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Mohammed Bakheet M, Mohssin Ali H, Jalil Talab T. Evaluation of some proinflammatory cytokines and biochemical parameters in pre and postmenopausal breast cancer women. Cytokine 2024; 179:156632. [PMID: 38701734 DOI: 10.1016/j.cyto.2024.156632] [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: 02/26/2024] [Revised: 04/08/2024] [Accepted: 04/28/2024] [Indexed: 05/05/2024]
Abstract
The study was planned to evaluate the differences in certain proinflammatory cytokines(IL-6, TNF-α) with CRP and biochemical parameters (E2, D3, LDH, GGT, TSB, Ca, Ph, uric acid), between women with pre- and postmenopausal breast cancer and seemingly healthy women in Iraqi women as controls; at medical city in teaching Oncology hospital,70 breast cancer patients women their ages ranged (47.51 ± 1.18) and 20 healthy women with age (44.45 ± 2.66) begun from September (2020) to February (2021). The aims of this study to investigate the evaluation of chemotherapy effects especially doxorubicin and cyclophosphamide only use in this study in pre and postmenopausal breast cancer women on proinflammatory cytokines(IL-6, TNF-α) with CRP and on biochemical parameters(E2, D3, LDH, GGT, TSB, Ca, Ph, uric acid) in pre and postmenapausal breast cancer women. The patients were divided into five groups and each group contains 14 patients women with breast cancer during pre and postmenopausal periods. The control groups were divided into 10 pre and 10 postmenopausal women(Fig. 1). The results of proinflammatory cytokines of and biochemical parameters in premenopausal groups were as the levels of IL-6 (pg/ml),TNF-α(pg/ml) and CRP (ng/ml) showed significant increase differences (P < 0.01)among breast cancer treated (BCT) groups in comparison with control groups,While the Liver enzymes GGT,LDH and TSB showed highly significant increase (P < 0.01) in BCT groups, Estrogen levels (pg/ml) and D3(ng/ml) increased significantly (P < 0.01)among BCT groups. Blood serum calcium and phosphorus with uric acid levels (mg/dl) showed significant difference (P < 0.01); While the result in postmenopausal of IL-6(pg/ml), TNF-α (pg/ml) and CRP (ng/ml) showed highly significant differences (P < 0.01)among BCT groups.While GGT(IU/L), LDH(IU/L) and TSB (mg/dl) enzymes were increased significantly (p < 0.01), Estrogen (pg/ml) and D3(ng/ml) levels showed significant increase (P < 0.01) among BCT groups.Blood calcium and phosphorus showed significant increase (P < 0.01) while uric acid was non-significant increase (P > 0.05).
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Affiliation(s)
| | - Hiba Mohssin Ali
- Department of Biology, College of Science, Mustansiriyah University, Bagdad, Iraq.
| | - Tabarak Jalil Talab
- Department of Biology, College of Science, Mustansiriyah University, Bagdad, Iraq.
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Holm JB, Baggesen E, Cronin-Fenton D, Frystyk J, Bruun JM, Christiansen P, Borgquist S. Circulating C-reactive protein levels as a prognostic biomarker in breast cancer across body mass index groups. Sci Rep 2024; 14:14486. [PMID: 38914635 PMCID: PMC11196728 DOI: 10.1038/s41598-024-64428-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/10/2024] [Indexed: 06/26/2024] Open
Abstract
Obesity and systemic inflammation are associated with breast cancer (BC) outcomes. Systemic inflammation is increased in obesity. We examined the association between C-reactive protein (CRP) and disease-free survival (DFS) and overall survival (OS) overall, and according to body mass index (BMI). We assembled a cohort of women with BC (stage I-III) seen at Aarhus University Hospital between 2010 and 2020 who donated blood at BC diagnosis (N = 2673). CRP levels were measured and divided into quartiles. We followed patients from surgery to recurrence, contralateral BC, other malignancy, death, emigration, or end-of-follow-up. We used Cox regression to estimate hazard ratios (HRs) with 95% confidence intervals (95% CIs) to compare outcomes across CRP quartiles, overall and stratified by BMI (normal-weight (18.5 ≤ BMI < 25 kg/m2), overweight (25 ≤ BMI < 30 kg/m2), and obesity (BMI ≥ 30 kg/m2)). During follow-up, 368 events (212 recurrences, 38 contralateral BCs, and 118 deaths) occurred (median follow-up 5.55 years). For DFS, high CRP (CRP ≥ 3.19 mg/L) was associated with an increased risk of events (HRadj:1.62 [95% CI = 1.14-2.28]). In BMI-stratified analyses, high CRP was associated with elevated risk of events in normal-weight and overweight (HRadj:1.70 [95% CI = 1.09-2.66]; HRadj:1.75 [95% CI = 1.08-2.86]), but in obesity, the estimate was less precise (HRadj:1.73 [95% CI = 0.78-3.83]). For OS, high CRP was associated with increased risk of death (HRadj:2.47 [95% CI = 1.62-3.76]). The association was strong in normal-weight and overweight (HRadj:3.66 [95% CI = 1.95-6.87]; HRadj:1.92 [95% CI = 1.06-3.46]), but less clear in obesity (HRadj:1.40 [95% CI = 0.64-3.09]). To sum up, high CRP levels at BC diagnosis were associated with inferior prognosis in early BC irrespective of BMI, although less clear in patients with obesity.
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Affiliation(s)
- J B Holm
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - E Baggesen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - D Cronin-Fenton
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - J Frystyk
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - J M Bruun
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - P Christiansen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - S Borgquist
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Andersen HH, Bojesen SE, Johansen JS, Ejlertsen B, Berg T, Tuxen M, Madsen K, Danø H, Flyger H, Jensen MB, Nielsen DL. Prognostic Value of Pretreatment Plasma C-Reactive Protein in Patients with Early-Stage Breast Cancer. Cancer Epidemiol Biomarkers Prev 2024; 33:662-670. [PMID: 38358318 DOI: 10.1158/1055-9965.epi-23-1299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/22/2023] [Accepted: 02/08/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Breast cancer incidence is now the highest among all cancers and accountable for 6.6% of all cancer-related deaths worldwide. Studies of the prognostic utility of plasma C-reactive protein (CRP) measurement in early-stage breast cancer have given discrepant results. METHODS We identified 6,942 patients in the Danish Breast Cancer Cooperative Group database with early-stage breast cancer diagnosed between 2002 and 2016 who had a measure of pretreatment plasma CRP. Outcomes were recurrence-free interval and survival for a period up to 10 years. We analyzed associations with plasma CRP using Fine-Gray proportional subdistribution hazards model with recurrence-free interval. Data on plasma CRP were analyzed per doubling of concentration and in relation to CRP levels of <3 mg/L, 3 to 10 mg/L, and >10 mg/L and stratified according to standard clinical parameters in sensitivity analyses. RESULTS A doubling of the plasma CRP concentration was associated with increased risk of recurrence (multivariate adjusted HR, 1.05; 95% CI, 1.01-1.08) and shorter survival (HR, 1.13; 95% CI, 1.09-1.16) in multivariate analyses. Survival was shorter in patients with plasma CRP levels of 3 to 10 and >10 mg/L versus <3 mg/L, with multivariate adjusted HRs of 1.30; 95% CI, 1.17-1.45 and 1.65; 95% CI, 1.39-1.95, respectively. CONCLUSIONS Elevated plasma CRP measured before treatment in patients with early-stage breast cancer is an independent biomarker of increased risk of recurrence and early death. IMPACT CRP measures before treatment might be used to individualize follow-up of patients with early-stage breast cancer.
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Affiliation(s)
- Høgni H Andersen
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Stig E Bojesen
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Julia S Johansen
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- Department of Medicine, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Group (DBCG), Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Tobias Berg
- Danish Breast Cancer Group (DBCG), Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Malgorzata Tuxen
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Kasper Madsen
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Hella Danø
- Department of Oncology, North Zealand Hospital, Hillerød, Denmark
| | - Henrik Flyger
- Department of Breast Surgery, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Group (DBCG), Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Dorte L Nielsen
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Lynce F, Stevens LE, Li Z, Brock JE, Gulvady A, Huang Y, Nakhlis F, Patel A, Force JM, Haddad TC, Ueno N, Stearns V, Wolff AC, Clark AS, Bellon JR, Richardson ET, Balko JM, Krop IE, Winer EP, Lange P, Hwang ES, King TA, Tolaney SM, Thompson A, Gupta GP, Mittendorf EA, Regan MM, Overmoyer B, Polyak K. TBCRC 039: a phase II study of preoperative ruxolitinib with or without paclitaxel for triple-negative inflammatory breast cancer. Breast Cancer Res 2024; 26:20. [PMID: 38297352 PMCID: PMC10829369 DOI: 10.1186/s13058-024-01774-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/18/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Patients with inflammatory breast cancer (IBC) have overall poor clinical outcomes, with triple-negative IBC (TN-IBC) being associated with the worst survival, warranting the investigation of novel therapies. Preclinical studies implied that ruxolitinib (RUX), a JAK1/2 inhibitor, may be an effective therapy for TN-IBC. METHODS We conducted a randomized phase II study with nested window-of-opportunity in TN-IBC. Treatment-naïve patients received a 7-day run-in of RUX alone or RUX plus paclitaxel (PAC). After the run-in, those who received RUX alone proceeded to neoadjuvant therapy with either RUX + PAC or PAC alone for 12 weeks; those who had received RUX + PAC continued treatment for 12 weeks. All patients subsequently received 4 cycles of doxorubicin plus cyclophosphamide prior to surgery. Research tumor biopsies were performed at baseline (pre-run-in) and after run-in therapy. Tumors were evaluated for phosphorylated STAT3 (pSTAT3) by immunostaining, and a subset was also analyzed by RNA-seq. The primary endpoint was the percent of pSTAT3-positive pre-run-in tumors that became pSTAT3-negative. Secondary endpoints included pathologic complete response (pCR). RESULTS Overall, 23 patients were enrolled, of whom 21 completed preoperative therapy. Two patients achieved pCR (8.7%). pSTAT3 and IL-6/JAK/STAT3 signaling decreased in post-run-in biopsies of RUX-treated samples, while sustained treatment with RUX + PAC upregulated IL-6/JAK/STAT3 signaling compared to RUX alone. Both treatments decreased GZMB+ T cells implying immune suppression. RUX alone effectively inhibited JAK/STAT3 signaling but its combination with PAC led to incomplete inhibition. The immune suppressive effects of RUX alone and in combination may negate its growth inhibitory effects on cancer cells. CONCLUSION In summary, the use of RUX in TN-IBC was associated with a decrease in pSTAT3 levels despite lack of clinical benefit. Cancer cell-specific-targeting of JAK2/STAT3 or combinations with immunotherapy may be required for further evaluation of JAK2/STAT3 signaling as a cancer therapeutic target. TRIAL REGISTRATION www. CLINICALTRIALS gov , NCT02876302. Registered 23 August 2016.
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Affiliation(s)
- Filipa Lynce
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA.
- Harvard Medical School, Boston, MA, USA.
- Brigham and Women's Hospital, Boston, MA, USA.
| | - Laura E Stevens
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Zheqi Li
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Jane E Brock
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Anushree Gulvady
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Ying Huang
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Faina Nakhlis
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Ashka Patel
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Naoto Ueno
- MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Amy S Clark
- University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer R Bellon
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Edward T Richardson
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Justin M Balko
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ian E Krop
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Eric P Winer
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Paulina Lange
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
| | | | - Tari A King
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Sara M Tolaney
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Elizabeth A Mittendorf
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Meredith M Regan
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Beth Overmoyer
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Kornelia Polyak
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA.
