
| | - Rongrong Tang
- School of Medicine, ShaoXing University, Shaoxing, Zhejiang, China
| | - Yihong Pan
- Department of Obstetrics and Gynecology, Taizhou Hospital of Zhejiang Province Affiliate to Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Jianhua Yang
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China
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Lin S, Fang Y, Lin Y, Mo Z, Hong X, Jian Z, Ji C. Meta-analysis of the prognostic value of pretreatment serum ferritin in hepatobiliary and pancreas (HBP) cancers. BMJ Open 2021; 11:e040801. [PMID: 34049899 PMCID: PMC8166605 DOI: 10.1136/bmjopen-2020-040801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Studies have shown that serum ferritin (SF) has unfavourable prognostic value in hepatobiliary and pancreas (HBP) cancers. This meta-analysis aimed to comprehensively assess the prognostic role of pretreatment SF in patients with HBP cancers. METHODS Eligible studies published before January 2020 were obtained through a comprehensive search in the PubMed, Web of Science, Cochrane Library and EMBASE databases. Pooled HRs and 95% CIs were then employed as effect sizes. RESULTS Seven studies comprising 1244 patients were pooled. Elevated pretreatment SF was associated with worse overall survival (OS) (HR 1.60, 95% CI 1.36 to 1.88, p<0.001) and recurrence-free survival/progression-free survival/time to recurrence (HR 1.70, 95% CI 1.15 to 2.52, p=0.008). Significant prognostic value of elevated pretreatment SF on OS was detected in the subgroups regardless of the cancer type, race, SF cut-off value, tumour-node-metastasis stage and Newcastle-Ottawa Scale score. CONCLUSION Elevated pretreatment SF was associated with worse survival outcome of patients with HBP cancers. As such, it may serve as a novel prognostic biomarker for HBP cancers.
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Affiliation(s)
- Shuwen Lin
- General Surgery, Binhaiwan Central Hospital of Dongguan, Dongguan, China
| | - Yinghua Fang
- Pain, Binhaiwan Central Hospital of Dongguan, Dongguan, China
| | - Ye Lin
- General Surgery, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Zhikang Mo
- General Surgery, Binhaiwan Central Hospital of Dongguan, Dongguan, China
| | - Xiaocheng Hong
- General Surgery, Binhaiwan Central Hospital of Dongguan, Dongguan, China
| | - Zhixiang Jian
- General Surgery, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Chenggang Ji
- General Surgery, Binhaiwan Central Hospital of Dongguan, Dongguan, China
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Zaitsev VG, Zheltova AA, Martynova SA, Tibirkova EV. Can conventional clinical chemistry tests help doctors in the monitoring of oncology patients? RUSSIAN OPEN MEDICAL JOURNAL 2021. [DOI: 10.15275/rusomj.2021.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The use of laboratory assays in the diagnostic care of oncology patients can markedly increase the efficacy of cancer treatments. Many cancer-specific biomarker assays have been developed. However, the use of these has some limitations due to their cost. Moreover, not every diagnostic laboratory can perform a complete set of these assays. On the other hand, the smart use of conventional clinical chemistry tests could improve the management of cancer. They could be especially valuable tools in the long-term care of patients with a verified diagnosis. In this review, we discuss the utilization of the conventional clinical chemistry assays for the diagnosis, monitoring and prognosis of various oncological diseases. The use of conventional blood tests to assess the levels of chemical elements, metabolites and proteins (including enzymatic activity measurements) in the care of oncology patients is discussed. We have shown that some clinical chemistry assays could be used in the management of distinct kinds of cancer.
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Wu SJ, Zhang ZZ, Cheng NS, Xiong XZ, Yang L. Preoperative serum ferritin is an independent prognostic factor for liver cancer after hepatectomy. Surg Oncol 2019; 29:159-167. [DOI: 10.1016/j.suronc.2019.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 05/04/2019] [Accepted: 05/18/2019] [Indexed: 02/07/2023]
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Nasr R, Salim Hammoud M, Nassar F, Mukherji D, Shamseddine A, Temraz S. Inflammatory Markers and MicroRNAs: The Backstage Actors Influencing Prognosis in Colorectal Cancer Patients. Int J Mol Sci 2018; 19:E1867. [PMID: 29949857 PMCID: PMC6073730 DOI: 10.3390/ijms19071867] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 06/17/2018] [Accepted: 06/25/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) remains a deadly disease, afflicting the lives of millions worldwide. The prognosis of CRC patients is best predicted by surgical resection and pathological analysis of specimens. Emerging evidence has attributed a significant role to inflammatory markers and microRNAs (miRNAs) in the prognosis and survival of CRC patients. AIM Here, we review the literature on inflammatory markers and miRNAs with an established role on survival rates, response to systemic chemotherapy, and other clinic-pathological parameters in CRC patients. RESULTS Our literature review revealed a critical role of inflammatory markers—specifically, the acute-phase proteins, inflammatory cytokines, and blood cell ratios—on prognostic outcomes in CRC patients. MiRNAs, on the other hand, were useful in predicting prognosis and clinical response and accordingly stratifying CRC patients for optimal drug selection. CONCLUSION These biomarkers are easily measured in routine blood exams and can be used in adjunct to the tumor-node-metastasis (TNM) staging system to identify high-risk patients and those who are more likely to benefit from chemotherapy and other targeted therapies. However, more prospective studies are needed for the validation of these discussed prognostic and predictive biomarkers.
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Affiliation(s)
- Rihab Nasr
- Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh, Beirut 110 72020, Lebanon.
| | - Miza Salim Hammoud
- Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh, Beirut 110 72020, Lebanon.
| | - Farah Nassar
- Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh, Beirut 110 72020, Lebanon.
| | - Deborah Mukherji
- Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh, Beirut 110 72020, Lebanon.
| | - Ali Shamseddine
- Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh, Beirut 110 72020, Lebanon.
| | - Sally Temraz
- Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh, Beirut 110 72020, Lebanon.
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