- Harvard Medical School, Boston, MA, USA.
- Brigham and Women's Hospital, Boston, MA, USA.
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Motyka J, Gacuta E, Kicman A, Kulesza M, Malinowski P, Ławicki S. CXCL12 and CXCR4 as Potential Early Biomarkers for Luminal A and Luminal B Subtypes of Breast Cancer. Cancer Manag Res 2023; 15:573-589. [PMID: 37426394 PMCID: PMC10329441 DOI: 10.2147/cmar.s416382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 06/15/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose Breast cancer is the most common type of malignancy in women. Factors that increase the risk of occurrence include chronic inflammation, with chemokines as its mediators. Therefore, the purpose of the present study was to determine the diagnostic utility of CXCL12 and CXCR4 as modern tumor markers in patients with early-stage luminal A and luminal B subtype of breast cancer and also to compare the results with the routinely used marker - CA 15-3. Patients and Methods The study included 100 patients with early breast cancer of luminal A and B subtypes, 50 women with benign breast lesion and 50 healthy women. The levels of CXCL12 and CXCR4 concentrations were determined by enzyme-linked immunosorbent assay (ELISA), comparative marker CA 15-3 - by electrochemiluminescence method (ECLIA). Results Concentrations of CXCL12 were significantly lower, while CXCR4 and CA 15-3 - significantly higher among patients with early-stage breast cancer than healthy women. CXCL12 also showed lower concentrations among fibroadenoma patients in comparison to healthy women, while CXCR4 - lower concentrations among fibroadenoma patients than cancer group. CXCL12 showed significantly higher values of sensitivity (79%), specificity (82%), positive predictive value (89.72%), negative predictive value (80%), diagnostic accuracy (80%) and diagnostic power (AUC = 0.8196) in the whole breast cancer group compared to the CA 15-3 marker (58%; 72%; 80.56%; 46.15%, 62.67%, 0.6434, resp.). Analysis of combined parameters resulted in increased sensitivity, negative predictive value and power of the test with a slight decrease in positive predictive value and a more significant decrease in specificity, reaching the best values for the three-parameter test CXCL12+CXCR4+CA15-3 (96%; 85.71%; AUC = 0.8812; 78.69%; 48%, resp.). Conclusion The results indicate the preliminary usefulness of CXCL12 and CXCR4 as early biomarkers in the diagnosis of breast cancer, especially in the combined panel with CA 15-3.
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Affiliation(s)
- Joanna Motyka
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, Bialystok, Poland
| | - Ewa Gacuta
- Department of Perinatology, University Clinical Hospital of Bialystok, Bialystok, Poland
| | - Aleksandra Kicman
- Department of Aesthetic Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Monika Kulesza
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, Bialystok, Poland
| | - Paweł Malinowski
- Department of Oncological Surgery, Bialystok Oncology Center, Bialystok, Poland
| | - Sławomir Ławicki
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, Bialystok, Poland
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Liu X, Morelli D, Littlejohns TJ, Clifton DA, Clifton L. Combining machine learning with Cox models to identify predictors for incident post-menopausal breast cancer in the UK Biobank. Sci Rep 2023; 13:9221. [PMID: 37286615 DOI: 10.1038/s41598-023-36214-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/31/2023] [Indexed: 06/09/2023] Open
Abstract
We aimed to identify potential novel predictors for breast cancer among post-menopausal women, with pre-specified interest in the role of polygenic risk scores (PRS) for risk prediction. We utilised an analysis pipeline where machine learning was used for feature selection, prior to risk prediction by classical statistical models. An "extreme gradient boosting" (XGBoost) machine with Shapley feature-importance measures were used for feature selection among [Formula: see text] 1.7 k features in 104,313 post-menopausal women from the UK Biobank. We constructed and compared the "augmented" Cox model (incorporating the two PRS, known and novel predictors) with a "baseline" Cox model (incorporating the two PRS and known predictors) for risk prediction. Both of the two PRS were significant in the augmented Cox model ([Formula: see text]). XGBoost identified 10 novel features, among which five showed significant associations with post-menopausal breast cancer: plasma urea (HR = 0.95, 95% CI 0.92-0.98, [Formula: see text]), plasma phosphate (HR = 0.68, 95% CI 0.53-0.88, [Formula: see text]), basal metabolic rate (HR = 1.17, 95% CI 1.11-1.24, [Formula: see text]), red blood cell count (HR = 1.21, 95% CI 1.08-1.35, [Formula: see text]), and creatinine in urine (HR = 1.05, 95% CI 1.01-1.09, [Formula: see text]). Risk discrimination was maintained in the augmented Cox model, yielding C-index 0.673 vs 0.667 (baseline Cox model) with the training data and 0.665 vs 0.664 with the test data. We identified blood/urine biomarkers as potential novel predictors for post-menopausal breast cancer. Our findings provide new insights to breast cancer risk. Future research should validate novel predictors, investigate using multiple PRS and more precise anthropometry measures for better breast cancer risk prediction.
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Affiliation(s)
- Xiaonan Liu
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.
- Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK.
| | - Davide Morelli
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Thomas J Littlejohns
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - David A Clifton
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Lei Clifton
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
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The modified Glasgow prognostic score (MGPS) and the mortality prediction model II (MPM II) can predict mortality in patients with breast cancer admitted to intensive care: A retrospective cohort study. JOURNAL OF SURGERY AND MEDICINE 2023. [DOI: 10.28982/josam.7606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background/Aim: Breast cancer is the second most common cause of cancer-related death in women worldwide. Predicting the prognosis in breast cancer with very high mortality is important in terms of disease treatment and increasing life expectancy. In our study, we aimed to examine the importance of some inflammatory markers and scoring systems in predicting prognosis in patients with breast cancer who were hospitalized in the intensive care unit.
Methods: This retrospective cohort study was conducted in the Department of Medical Oncology and Intensive Care Unit between 2014 and 2020. Breast cancer patients who were admitted to the intensive care unit at any stage of their treatment during the study and followed up and treated in the medical oncology department of the hospital were included in the study. All data were compared between groups (discharged or exitus) based on survival status. Socio-demographic information, laboratory findings (hemoglobin, leukocytes, neutrophils, lymphocytes, platelets, eosinophils, monocytes, C-reactive protein [CRP], albumin, lactate dehydrogenase [LDH], clinical status [co-morbidities, length of stay in intensive care, mechanical ventilation, and reason for hospitalization in the intensive care unit]), and survival data of the patients were collected retrospectively from hospital medical records. We also recorded treatment-related data and relapse/progression information. Neutrophil–lymphocyte, platelet–lymphocyte, and lymphocyte–monocyte ratios (NLR, PLR, and LMR, respectively) were calculated.
Results: Thirty-seven (52.1%) patients died and 34 (47.9%) patients survived. The NLR (P=0.021), Modified Glasgow Prognostic score (P<0.001), APACHE II score (P<0.001) and mortality probability model (MPM II) upon admission (P<0.001) were significantly higher in the exitus group than in the survivors. The lymphocyte_monocyte ratio (P=0.030) and prognostic nutritional index (P=0.004) were significantly higher in the discharged group than in the death group. When we evaluated performance of the prognostic scores to predict mortality, we found that the APACHE II score (area under the curve [AUC]: 0.939, 95% confidence interval [CI]: 0.888–0.990), MPM II-Admission (AUC: 0.936, 95% CI: 0.880–0.992), and modified Glasgow Prognostic Score ([mGPS] AUC: 0.727, 95% CI: 0.600–0.854) had the highest area under curve values. Multivariable regression revealed that longer chemotherapy duration (≥2 weeks), an mGPS score of two points, and high MPM-II (≥36 points) were independently associated with mortality.
Conclusion: Among the inflammatory markers and scores examined, mGPS and MPM-II were found to be independently associated with mortality in breast cancer patients who were hospitalized in the intensive care unit. In addition, patients with longer chemotherapy duration had a higher risk of mortality, but this result was limited by various possible confounders.
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Pinheiro BQ, de Magalhães FF, Alves FWDS, Silva ING, Faustino AMR, da Silva LDM. CA 15-3, CRP, and LDH correlates with prognostic parameters in canine mammary neoplasms. Anim Reprod 2023; 20:e20220086. [PMID: 36938312 PMCID: PMC10023068 DOI: 10.1590/1984-3143-ar2022-0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 02/01/2023] [Indexed: 03/15/2023] Open
Abstract
The identification of putative prognostic factors in canine mammary neoplasms (CMNs) has been focused on tissue-specific biomarkers, but the serum biomarkers, including cancer antigen 15-3 (CA 15-3), c-reactive protein (CRP), and lactate dehydrogenase (LDH) have been demonstrated to display clinical application in cases of CMNs. The aim of the study was to evaluate the levels of these serum biomarkers and their association with well-established prognostic factors in CMNs. Samples from 15 female canines with CMNs and 15 clinically healthy ones were collected. The results were evaluated using the Tukey's, Pearson, or Spearman tests. The cut-off point, sensitivity, specificity, and area under curve (AUC) were evaluated using the receiver operating characteristic (ROC) curve analysis in a logistic regression model (P<0.05). The levels of CA 15-3, CRP and LDH were significantly higher in the serum of female dogs with CMNs compared to the healthy ones. Moreover, these factors were positively correlated with ulceration, tumor size, histopathological grade, metastatic lymph node, and clinical staging. Female dogs with CMNs were found to exhibit highest serum levels of CA 15-3, CRP, and LDH. Therefore, they can be applied to improve the efficacy of the diagnosis and prognostic evaluation in casas of CMNs.
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Affiliation(s)
- Breno Queiroz Pinheiro
- Laboratório de Reprodução de Carnívoros, Faculdade de Veterinária, Universidade Estadual do Ceará, Fortaleza, CE, Brasil
| | - Francisco Felipe de Magalhães
- Laboratório de Reprodução de Carnívoros, Faculdade de Veterinária, Universidade Estadual do Ceará, Fortaleza, CE, Brasil
| | - Francisco Wesley da Silva Alves
- Laboratório de Patologia Clínica Veterinária, Faculdade de Veterinária, Universidade Estadual do Ceará, Fortaleza, CE, Brasil
| | - Isaac Neto Goes Silva
- Laboratório de Patologia Clínica Veterinária, Faculdade de Veterinária, Universidade Estadual do Ceará, Fortaleza, CE, Brasil
| | - Augusto Manuel Rodrigues Faustino
- Departamento de Patologia e Imunologia Molecular, Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Lúcia Daniel Machado da Silva
- Laboratório de Reprodução de Carnívoros, Faculdade de Veterinária, Universidade Estadual do Ceará, Fortaleza, CE, Brasil
- Corresponding author:
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9
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Winarto H, Habiburrahman M, Anggraeni TD, Nuryanto KH, Julianti RA, Purwoto G, Andrijono A. The Utility of Pre-Treatment Inflammation Markers as Associative Factors to the Adverse Outcomes of Vulvar Cancer: A Study on Staging, Nodal Involvement, and Metastasis Models. J Clin Med 2022; 12:jcm12010096. [PMID: 36614896 PMCID: PMC9821387 DOI: 10.3390/jcm12010096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Given the role of inflammation in carcinogenesis, this study investigated the utility of pre-treatment inflammatory markers as associative indicators for advanced-stage disease, lymph node metastasis (LNM), and distant metastasis (DM) in vulvar cancer (VC). METHODS A cross-sectional study was conducted on 86 women with VC in a single centre in Jakarta, Indonesia. The laboratory data was based on C-reactive protein (CRP), procalcitonin, the erythrocyte sedimentation rate (ESR) and fourteen derived, recorded and calculated ratios: leukocyte-to-platelet (LPR), neutrophil-to-lymphocyte (NLR), derived neutrophil-to-lymphocyte (dNLR), neutrophil-to-monocyte (NMR), platelet-to-monocyte (PLR), lymphocyte-to-monocyte (LMR), basophil-to-monocyte (BLR), systemic immune-inflammation index (SII), body mass index, albumin, and NLR (BAN) score, haemoglobin-to-platelet (HPR), prognostic nutritional index (PNI), modified Glasgow Prognostic Score (mGPS), CRP-to-albumin, and CRP-to-procalcitonin. The optimal cut-off for each marker was determined using receiver operating characteristic (ROC) curve analysis, and their diagnostic indicator performances were assessed. The utility of these ratios as associative factors for three endpoints was further evaluated in multivariate regression models. RESULTS Investigated inflammatory markers exhibited specific performances for individual adverse outcomes, proving a fair to excellent ability in case finding and screening. After adjustment, the BAN score ≤ 334.89 (OR 9.20, p = 0.001) and ESR ≥ 104 (OR 4.18, p = 0.048) become two advanced-stage associative factors with AUC: 0.769. LNM was solely determined by higher NLR ≥ 2.83 (OR 4.15, p = 0.014) with AUC: 0.615. Meanwhile, BLR ≥ 0.035 (OR 5.67, p = 0.001) and ESR ≥ 84 (OR 6.01, p = 0.003) were contributing factors for DM, with AUC: 0.765. CONCLUSIONS Inflammatory markers are crucial for identifying the deleterious outcomes of VC. Accordingly, yielded models require external validation.
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Affiliation(s)
- Hariyono Winarto
- Division of Gynecologic Oncology, Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
- Correspondence: (H.W.); (M.H.); Tel.: +62-21-3914806 (H.W.); +62-21-31930373 (M.H.)
| | - Muhammad Habiburrahman
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
- Correspondence: (H.W.); (M.H.); Tel.: +62-21-3914806 (H.W.); +62-21-31930373 (M.H.)
| | - Tricia Dewi Anggraeni
- Division of Gynecologic Oncology, Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Kartiwa Hadi Nuryanto
- Division of Gynecologic Oncology, Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Renny Anggia Julianti
- Division of Gynecologic Oncology, Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Gatot Purwoto
- Division of Gynecologic Oncology, Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Andrijono Andrijono
- Division of Gynecologic Oncology, Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
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10
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Mikkelsen MK, Lindblom NAF, Dyhl-Polk A, Juhl CB, Johansen JS, Nielsen D. Systematic review and meta-analysis of C-reactive protein as a biomarker in breast cancer. Crit Rev Clin Lab Sci 2022; 59:480-500. [PMID: 35403550 DOI: 10.1080/10408363.2022.2050886] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Inflammation is an enabling characteristic of the hallmarks of cancer. There has therefore been increasing interest in the clinical value of circulating inflammatory biomarkers in cancer. In this review, we summarize results on C-reactive protein (CRP), alone or as part of the Glasgow Prognostic Score (GPS, composed of CRP and serum albumin), as a biomarker of prognosis or prediction and monitoring of therapeutic response in patients with breast cancer. A systematic literature search was performed in Medline and Embase from 1990 to August 2021. The association of serum CRP and overall survival and disease/progression-free survival was summarized in meta-analyses using a random effects model. The results from a total of 35 included studies (20,936 patients) were divided according to three identified patient settings (metastatic, non-metastatic, and general setting). Most of the studies examined prognostic utility. Several larger studies observed associations between high serum CRP and poor survival, but the meta-analyses suggested a limited value in a non-metastatic and general breast cancer setting (populations with unknown or varied disease stage). In metastatic patients, however, more consistent findings supported an association between serum CRP and prognosis (hazard ratio for overall survival: 1.87 (95% CI 1.31-2.67). Only five studies examined a role in prediction or monitoring of therapeutic response. One study reported a significant association between serum CRP levels and response to chemotherapy. Findings regarding serum CRP as a biomarker in breast cancer appear inconsistent, particularly in non-metastatic and general breast cancer, where the prognostic value could not be confirmed. In patients with metastatic breast cancer we suggest that high serum CRP is an indicator of poor prognosis. Too few studies assessed the role of serum CRP in prediction or monitoring of treatment response to allow conclusions.
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Affiliation(s)
- Marta Kramer Mikkelsen
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | | | - Anne Dyhl-Polk
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Carsten Bogh Juhl
- Department of Physiotherapy and Occupational Therapy, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Julia Sidenius Johansen
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,Department of Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dorte Nielsen
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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11
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Gil-Herrero L, Pollán M, Martín M, López-Tarruella S, Castellanos M, Casla-Barrio S. The importance of physical exercise in cardiovascular fitness in breast cancer survivors. A cross-sectional study: women in Motion 2.0. Support Care Cancer 2022; 30:6745-6754. [PMID: 35524144 DOI: 10.1007/s00520-022-06993-9] [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: 12/02/2021] [Accepted: 03/15/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the cardiovascular fitness of breast cancer (BC) survivors with an active lifestyle to those with a sedentary lifestyle. METHODS A cross-sectional study was conducted. Participants were classified into four groups: two groups of active women who performed more than 150 min/week of physical exercise, active with BC (Act-BCW) and active without BC (Act-HW); and two groups of sedentary women who performed less than 90 min/week of physical exercise, sedentary with BC (Sed-BCW) and sedentary without BC (Sed-HW). VO2max was estimated by the 6-min walking test (6MWT); speed, isometric strength, lower body maximum strength, explosive strength, balance, and body composition were also measured. ANOVA was used to analyze group differences and post hoc comparisons were developed with the Bonferroni test. RESULTS A total of 92 women were recruited. Significant differences were found in VO2max between the Act-BCW and Sed-BCW groups (MeanDif = 5.86, p < 0.001). No differences in VO2max were observed between the active groups (MeanDif = 0.42, p = 0.753). Related body composition and fat mass levels were significantly lower in the Act-BCW group than in the sedentary groups (Sed-BCW MeanDif = - 6.78; p = 0.012; and Sed-HW MeanDif = - 12.07; p < 0.001). CONCLUSIONS Women who are Act-BCW can achieve similar values in physical condition as women who are Act-HW and have better values than women who are sedentary. Furthermore, our results suggest than physical activity level may have a greater impact in body composition than a previous history of BC.
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Affiliation(s)
| | | | - Miguel Martín
- Hospital General Universitario Gregorio Marañon, Madrid, Spain
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12
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Han CL, Meng GX, Ding ZN, Dong ZR, Chen ZQ, Hong JG, Yan LJ, Liu H, Tian BW, Yang LS, Xue JS, Li T. The Predictive Potential of the Baseline C-Reactive Protein Levels for the Efficiency of Immune Checkpoint Inhibitors in Cancer Patients: A Systematic Review and Meta-Analysis. Front Immunol 2022; 13:827788. [PMID: 35211122 PMCID: PMC8861087 DOI: 10.3389/fimmu.2022.827788] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/14/2022] [Indexed: 01/10/2023] Open
Abstract
Background The relationship between baseline C-reactive protein (CRP) level and the prognosis of cancer patients receiving immune checkpoint inhibitor (ICI) treatment remains controversial. The aim of this meta-analysis was to clarify whether baseline CRP level can serve as a biomarker to predict the efficiency of ICI therapy. Methods All associated articles published in the Cochrane Library, EMBASE, and PubMed databases from the inception of the database to December 30, 2021, were retrieved. Progression-free survival (PFS) and overall survival (OS) outcomes were meta-analyzed using the random-effects model and adjusted using the trim-and-fill method because of publication bias. Results Thirty-three studies (6,124 patients) conducted between 2013 and 2021 were identified. The pooled outcomes implied that high baseline CRP level patients had significantly worse OS (adjusted pooled value for univariate and multivariate analysis outcomes: HR = 1.48, 95% CI = 1.41-1.56; HR = 1.46, 95% CI = 1.34-1.59) and PFS (adjusted pooled value for univariate and multivariate analysis outcomes: HR = 1.29, 95% CI = 1.15-1.45; HR = 1.20, 95% CI = 1.02-1.40) than low baseline CRP level patients, irrespective of cancer or ICI type. Further analysis indicated that 1 mg/dl was appropriate as a cutoff value for determining the low or high level of baseline CRP to predict the OS or PFS of cancer patients receiving ICI treatment (univariate analysis: HR = 1.56, 95% CI = 1.24-1.97, P = 0.909; multivariate analysis: HR = 1.58, 95% CI = 1.23-2.03, P = 0.521). Conclusions High baseline CRP level (>1 mg/dl) may be an indicator for worse OS and PFS of cancer patients treated with ICIs. More high-quality prospective studies are warranted to assess the predictive value of CRP for ICI treatment.
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Affiliation(s)
- Cheng-Long Han
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Guang-Xiao Meng
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Zi-Niu Ding
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Zhao-Ru Dong
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Zhi-Qiang Chen
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Jian-Guo Hong
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Lun-Jie Yan
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Hui Liu
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Bao-Wen Tian
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Long-Shan Yang
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Jun-Shuai Xue
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Tao Li
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China.,Department of Hepatobiliary Surgery, The Second Hospital of Shandong University, Jinan, China
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13
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Association of empirically derived food-based inflammatory potential of the diet and breast cancer: A hospital based case-control study. Clin Breast Cancer 2022; 22:e567-e575. [DOI: 10.1016/j.clbc.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/29/2021] [Accepted: 12/19/2021] [Indexed: 12/09/2022]
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14
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Fabian CJ, Klemp JR, Marchello NJ, Vidoni ED, Sullivan DK, Nydegger JL, Phillips TA, Kreutzjans AL, Hendry B, Befort CA, Nye L, Powers KR, Hursting SD, Giles ED, Hamilton-Reeves JM, Li B, Kimler BF. Rapid Escalation of High-Volume Exercise during Caloric Restriction; Change in Visceral Adipose Tissue and Adipocytokines in Obese Sedentary Breast Cancer Survivors. Cancers (Basel) 2021; 13:cancers13194871. [PMID: 34638355 PMCID: PMC8508448 DOI: 10.3390/cancers13194871] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 02/02/2023] Open
Abstract
Simple Summary Aerobic exercise reduces risk for developing breast cancer or for breast cancer recurrence. In obese women exercise can significantly augment the effects of caloric restriction on visceral fat, reducing metabolic abnormalities and cancer. Women who are older, obese, and sedentary, especially those who have been treated for breast cancer, find it difficult to initiate and achieve the minimum or optimum levels of exercise. In a two-part pilot we found that by providing older, obese, sedentary breast cancer survivors 12 weeks of twice weekly personal training sessions, they could safely increase exercise to ≥200 min/week by 9 weeks during caloric restriction. At 24 weeks, high levels of exercise were still observed with continued behavioral support and study-provided exercise facility. Substantial improvement in visceral fat and breast cancer risk biomarkers were observed with this affordable intervention that is readily exportable to the community. Abstract Aerobic exercise reduces risk for breast cancer and recurrence and promotes visceral adipose tissue (VAT) loss in obesity. However, few breast cancer survivors achieve recommended levels of moderate to vigorous physical activity (MVPA) without supervision. In a two-cohort study, feasibility of 12 weeks of partially supervised exercise was started concomitantly with caloric restriction and effects on body composition and systemic risk biomarkers were explored. In total, 22 obese postmenopausal sedentary women (including 18 breast cancer survivors) with median age of 60 and BMI of 37 kg/m2 were enrolled. Using personal trainers twice weekly at area YMCAs, MVPA was escalated to ≥200 min/week over 9 weeks. For cohort 2, maintenance of effect was assessed when study provided trainer services were stopped but monitoring, group counseling sessions, and access to the exercise facility were continued. Median post-escalation MVPA was 219 min/week with median 12-week mass and VAT loss of 8 and 19%. MVPA was associated with VAT loss which was associated with improved adiponectin:leptin ratio. In total, 9/11 of cohort-2 women continued the behavioral intervention for another 12 weeks without trainers. High MVPA continued with median 24-week mass and VAT loss of 12 and 29%. This intervention should be further studied in obese sedentary women.
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Affiliation(s)
- Carol J. Fabian
- Department of Internal Medicine, Division of Medical Oncology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; (C.J.F.); (J.R.K.); (J.L.N.); (T.A.P.); (A.L.K.); (L.N.); (K.R.P.)
| | - Jennifer R. Klemp
- Department of Internal Medicine, Division of Medical Oncology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; (C.J.F.); (J.R.K.); (J.L.N.); (T.A.P.); (A.L.K.); (L.N.); (K.R.P.)
| | - Nicholas J. Marchello
- Department of Nutrition, Kinesiology, and Psychological Sciences, University of Central Missouri, P.O. Box 800, Warrensburg, MO 64093, USA;
| | - Eric D. Vidoni
- Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; (E.D.V.); (B.H.)
| | - Debra K. Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; (D.K.S.); (J.M.H.-R.)
| | - Jennifer L. Nydegger
- Department of Internal Medicine, Division of Medical Oncology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; (C.J.F.); (J.R.K.); (J.L.N.); (T.A.P.); (A.L.K.); (L.N.); (K.R.P.)
| | - Teresa A. Phillips
- Department of Internal Medicine, Division of Medical Oncology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; (C.J.F.); (J.R.K.); (J.L.N.); (T.A.P.); (A.L.K.); (L.N.); (K.R.P.)
| | - Amy L. Kreutzjans
- Department of Internal Medicine, Division of Medical Oncology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; (C.J.F.); (J.R.K.); (J.L.N.); (T.A.P.); (A.L.K.); (L.N.); (K.R.P.)
| | - Bill Hendry
- Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; (E.D.V.); (B.H.)
| | - Christie A. Befort
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA;
| | - Lauren Nye
- Department of Internal Medicine, Division of Medical Oncology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; (C.J.F.); (J.R.K.); (J.L.N.); (T.A.P.); (A.L.K.); (L.N.); (K.R.P.)
| | - Kandy R. Powers
- Department of Internal Medicine, Division of Medical Oncology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; (C.J.F.); (J.R.K.); (J.L.N.); (T.A.P.); (A.L.K.); (L.N.); (K.R.P.)
| | - Stephen D. Hursting
- Department of Nutrition, Nutrition Research Institute, University of North Carolina at Chapel Hill, 235 Dauer Drive, Chapel Hill, NC 27599, USA;
| | - Erin D. Giles
- Department of Nutrition, Texas A&M University, 214 Cater-Mattil 2253 TAMU, 373 Olsen Blvd, College Station, TX 77843, USA;
| | - Jill M. Hamilton-Reeves
- Department of Dietetics and Nutrition, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; (D.K.S.); (J.M.H.-R.)
- Department of Urology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Bing Li
- Department of Pathology, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA;
| | - Bruce F. Kimler
- Department of Radiation Oncology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
- Correspondence: ; Tel.: +1-913-588-4523
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15
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Possa LDO, Hinkelman JV, Santos CAD, Oliveira CAD, Faria BS, Hermsdorff HHM, Rosa CDOB. Association of dietary total antioxidant capacity with anthropometric indicators, C-reactive protein, and clinical outcomes in hospitalized oncologic patients. Nutrition 2021; 90:111359. [PMID: 34243042 DOI: 10.1016/j.nut.2021.111359] [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: 12/07/2020] [Revised: 04/03/2021] [Accepted: 05/20/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Many studies have shown an inverse association between higher dietary total antioxidant capacity (DTAC) and chronic non-communicable diseases, including cancer. The aim of this study was to evaluate the association of the DTAC with anthropometric and biochemical indicators and clinical outcomes in hospitalized patients with cancer. METHODS A cross-sectional study was carried out with 196 hospitalized patients diagnosed with cancer. The DTAC, determined by the ferric-reducing antioxidant power method, was calculated using a validated standard spreadsheet. Multivariate linear regression was used to assess the association, identifying anthropometric indicators that were associated with DTAC and the variables of interest. P < 0.05 was statistically significant. RESULTS The individuals included in the last tertile of DTAC presented lower occurrences of death (P = 0.032), constipation (P = 0.010), dysphagia (P = 0.010), painful swallowing and chewing (P = 0.019), and dehydration (P = 0.032) than individuals in the first tertile. The C-reactive protein values were significantly lower (P = 0.010) and handgrip strength values were higher (P = 0.037) in individuals in the third tertile than in the other participants. CONCLUSIONS DTAC was associated with a better prognosis of hospitalized cancer patients, considering signs and symptoms of nutritional impact, as well as the inflammatory state of the patients. These factors may influence the length of hospital stay and mortality. The findings of this research provide important information for a preventive and nutritional management perspective in this population.
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Affiliation(s)
- Luiza de Oliveira Possa
- Department of Nutrition and Health, Federal University of Viçosa, Viçosa, Minas Gerais, Brazil.
| | - Jéssica Viana Hinkelman
- Department of Nutrition and Health, Federal University of Viçosa, Viçosa, Minas Gerais, Brazil
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16
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Schvarcz CA, Danics L, Krenács T, Viana P, Béres R, Vancsik T, Nagy Á, Gyenesei A, Kun J, Fonović M, Vidmar R, Benyó Z, Kaucsár T, Hamar P. Modulated Electro-Hyperthermia Induces a Prominent Local Stress Response and Growth Inhibition in Mouse Breast Cancer Isografts. Cancers (Basel) 2021; 13:1744. [PMID: 33917524 PMCID: PMC8038813 DOI: 10.3390/cancers13071744] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/20/2021] [Accepted: 03/24/2021] [Indexed: 02/07/2023] Open
Abstract
Modulated electro-hyperthermia (mEHT) is a selective cancer treatment used in human oncology complementing other therapies. During mEHT, a focused electromagnetic field (EMF) is generated within the tumor inducing cell death by thermal and nonthermal effects. Here we investigated molecular changes elicited by mEHT using multiplex methods in an aggressive, therapy-resistant triple negative breast cancer (TNBC) model. 4T1/4T07 isografts inoculated orthotopically into female BALB/c mice were treated with mEHT three to five times. mEHT induced the upregulation of the stress-related Hsp70 and cleaved caspase-3 proteins, resulting in effective inhibition of tumor growth and proliferation. Several acute stress response proteins, including protease inhibitors, coagulation and heat shock factors, and complement family members, were among the most upregulated treatment-related genes/proteins as revealed by next-generation sequencing (NGS), Nanostring and mass spectrometry (MS). pathway analysis demonstrated that several of these proteins belong to the response to stimulus pathway. Cell culture treatments confirmed that the source of these proteins was the tumor cells. The heat-shock factor inhibitor KRIBB11 reduced mEHT-induced complement factor 4 (C4) mRNA increase. In conclusion, mEHT monotherapy induced tumor growth inhibition and a complex stress response. Inhibition of this stress response is likely to enhance the effectiveness of mEHT and other cancer treatments.
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Affiliation(s)
- Csaba András Schvarcz
- Institute of Translational Medicine, Semmelweis University, 1094 Budapest, Hungary; (C.A.S.); (L.D.); (P.V.); (R.B.); (T.V.); (Z.B.); (T.K.)
| | - Lea Danics
- Institute of Translational Medicine, Semmelweis University, 1094 Budapest, Hungary; (C.A.S.); (L.D.); (P.V.); (R.B.); (T.V.); (Z.B.); (T.K.)
| | - Tibor Krenács
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, 1085 Budapest, Hungary;
| | - Pedro Viana
- Institute of Translational Medicine, Semmelweis University, 1094 Budapest, Hungary; (C.A.S.); (L.D.); (P.V.); (R.B.); (T.V.); (Z.B.); (T.K.)
| | - Rita Béres
- Institute of Translational Medicine, Semmelweis University, 1094 Budapest, Hungary; (C.A.S.); (L.D.); (P.V.); (R.B.); (T.V.); (Z.B.); (T.K.)
| | - Tamás Vancsik
- Institute of Translational Medicine, Semmelweis University, 1094 Budapest, Hungary; (C.A.S.); (L.D.); (P.V.); (R.B.); (T.V.); (Z.B.); (T.K.)
| | - Ákos Nagy
- Molecular Oncohematology Research Group, 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, 1085 Budapest, Hungary;
| | - Attila Gyenesei
- Bioinformatics Research Group, Genomics and Bioinformatics Core Facility, János Szentágothai Research Centre, University of Pécs, H-7624 Pécs, Hungary; (A.G.); (J.K.)
| | - József Kun
- Bioinformatics Research Group, Genomics and Bioinformatics Core Facility, János Szentágothai Research Centre, University of Pécs, H-7624 Pécs, Hungary; (A.G.); (J.K.)
- Department of Pharmacology and Pharmacotherapy, Medical School & Szentágothai Research Centre, Molecular Pharmacology Research Group, Centre for Neuroscience, University of Pécs, H-7624 Pécs, Hungary
| | - Marko Fonović
- Department of Biochemistry and Molecular and Structural Biology, Jožef Stefan Institute, 1000 Ljubljana, Slovenia; (M.F.); (R.V.)
| | - Robert Vidmar
- Department of Biochemistry and Molecular and Structural Biology, Jožef Stefan Institute, 1000 Ljubljana, Slovenia; (M.F.); (R.V.)
| | - Zoltán Benyó
- Institute of Translational Medicine, Semmelweis University, 1094 Budapest, Hungary; (C.A.S.); (L.D.); (P.V.); (R.B.); (T.V.); (Z.B.); (T.K.)
| | - Tamás Kaucsár
- Institute of Translational Medicine, Semmelweis University, 1094 Budapest, Hungary; (C.A.S.); (L.D.); (P.V.); (R.B.); (T.V.); (Z.B.); (T.K.)
| | - Péter Hamar
- Institute of Translational Medicine, Semmelweis University, 1094 Budapest, Hungary; (C.A.S.); (L.D.); (P.V.); (R.B.); (T.V.); (Z.B.); (T.K.)
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Micheletti PL, Carla-da-Silva J, Scandolara TB, Kern R, Alves VD, Malanowski J, Victorino VJ, Herrera ACSA, Rech D, Souza JAO, Simão ANC, Panis C, Dichi I. Proinflammatory circulating markers: new players for evaluating asymptomatic acute cardiovascular toxicity in breast cancer treatment. J Chemother 2021; 33:106-115. [PMID: 33480330 DOI: 10.1080/1120009x.2021.1873632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE This study aimed to evaluate markers of cardiac damage (total CK, CKMB and CRP), inflammatory markers (free iron, homocysteine and TNF-α) as well as lipidogram in breast cancer patients undergoing acute cycles of doxorubicin (DOX), paclitaxel (PTX) or trastuzumab (TZ) and to verify if there is an association between these markers and the toxicity of the chemotherapeutic treatment. Methods: Included in the study were 120 breast cancer patients and 50 healthy controls. All analyzes were performed on automated systems. For the statistical analysis, each group was compared with the controls according to their normality by Student's t-test and Mann-Whitney test. Results: Our results showed that DOX treatment led to increased hsCRP (4.80 ± 1.23 mg/dL, p = 0.0005), triglycerides (187.6 ± 25.06, p = 0.0231), TNF-α (42.31 ± 17.96 pg/mL, p = 0.01) and Fe levels (138.8 ± 18.6 μg/dL, p = 0.0193). In the meantime, PTX induced changes in CK-MB (8.78 ± 4.2 U/L, p = 0.0361), hsCRP (7.12 ± 1.87 mg/dL, p = 0.0006), cholesterol (201.7 ± 19.54, p = 0.05), triglycerides (201.7 ± 19.54, p = 0.0277), TNF-α (38.27 ± 9.12 pg/mL, p = 0.023), homocysteine (10.95 ± 0, 86 μmol/L, p = 0.005), and free iron (113 ± 18 6 μg/dL, p = 0.045) while TZ augmented CK-MB (6.9 ± 1.97 U/L, p < 0.00), hsPCR (3.12 ± 0.68 mg/dL, p = 0.095), cholesterol (218.3 ± 16.79, p = 0.0317), triglycerides (218.3 ± 16.79, p = 0.0127), TNF-α (89.6 ± 12.11, p = 0.032), homocysteine (9.95 ± 1.15 μmol/L, p = 0.0396), free iron (120.5 ± 4.64 μg/dl, p = 0.0058) as well. Conclusions: Our data demonstrated the existence of a proinflammatory net triggered by breast cancer chemotherapy that could increase cardiomyocytes permeability and allow the leakage of circulating proteins as CK-MB and induce the production of hsCRP.
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Affiliation(s)
- P L Micheletti
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Londrina, Paraná, Brazil
| | - J Carla-da-Silva
- Laboratório de Biologia de Tumores, Universidade Estadual do Oeste do Paraná, Paraná, Brazil
| | - T B Scandolara
- Laboratório de Biologia de Tumores, Universidade Estadual do Oeste do Paraná, Paraná, Brazil
| | - R Kern
- Laboratório de Biologia de Tumores, Universidade Estadual do Oeste do Paraná, Paraná, Brazil
| | - V D Alves
- Laboratório de Biologia de Tumores, Universidade Estadual do Oeste do Paraná, Paraná, Brazil
| | - J Malanowski
- Laboratório de Biologia de Tumores, Universidade Estadual do Oeste do Paraná, Paraná, Brazil
| | - V J Victorino
- Instituto Federal do Rio de Janeiro, Campus Engenheiro Paulo de Frontin, Rio de Janeiro, Brazil
| | - A C S A Herrera
- Pontifícia Universidade Católica de Londrina, Paraná, Brazil
| | - D Rech
- Laboratório de Biologia de Tumores, Universidade Estadual do Oeste do Paraná, Paraná, Brazil.,Hospital de Câncer de Francisco Beltrão, Ceonc, Paraná, Brazil
| | - J A O Souza
- Hospital de Câncer de Francisco Beltrão, Ceonc, Paraná, Brazil
| | - A N C Simão
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Londrina, Paraná, Brazil
| | - C Panis
- Laboratório de Biologia de Tumores, Universidade Estadual do Oeste do Paraná, Paraná, Brazil
| | - I Dichi
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Londrina, Paraná, Brazil
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18
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Obesity-related protein biomarkers for predicting breast cancer risk: an overview of systematic reviews. Breast Cancer 2020; 28:25-39. [PMID: 33237347 DOI: 10.1007/s12282-020-01182-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/28/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Based on the biological mechanisms underlying the obesity-breast cancer connections, potential protein biomarkers involved in breast cancer development have been identified, which may be helpful for the estimation of breast cancer risk. This study aimed to carry out a comprehensive overview of systematic reviews on circulating levels of obesity-related protein biomarkers for female breast cancer risk to provide a solid reference for potential breast cancer predictors. METHODS Comprehensive literature searches were conducted in MEDLINE, EMBASE and Cochrane Database of Systematic Reviews up to Dec 2019. The AMSTAR tool was used for the methodological quality assessment of the included systematic reviews. Evidence was reported narratively. RESULTS A total of 28 relevant systematic reviews which were mostly of moderate quality were included in the overview. Protein biomarkers relating to adipokines, insulin/insulin-like growth factor-1 (IGF-1) axis, inflammatory cytokines and sex hormones were investigated. Higher levels of circulating IGF-1, IGF-binding protein-3, leptin and resistin were found to be associated with an increased risk of premenopausal breast cancer; lower levels of circulating adiponectin and higher levels of circulating c-reactive protein, leptin, and resistin were found to be associated with an increased risk of postmenopausal breast cancer. CONCLUSIONS We found sufficient evidence on the positive associations between certain obesity-related protein biomarkers with pre- and/or postmenopausal breast cancer risk. These biomarkers could be used jointly as predictors, so as to build a comprehensive risk predictive score for female breast cancer. PROSPERO REGISTRATION NUMBER CRD42020175328.
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19
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Bruserud Ø, Aarstad HH, Tvedt THA. Combined C-Reactive Protein and Novel Inflammatory Parameters as a Predictor in Cancer-What Can We Learn from the Hematological Experience? Cancers (Basel) 2020; 12:cancers12071966. [PMID: 32707721 PMCID: PMC7409204 DOI: 10.3390/cancers12071966] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 02/06/2023] Open
Abstract
The acute phase reaction is a systemic response to acute or chronic inflammation. The serum level of C-reactive protein (CRP) is the only acute phase biomarker widely used in routine clinical practice, including its uses for prognostics and therapy monitoring in cancer patients. Although Interleukin 6 (IL6) is a main trigger of the acute phase reactions, a series of acute phase reactants can contribute (e.g., other members in IL6 family or IL1 subfamily, and tumor necrosis factor α). However, the experience from patients receiving intensive chemotherapy for hematological malignancies has shown that, besides CRP, other biomarkers (e.g., cytokines, soluble cytokine receptors, soluble adhesion molecules) also have altered systemic levels as a part of the acute phase reaction in these immunocompromised patients. Furthermore, CRP and white blood cell counts can serve as a dual prognostic predictor in solid tumors and hematological malignancies. Recent studies also suggest that biomarker profiles as well as alternative inflammatory mediators should be further developed to optimize the predictive utility in cancer patients. Finally, the experience from allogeneic stem cell transplantation suggests that selected acute phase reactants together with specific markers of organ damages are useful for predicting or diagnosing graft versus host disease. Acute phase proteins may also be useful to identify patients (at risk of) developing severe immune-mediated toxicity after anticancer immunotherapy. To conclude, future studies of acute phase predictors in human malignancies should not only investigate the conventional inflammatory mediators (e.g., CRP, white blood cell counts) but also combinations of novel inflammatory parameters with specific markers of organ damages.
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Affiliation(s)
- Øystein Bruserud
- Section for Hematology, Institute of Clinical Science, Faculty of Medicine, University of Bergen, 5007 Bergen, Norway;
- Section for Hematology, Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway;
- Correspondence: ; Tel.: +47-5597-2997
| | - Helene Hersvik Aarstad
- Section for Hematology, Institute of Clinical Science, Faculty of Medicine, University of Bergen, 5007 Bergen, Norway;
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20
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Maskarinec G, Ju D, Shvetsov YB, Horio D, Chan O, Loo LWM, Hernandez BY. Breast tumor tissue inflammation but not lobular involution is associated with survival among breast cancer patients in the Multiethnic Cohort. Cancer Epidemiol 2020; 65:101685. [PMID: 32058311 DOI: 10.1016/j.canep.2020.101685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/29/2020] [Accepted: 02/02/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND This study investigated the association of breast lobular involution status and three inflammatory markers as predictors of survival among breast cancer patients in the Multiethnic Cohort. METHODS Lobular involution was evaluated in tissue sections of normal breast tissue and COX-2, TNF-α, and TGF-β proteins were assessed by immunohistochemistry in tumor microarrays. A summary score added the expression levels of the three markers. Cox regression was applied to estimate hazard ratios (HRs) and 95 % confidence intervals (CI) with age as the time metric and adjustment for factors known to affect mortality. RESULTS Among 254 women (mean age = 61.7 ± 8.7 years) with pathologic blocks and follow-up information, 54 all-cause and 10 breast cancer-specific deaths were identified after a mean follow-up time of 16.0 ± 3.1 years. For 214 participants, an inflammatory score was available and 157 women had information on lobular involution. Lobular involution was not significantly associated with survival. Expression of both COX-2 and TNF-α were significant predictors of lower survival (p = 0.02 and 0.04), while the association for TGF-β was weaker (p = 0.09). When combined into one overall inflammation score, both intermediate (HR = 2.72; 95 % CI 0.90-8.28) and high (HR = 4.21; 95 % CI 1.51-11.8) scores were associated with higher mortality but only the latter was statistically significant. No significant association with breast cancer-specific mortality was detected. CONCLUSIONS These results suggest that strong expression of inflammatory markers in breast tissue predicts a poorer prognosis possibly due to a system-wide state of chronic inflammation.
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Affiliation(s)
| | - Dan Ju
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | | | - David Horio
- University of Hawaii Cancer Center, Honolulu, HI, United States
| | - Owen Chan
- University of Hawaii Cancer Center, Honolulu, HI, United States
| | - Lenora W M Loo
- University of Hawaii Cancer Center, Honolulu, HI, United States
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21
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Anber ZNH, Saleh BOM, Al-Rawi SA. The cardiotoxicity effect of different chemotherapeutic regimens in Iraqi patients with breast cancer: A follow up study. Heliyon 2019; 5:e02194. [PMID: 31406940 PMCID: PMC6684458 DOI: 10.1016/j.heliyon.2019.e02194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/13/2019] [Accepted: 07/29/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction Breast cancer is the first in ranking among cancers in Iraq. Anthracyclines, cyclophosphamide and taxane are the most active chemotherapeutic regimens used. Anthracyclines induced cardiotoxicity through free radical formation while there is no full understanding about that of cyclophosphamide, but it thought that it may cause direct cardiac muscle damage. While, taxane induced cardiotoxicity through coronary vasoconstriction and oxidative stress. Thus; it is very important to study changes in the cardiac biomarkers as they were the most reliable and sensitive markers associated with cardiotoxicity. Aim This research was designed to carry out investigations on the cardiotoxicity effects of these chemotherapeutic drugs in Iraqi patients with breast cancer. Materials and methods This research was performed at the Department of Biochemistry, Medicine College, Baghdad University and at the Oncology Department of the Teaching Hospital, Baghdad - Iraq, during the period from May 2018 to October 2018. It was carried out on 56 women with undisturbed menstrual cycle (25–45 years), These women were divided into 3 groups: GI was of 29 women with primary breast cancer without starting any kind of chemotherapy, GII: the same 29 women of GI after finishing 4 cycles of anthracyclines (course 1) and GIII: which involved another 27 women after finishing both course 1 and course 2 (4 cycles of taxanes). Investigations included serum measurements of high sensitive cardiac troponin (hs-cTn), NT-pro-brain natriuretic peptide (NT-ProBNP), and high sensitive- C reactive protein (hs-CRP) by using ELISA technique. The statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 23, when the P-values were less than 0.05, it was considered as significant. Results The mean (±SEM) value of the serum hs-CRP levels was decreased significantly in GIII in comparison to both GI (p = 0.004) and GII (p = 0.049) while there was no significant difference between GI and GII. Also, there was no significant difference in the mean (±SEM) value of the serum hs-cTn and the serum NT-PROBNP levels between all groups. The results also showed that there was a significant negative correlation between BMI values and serum NT-proBNP levels in GI (r = −0.435, p = 0.018), GII (r = −0.438, p = 0.018), and GIII (r = −0.384, p = 0.048). In GI, there was also a significant positive correlation between BMI and serum hs-CRP levels (r = 0.395, p = 0.034). Also, there was a significant positive correlation between serum hs-cTn levels and NT-proBNP levels in GI (r = 0.416, p = 0.025) and GII (r = 0.467, p = 0.011). Moreover, there was a significant negative correlation between the serum hs-cTn levels and serum hs- CRP concentrations (r = −0.397, p = 0.040) in GIII. Conclusion This study had concluded insignificant changes of cardiac biochemical markers during the chemotherapeutic treatment and that chemotherapy-induced cardiotoxicity is negligible.
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Affiliation(s)
- Zainab Nazar Hasan Anber
- Department of Therapeutics and Clinical Pharmacy, Baghdad College of Medical Sciences, Baghdad, Iraq
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22
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The pretreatment erythrocyte sedimentation rate predicts survival outcomes after surgery and adjuvant radiotherapy for extremity soft tissue sarcoma. Radiat Oncol 2019; 14:116. [PMID: 31272506 PMCID: PMC6610892 DOI: 10.1186/s13014-019-1331-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/27/2019] [Indexed: 12/18/2022] Open
Abstract
Background Systemic inflammation plays a critical role in cancer progression and oncologic outcomes in cancer patients. We investigated whether preoperative inflammatory biomarkers, including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and neutrophil to lymphocyte ratio (NLR), could be surrogate biomarkers for predicting overall survival (OS) in soft tissue sarcoma (STS) patients treated with surgery and postoperative radiotherapy. Methods A series of 99 patients who presented with localized extremity STS were retrospectively reviewed. The preoperative CRP levels, ESR, and NLR were evaluated for associations with OS, disease-free survival (DFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS). Cutoff values for CRP, ESR, and NLR were derived from receiver-operating characteristic curve analysis. Results Elevated CRP (> 0.14 mg/dL), ESR (> 15 mm/h), and NLR (> 1.95) levels were seen in 33, 44, and 45 patients, respectively. Of these three inflammatory biomarkers, elevated CRP and ESR were associated with a poorer OS (CRP: P = 0.050; ESR: P = 0.001), DFS (CRP: P = 0.023; ESR: P = 0.003), and DMFS (CRP: P = 0.015; ESR: P = 0.001). By multivariate analysis, an elevated ESR was found to be an independent prognostic factor for OS (HR 3.580, P = 0.025) and DMFS (HR 3.850, P = 0.036) after adjustment for other established prognostic factors. Conclusions The preoperative ESR level is a simple and useful surrogate biomarker for predicting survival outcomes in STS patients and might improve the identification of high-risk patients of tumor relapse in clinical practice.
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23
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Association of elevated levels of C-reactive protein with breast cancer, breast cancer subtypes, and poor outcome. Curr Probl Cancer 2019; 43:123-129. [DOI: 10.1016/j.currproblcancer.2018.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 05/17/2018] [Indexed: 01/13/2023]
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24
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Martínez N, Herrera M, Frías L, Provencio M, Pérez-Carrión R, Díaz V, Morse M, Crespo MC. A combination of hydroxytyrosol, omega-3 fatty acids and curcumin improves pain and inflammation among early stage breast cancer patients receiving adjuvant hormonal therapy: results of a pilot study. Clin Transl Oncol 2018; 21:489-498. [PMID: 30293230 DOI: 10.1007/s12094-018-1950-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 09/07/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE Breast cancer patients receiving hormonal therapies face risks of relapse, increased rates of cardiovascular events, and toxicities of therapy such as aromatase inhibitor (AI)-associated musculoskeletal symptoms (AIMSS). C-reactive protein (CRP), a marker for inflammation, is associated with breast cancer outcomes. We evaluated whether the olive-derived polyphenol hydroxytyrosol combined with omega-3 fatty acids and curcumin would reduce CRP and musculoskeletal symptoms in breast cancer patients receiving adjuvant hormonal therapies. EXPERIMENTAL DESIGN This prospective, multicenter, open-label, single arm, clinical trial enrolled post-menopausal breast cancer patients (n = 45) with elevated C-reactive protein (CRP) taking predominantly aromatase inhibitors to receive a combination of hydroxytyrosol, omega-3 fatty acids, and curcumin for 1 month. CRP, other inflammation-associated cytokines, and pain scores on the Brief Pain Inventory were measured before therapy, at the end of therapy and 1 month after completion of therapy. RESULTS CRP levels declined during the therapy [from 8.2 ± 6.4 mg/L at baseline to 5.3 ± 3.2 mg/L (p = 0.014) at 30 days of treatment], and remained decreased during the additional 1 month off therapy. Subjects with the highest baseline CRP levels had the greatest decrease with the therapy. Pain scores also decreased during the therapy. There were no significant adverse events. CONCLUSIONS The combination of hydroxytyrosol, omega-3 fatty acids, and curcumin reduced inflammation as indicated by a reduction in CRP and reduced pain in patients with aromatase-induced musculoskeletal symptoms. Longer studies comparing this combination to other anti-inflammatories in larger groups of patients with clinical outcome endpoints are warranted.
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Affiliation(s)
- N Martínez
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M Herrera
- Hospital Clínico San Carlos, Madrid, Spain
| | - L Frías
- Hospital Universitario La Paz, Madrid, Spain
| | - M Provencio
- Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | - V Díaz
- Hospital Universitario Puerta del Mar, Cádiz, Spain
| | | | - M C Crespo
- IMDEA-Food, CEI UAM + CSIC, Madrid, Spain
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25
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Jaskulski S, Jung AY, Behrens S, Johnson T, Kaaks R, Thöne K, Flesch-Janys D, Sookthai D, Chang-Claude J. Circulating enterolactone concentrations and prognosis of postmenopausal breast cancer: assessment of mediation by inflammatory markers. Int J Cancer 2018; 143:2698-2708. [PMID: 29974464 DOI: 10.1002/ijc.31647] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/07/2018] [Accepted: 05/25/2018] [Indexed: 01/21/2023]
Abstract
Higher lignan exposure has been associated with lower all-cause mortality (ACM) and breast cancer-specific mortality (BCSM) for postmenopausal breast cancer patients. However, the biological mechanisms underpinning these associations are still unclear. We investigated for the first time whether and to what extent the association between enterolactone (ENL), the major lignan metabolite, and postmenopausal breast cancer prognosis is mediated by inflammatory biomarkers. Circulating concentrations of ENL and inflammatory markers were measured in a population-based prospective cohort of 1,743 breast cancer patients recruited between 2002 and 2005 and followed-up until 2009. Hazard ratios (HR) and 95% CIs were estimated using multivariable Cox regression. Mediation analysis was performed to estimate the percentage association between ENL (log2) and ACM, BCSM and distant disease-free survival (DDFS), which is mediated by C-reactive protein (CRP) (log2), as the strongest potential mediator, and also interleukin (IL)-10. Median serum/plasma ENL and CRP concentrations for all patients, including 180 deceased patients, were 23.2 and 17.5 nmol/L, and 3.2 and 6.5 mg/l, respectively. ENL concentrations were significantly inversely associated with ACM, BCSM and DDFS (per doubling of ENL concentrations: HRs 0.93 [0.87, 0.99], 0.91 [0.84, 0.99] and 0.92 [0.87, 0.99]), after adjusting for prognostic factors and BMI. Estimated 18, 14 and 12% of the effects of ENL on ACM, BCSM and DDFS, respectively, were mediated through CRP. No mediational effect of IL-10 was found. We provide first evidence that the proinflammatory marker CRP may partially mediate the association of ENL with postmenopausal breast cancer survival, which supports hormone-independent mechanisms.
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Affiliation(s)
- Stefanie Jaskulski
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Audrey Y Jung
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sabine Behrens
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Theron Johnson
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kathrin Thöne
- Department of Cancer Epidemiology/Clinical Cancer Registry, University Medical Center Hamburg-Eppendorf, University Cancer Center Hamburg, Hamburg, Germany
| | - Dieter Flesch-Janys
- Department of Cancer Epidemiology/Clinical Cancer Registry, University Medical Center Hamburg-Eppendorf, University Cancer Center Hamburg, Hamburg, Germany
| | - Disorn Sookthai
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Genetic Tumour Epidemiology Group, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Gathirua-Mwangi WG, Song Y, Monahan PO, Champion VL, Zollinger TW. Associations of metabolic syndrome and C-reactive protein with mortality from total cancer, obesity-linked cancers and breast cancer among women in NHANES III. Int J Cancer 2018; 143:535-542. [PMID: 29488212 PMCID: PMC6019165 DOI: 10.1002/ijc.31344] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 02/10/2018] [Accepted: 02/21/2018] [Indexed: 12/11/2022]
Abstract
Although metabolic syndrome (MetS) is a prognostic factor for cancer occurrence, the association of MetS and cancer mortality remains unclear. The purpose of this study was to evaluate whether MetS, components of MetS and C-reactive protein (CRP) are associated with cancer mortality in women. A total of 400 cancer deaths, with 140 deaths from obesity-linked-cancers (OLCas), [breast (BCa), colorectal, pancreatic and endometrial], linked through the National Death Index, were identified from 10,104 eligible subjects aged ≥18 years. Cox proportional hazards regression was used to estimate multivariable-adjusted hazard ratios (HR) for cancer mortality. MetS was associated with increased deaths for total cancer [HR = 1.33, 95% confidence interval (CI) 1.04-1.70] and BCa [HR = 2.1, 95% CI, 1.09-4.11]. The risk of total cancer [HR = 1.7, 95% CI, 1.12-2.68], OLCas [HR = 2.1, 95% CI, 1.00-4.37] and BCa [HR = 3.8, 95% CI, 1.34-10.91] mortality was highest for women with all MetS components abnormal, compared to those without MetS. Linear associations of blood-pressure [HR = 2.5, 1.02-6.12, Quartile (Q) 4 vs Q1, p trend = 0.004] and blood-glucose [HR = 2.2, 1.04-4.60, Q4 vs. Q1, p trend = 0.04] with total-OLCas mortality were observed. A threefold increased risk of BCa mortality was observed for women with enlarged waist circumference, ≥100.9 cm, [HR = 3.5, 1.14-10.51, p trend = 0.008] and in those with increased blood glucose, ≥101 mg/dL, [HR = 3.2, 1.11-9.20, p trend = 0.03] compared to those in Q1. None of the components of MetS were associated with total-cancer mortality. CRP was not associated with cancer mortality. In conclusion, MetS is associated with total-cancer and breast-cancer mortality, with waist circumference, blood pressure and blood glucose as independent predictors of OLCas and BCa mortality.
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Affiliation(s)
- Wambui G Gathirua-Mwangi
- Center for Nursing Research, School of Nursing, Indiana University, Indianapolis, IN
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN
| | - Yiqing Song
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN
| | - Patrick O Monahan
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
| | - Victoria L Champion
- Center for Nursing Research, School of Nursing, Indiana University, Indianapolis, IN
| | - Terrell W Zollinger
- Center for Nursing Research, School of Nursing, Indiana University, Indianapolis, IN
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27
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Sylman JL, Mitrugno A, Atallah M, Tormoen GW, Shatzel JJ, Tassi Yunga S, Wagner TH, Leppert JT, Mallick P, McCarty OJT. The Predictive Value of Inflammation-Related Peripheral Blood Measurements in Cancer Staging and Prognosis. Front Oncol 2018; 8:78. [PMID: 29619344 PMCID: PMC5871812 DOI: 10.3389/fonc.2018.00078] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/07/2018] [Indexed: 12/23/2022] Open
Abstract
In this review, we discuss the interaction between cancer and markers of inflammation (such as levels of inflammatory cells and proteins) in the circulation, and the potential benefits of routinely monitoring these markers in peripheral blood measurement assays. Next, we discuss the prognostic value and limitations of using inflammatory markers such as neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios and C-reactive protein measurements. Furthermore, the review discusses the benefits of combining multiple types of measurements and longitudinal tracking to improve staging and prognosis prediction of patients with cancer, and the ability of novel in silico frameworks to leverage this high-dimensional data.
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Affiliation(s)
- Joanna L Sylman
- VA Palo Alto Health Care System, Palo Alto, CA, United States.,Biomedical Engineering, School of Medicine, Oregon Health & Science University, Portland, OR, United States.,Canary Center at Stanford, Department of Radiology, Stanford University School of Medicine, Stanford, CA, United States
| | - Annachiara Mitrugno
- Biomedical Engineering, School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Michelle Atallah
- Canary Center at Stanford, Department of Radiology, Stanford University School of Medicine, Stanford, CA, United States
| | - Garth W Tormoen
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Joseph J Shatzel
- Division of Hematology and Medical Oncology, Oregon Health & Science University, Portland, OR, United States.,Cancer Early Detection & Advanced Research Center, Oregon Health & Science University, Portland, OR, United States
| | - Samuel Tassi Yunga
- Cancer Early Detection & Advanced Research Center, Oregon Health & Science University, Portland, OR, United States.,Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States
| | - Todd H Wagner
- VA Palo Alto Health Care System, Palo Alto, CA, United States.,Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - John T Leppert
- VA Palo Alto Health Care System, Palo Alto, CA, United States.,Department of Urology, Stanford University School of Medicine, Stanford, CA, United States
| | - Parag Mallick
- Canary Center at Stanford, Department of Radiology, Stanford University School of Medicine, Stanford, CA, United States
| | - Owen J T McCarty
- Biomedical Engineering, School of Medicine, Oregon Health & Science University, Portland, OR, United States
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Saqib R, Pathak S, Smart N, Nunes Q, Rees J, Finch Jones M, Poston G. Prognostic significance of pre-operative inflammatory markers in resected gallbladder cancer: a systematic review. ANZ J Surg 2017; 88:554-559. [DOI: 10.1111/ans.14300] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/01/2017] [Accepted: 10/08/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Rukhtam Saqib
- Department of HPB Surgery; Bristol Royal Infirmary; Bristol UK
| | - Samir Pathak
- Department of HPB Surgery; Bristol Royal Infirmary; Bristol UK
| | - Neil Smart
- Exeter Surgical Health Services Research Unit; Royal Devon and Exeter NHS Foundation Trust; Exeter UK
| | - Quentin Nunes
- Department of Hepatobiliary Surgery; University Hospital Aintree; Liverpool UK
| | - Jonathan Rees
- Department of HPB Surgery; Bristol Royal Infirmary; Bristol UK
| | | | - Graeme Poston
- Department of Hepatobiliary Surgery; University Hospital Aintree; Liverpool UK
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29
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Winters-Stone KM, Wood LJ, Stoyles S, Dieckmann NF. The Effects of Resistance Exercise on Biomarkers of Breast Cancer Prognosis: A Pooled Analysis of Three Randomized Trials. Cancer Epidemiol Biomarkers Prev 2017; 27:146-153. [PMID: 29141853 DOI: 10.1158/1055-9965.epi-17-0766] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/05/2017] [Accepted: 11/02/2017] [Indexed: 12/17/2022] Open
Abstract
Background: Using a secondary data analysis from randomized controlled trials comparing one year of resistance exercise (n = 109) to a placebo control condition (n = 106) in postmenopausal, posttreatment breast cancer survivors, we investigated the influence of resistance training and changes in body composition on markers associated with cancer progression.Methods: Measures included serum levels of insulin, IGF-1, IGFBP1-3, leptin, serum amyloid A (SAA), adiponectin, C-reactive protein (CRP), IL1β, TNFα, IL6, and IL8, and body composition (total, lean and fat mass in kg) by DXA at baseline, 6, and 12 months. Linear mixed effects models were used to examine the association between group, biomarkers, and body composition and whether or not changes in muscle strength or body composition influenced the effect of exercise on biomarkers.Results: CRP decreased over time among women participating in resistance training compared with increases in controls (P = 0.045). In stratified analyses and compared with increases in controls, women who gained strength reduced CRP (P = 0.003) and maintained levels of IL1β and IL6. Among exercisers who lost weight (≥2 kg), CRP (P = 0.045), leptin (P < 0.01), and SAA (P = 0.029) decreased, whereas IGF-BP1 (P = 0.036) increased compared with controls.Conclusions: Resistance training may lower inflammation and improve insulin pathway profiles, but the magnitude and degree of benefit from exercise may depend upon whether or not women gained strength, a possible marker of compliance with training, and/or lost weight during exercise.Impact: Future resistance training trials should consider these potential influencing factors as they may determine how well exercise can slow cancer progression and prevent disease recurrence. Cancer Epidemiol Biomarkers Prev; 27(2); 146-53. ©2017 AACR.
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Affiliation(s)
- Kerri M Winters-Stone
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon. .,School of Nursing, Oregon Health & Science University, Portland, Oregon
| | - Lisa J Wood
- School of Nursing, Massachusetts General Hospital Institutes of Health Professions, Boston, Massachusetts
| | - Sydnee Stoyles
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon.,School of Nursing, Oregon Health & Science University, Portland, Oregon
| | - Nathan F Dieckmann
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon.,School of Nursing, Oregon Health & Science University, Portland, Oregon
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30
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Dietary inflammatory index before diagnosis and survival in an Italian cohort of women with breast cancer. Br J Nutr 2017; 117:1456-1462. [PMID: 28606221 DOI: 10.1017/s0007114517001258] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The dietary inflammatory indexTM (DII) has been shown to correlate with concentrations of several inflammatory markers and a variety of chronic disease endpoints, including cancers of various anatomic sites. We investigated whether the DII was associated with the risk for death among women with breast cancer (BrCa). This retrospective cohort study included 1453 women with BrCa, diagnosed between 1990 and 1994, and previously enrolled in a case-control study in northern Italy. With a median follow-up of 12·6 years, we observed 503 deaths, among which 398 were due to BrCa. The usual diet was assessed at BrCa diagnosis using a validated FFQ. DII scores were calculated using thirty-one foods/nutrients. Hazard ratios (HR) of death from all causes or from BrCa, with corresponding 95 % CI, were calculated using the Cox models, adjusted for age at diagnosis, tumour stage, oestrogen/progesterone receptor status and other potential confounders. The median DII score of the study women was -1·23, with a relatively narrow range (interquartile range -2·24 to -0·11), indicating a mainly anti-inflammatory diet. There was no difference in survival according to DII tertiles, neither considering all-cause mortality (HRtertile III v. I 1·00; 95 % CI 0·78, 1·28) nor BrCa-specific mortality (HRtertile III v. I 0·97; 95 % CI 0·73, 1·27). Study findings did not suggest an association between the inflammatory potential of diet, measured by the DII, and the survival of BrCa women. However, further studies are needed in populations reporting higher DII scores and a broader range of variability in the scores.
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31
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Djuric Z. Obesity-associated cancer risk: the role of intestinal microbiota in the etiology of the host proinflammatory state. Transl Res 2017; 179:155-167. [PMID: 27522986 PMCID: PMC5164980 DOI: 10.1016/j.trsl.2016.07.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 07/10/2016] [Accepted: 07/20/2016] [Indexed: 02/06/2023]
Abstract
Obesity increases the risks of many cancers. One important mechanism behind this association is the obesity-associated proinflammatory state. Although the composition of the intestinal microbiome undoubtedly can contribute to the proinflammatory state, perhaps the most important aspect of host-microbiome interactions is host exposure to components of intestinal bacteria that stimulate inflammatory reactions. Systemic exposures to intestinal bacteria can be modulated by dietary factors through altering both the composition of the intestinal microbiota and the absorption of bacterial products from the intestinal lumen. In particular, high-fat and high-energy diets have been shown to facilitate absorption of bacterial lipopolysaccharide (LPS) from intestinal bacteria. Biomarkers of bacterial exposures that have been measured in blood include LPS-binding protein, sCD14, fatty acids characteristic of intestinal bacteria, and immunoglobulins specific for bacterial LPS and flagellin. The optimal strategies to reduce these proinflammatory exposures, whether by altering diet composition, avoiding a positive energy balance, or reducing adipose stores, likely differ in each individual. Biomarkers that assess systemic bacterial exposures therefore should be useful to (1) optimize and personalize preventive approaches for individuals and groups with specific characteristics and to (2) gain insight into the possible mechanisms involved with different preventive approaches.
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Affiliation(s)
- Zora Djuric
- Department of Family Medicine, University of Michigan, Ann Arbor, Mich; Department of Nutritional Sciences, University of Michigan, Ann Arbor, Mich.
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32
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Sørensen MS, Hovgaard TB, Hindsø K, Petersen MM. Prognostic value of biochemical variables for survival after surgery for metastatic bone disease of the extremities. J Surg Oncol 2016; 115:442-448. [PMID: 28019011 DOI: 10.1002/jso.24537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/17/2016] [Accepted: 12/06/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVE Prediction of survival in patients having surgery for metastatic bone disease in the extremities (MBDex) has been of interest in more than two decades. Hitherto no consensus on the value of biochemical variables has been achieved. Our purpose was (1) to investigate if standard biochemical variables have independent prognostic value for survival after surgery for MBDex and (2) to identify optimal prognostic cut off values for survival of biochemical variables. METHODS In a consecutive cohort of 270 patients having surgery for MBDex, we measured preoperative biochemical variables: hemoglobin, alkaline phosphatase, C-reactive protein and absolute, neutrophil and lymphocyte count. ROC curve analyses were performed to identify optimal cut off levels. Independent prognostic factors for variables were addressed with multiple Cox regression analyses. RESULTS Optimal cut off levels were identified as: hemoglobin 7.45 mmol/L, absolute lymphocyte count 8.5 × 109 /L, neutrophil 5.68 × 109 /L, lymphocyte 1.37 × 109 /L, C-reactive protein 22.5 mg/L, and alkaline phosphatase 129 U/L. Regression analyses found alkaline phosphatase (HR 2.49) and neutrophil count (HR 2.49) to be independent prognostic factors. CONCLUSIONS We found neutrophil count and alkaline phosphatase to be independent prognostic variables in predicting survival in patients after surgery for MBDex.
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Affiliation(s)
- Michala Skovlund Sørensen
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen Ø, Denmark
| | - Thea Bechman Hovgaard
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen Ø, Denmark
| | - Klaus Hindsø
- Pediatric Orthopedic Section, University of Copenhagen, Copenhagen Ø, Denmark
| | - Michael Mørk Petersen
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen Ø, Denmark
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Lin ZY, Liang ZX, Zhuang PL, Chen JW, Cao Y, Yan LX, Yun JP, Xie D, Cai MY. Intrahepatic cholangiocarcinoma prognostic determination using pre-operative serum C-reactive protein levels. BMC Cancer 2016; 16:792. [PMID: 27733196 PMCID: PMC5059936 DOI: 10.1186/s12885-016-2827-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 09/30/2016] [Indexed: 02/08/2023] Open
Abstract
Background Serum C-reactive protein (CRP), an acute inflammatory response biomarker, has been recognized as an indicator of malignant disease progression. However, the prognostic significance of CRP levels collected before tumor removal in intrahepatic cholangiocarcinoma requires further investigation. Methods We sampled the CRP levels in 140 patients with intrahepatic cholangiocarcinoma who underwent hepatectomies with regional lymphadenectomies between 2006 and 2013. A retrospective analysis of the clinicopathological data was performed. We focused on the impact of serum CRP on the patients’ cancer-specific survival and recurrence-free survival rates. Results High levels of preoperative serum CRP were significantly associated with well-established clinicopathologic features, including gender, advanced tumor stage, and elevated carcinoembryonic antigen and carbohydrate antigen 19-9 levels (P < 0.05). Univariate analysis demonstrated a significant association between high levels of serum CRP and adverse cancer-specific survival (P = 0.001) and recurrence-free survival (P < 0.001). In patients with stage I/II intrahepatic cholangiocarcinoma, the serum CRP level was a prognostic indicator for cancer-specific survival. In patients with stage I/II or stage III/IV, the serum CRP level was a prognostic indicator for recurrence-free survival (P < 0.05). Additionally, multivariate analysis identified serum CRP level in intrahepatic cholangiocarcinoma as an independent prognostic factor (P < 0.05). Conclusions We confirmed a significant association of elevated pre-operative CRP levels with poor clinical outcomes for the tested patients with intrahepatic cholangiocarcinoma. Our results indicate that the serum CRP level may represent a useful factor for patient stratification in intrahepatic cholangiocarcinoma management.
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Affiliation(s)
- Zi-Ying Lin
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Pathology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, 510060, Guangzhou, China
| | - Zhen-Xing Liang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Pathology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, 510060, Guangzhou, China
| | - Pei-Lin Zhuang
- Department of Prosthodontics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jie-Wei Chen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Pathology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, 510060, Guangzhou, China
| | - Yun Cao
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Pathology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, 510060, Guangzhou, China
| | - Li-Xu Yan
- Department of Pathology and Laboratory Medicine, Guangdong General Hospital, Guangzhou, China
| | - Jing-Ping Yun
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Pathology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, 510060, Guangzhou, China
| | - Dan Xie
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Pathology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, 510060, Guangzhou, China
| | - Mu-Yan Cai
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China. .,Department of Pathology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, 510060, Guangzhou, China.
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34
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Wang J, Kalhor N, Hu J, Wang B, Chu H, Zhang B, Guan Y, Wu Y. Pretreatment Neutrophil to Lymphocyte Ratio Is Associated with Poor Survival in Patients with Stage I-III Non-Small Cell Lung Cancer. PLoS One 2016; 11:e0163397. [PMID: 27695079 PMCID: PMC5047446 DOI: 10.1371/journal.pone.0163397] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 08/15/2016] [Indexed: 02/07/2023] Open
Abstract
Background Neutrophil-to-lymphocyte ratio (NLR) has been shown to be a prognostic indicator in several types of cancer. We aimed to investigate the association between NLR and survival in surgery-treated non-small cell lung cancer (NSCLC) patients. Study Design This large retrospective study included 1,245 patients who underwent initial surgery for stage I–III NSCLC at The University of Texas MD Anderson Cancer Center between December 2002 and November 2010. We analyzed the relationship of NLR with clinicopathological variables, local recurrence-free survival (LRFS), distant recurrence-free survival (DRFS), recurrence-free survival (RFS), overall survival (OS), and disease-specific survival (DSS) in patients with high or low NLR using Kaplan-Meier method. Hazard ratios (HRs) with 95% confidence intervals (CIs) were used to assess the prognostic strength of NLR. Results There was a statistically significant association between the pretreatment NLR and histology type (P = 0.003) and tumor grade (P = 0.028). At a median follow-up time of 50.6 months, high NLR was associated with reduced DRFS (P = 0.011), OS (P < 0.0001) and DSS (P = 0.004); it was not associated with LRFS and RFS. Multivariable Cox analysis further revealed that NLR (P = 0.027), pathologic stage (P < 0.0001) and lymphovascular invasion (P < 0.0001) were strong independent predictors for DRFS. NLR was also an independent marker predicting poor OS (P = 0.002) and DSS (P = 0.017). Conclusion The pretreatment NLR can serve as a biomarker to predict distant recurrence and death in stage I–III NSCLC patients. Combination of NLR and pathologic stage can better predict the OS and DSS in stage I-II NSCLC patients.
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Affiliation(s)
- Jun Wang
- Department of Oncology, General Hospital, Jinan Command of the People’s Liberation Army, Jinan, China
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Neda Kalhor
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Jianhua Hu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Baocheng Wang
- Department of Oncology, General Hospital, Jinan Command of the People’s Liberation Army, Jinan, China
| | - Huili Chu
- Department of Oncology, General Hospital, Jinan Command of the People’s Liberation Army, Jinan, China
| | - Bicheng Zhang
- Department of Oncology, Wuhan General Hospital of Guangzhou Command of the People’s Liberation Army, Wuhan, China
| | - Yaping Guan
- Department of Oncology, General Hospital, Jinan Command of the People’s Liberation Army, Jinan, China
| | - Yun Wu
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- * E-mail:
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35
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Salmiheimo A, Mustonen H, Stenman UH, Puolakkainen P, Kemppainen E, Seppänen H, Haglund C. Systemic Inflammatory Response and Elevated Tumour Markers Predict Worse Survival in Resectable Pancreatic Ductal Adenocarcinoma. PLoS One 2016; 11:e0163064. [PMID: 27632196 PMCID: PMC5025052 DOI: 10.1371/journal.pone.0163064] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/01/2016] [Indexed: 12/26/2022] Open
Abstract
Background Estimation of the prognosis of resectable pancreatic ductal adenocarcinoma (PDAC) currently relies on tumour-related factors such as resection margins and on lymph-node ratio (LNR) both inconveniently available only postoperatively. Our aim was to assess the accuracy of preoperative laboratory data in predicting PDAC prognosis. Methods Collection of laboratory and clinical data was retrospective from 265 consecutive patients undergoing surgery for PDAC at Helsinki University Hospital. Cancer-specific survival assessment utilized Kaplan-Meier analysis, and independent associations between factors were by the Cox regression model. Results During follow-up, 76% of the patients died of PDAC, with a median survival time of 19.6 months. In univariate analysis, CRP, albumin, CEA, and CA19-9 were significantly associated with postoperative cancer-specific survival. In multivariate analysis, taking into account age, gender, LNR, resection margins, tumour status, and adjuvant chemotherapy, the preoperative biomarkers independently associated with adverse prognosis were hypoalbuminemia (< 36 g/L, hazard ratio (HR) 1.56, 95% confidence interval (CI) 1.10–2.19, p = 0.011), elevated CRP (> 5 mg/L, HR 1.44, 95% CI 1.03–2.02, p = 0.036), CEA (> 5 μg/L, HR 1.60, 95% CI 1.07–2.53, p = 0.047), and CA19-9 (≥555 kU/L, HR 1.91, 95% CI 1.18–3.08, p = 0.008). Conclusion For patients with resectable PDAC, preoperative CRP, along with albumin and tumour markers, is useful for predicting prognosis.
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Affiliation(s)
- Aino Salmiheimo
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- * E-mail:
| | - Harri Mustonen
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ulf-Håkan Stenman
- Department of Clinical Chemistry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pauli Puolakkainen
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Esko Kemppainen
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Seppänen
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Caj Haglund
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Translational Cancer Biology Program, University of Helsinki, Helsinki, Finland
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36
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Celik B, Yalcin AD, Genc GE, Bulut T, Kuloglu Genc S, Gumuslu S. CXCL8, IL-1β and sCD200 are pro-inflammatory cytokines and their levels increase in the circulation of breast carcinoma patients. Biomed Rep 2016; 5:259-263. [PMID: 27446554 PMCID: PMC4950671 DOI: 10.3892/br.2016.709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/03/2016] [Indexed: 02/05/2023] Open
Abstract
The influence of biomarkers on carcinogenesis has been investigated extensively. Whether they promote carcinogenesis or work against cancer development remains to be elucidated. To the best of our knowledge, the novel molecule cluster of differentiation 200 (CD200) has not been studied on human breast cancer subjects. The present study aimed to evaluate interleukin-1β (IL-1β), C-X-C motif chemokine ligand 8 (CXCL8), cancer antigen 15.3 (CA 15.3) and the soluble CD200 (sCD200) levels in the serum samples of breast carcinoma patients in order to predict their role in breast carcinoma. The subjects included individuals with early and advanced stage breast cancers, as well as healthy controls. Commercially available ELISA kits were used to measure the serum concentrations of sCD200, IL-1β, CXCL8, CA 15.3, C-reactive protein (CRP) and leukocyte count. A total of 130 subjects were recruited; 50 early stage cancer, 50 advanced stage and 30 control subjects. Serum sCD200, CXCL8, IL-1β and CRP levels were significantly higher in the early as well as the advanced stage breast cancer patients compared to the control group. The level of CA 15.3 was statistically different between early and advanced stage. There were significant positive correlations between IL-1β and CXCL8, and IL-1β and serum sCD200 levels in the control group. These correlations did not persist in the early or the advanced stage cancer groups except CRP and CA 15.3, but new correlations appeared between serum sCD200 level and leukocyte count for advanced stage breast cancer group. Multivariate regression correlation analysis revealed positive correlation between IL-1β and sCD200; and IL-1β and CXCL8. In conclusion, sCD200, CXCL8, CA 15.3 and IL-1β are proinflammatory molecules and their levels are influenced in breast cancer patients.
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Affiliation(s)
- Betul Celik
- Department of Pathology, Antalya Training and Research Hospital, 07100 Antalya, Turkey
- Correspondence to: Dr Betul Celik, Department of Pathology, Antalya Training and Research Hospital, Varlik Mahallesi Kazim Karabekir Cad, 07100 Antalya, Turkey, E-mail:
| | - Arzu Didem Yalcin
- Department of Internal Medicine, Allergy and Clinical Immunology Unit, Antalya Training and Research Hospital, 07100 Antalya, Turkey
- Genomics Research Center, Academia Sinica, Taipei 115, Taiwan, R.O.C
| | - Gizem Esra Genc
- Department of Medical Biochemistry, Faculty of Medicine, Akdeniz University, 07070 Antalya, Turkey
| | - Tangul Bulut
- Department of Pathology, Antalya Training and Research Hospital, 07100 Antalya, Turkey
| | - Sibel Kuloglu Genc
- Department of Medical Biochemistry, Faculty of Medicine, Akdeniz University, 07070 Antalya, Turkey
| | - Saadet Gumuslu
- Department of Medical Biochemistry, Faculty of Medicine, Akdeniz University, 07070 Antalya, Turkey
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Associations of C-Reactive Protein, Granulocytes and Granulocyte-to-Lymphocyte Ratio with Mortality from Breast Cancer in Non-Institutionalized American Women. PLoS One 2016; 11:e0157482. [PMID: 27294662 PMCID: PMC4905698 DOI: 10.1371/journal.pone.0157482] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 05/31/2016] [Indexed: 12/16/2022] Open
Abstract
Inflammation may play a role in breast cancer, but evidence in the general population is lacking. We investigated the association between serum inflammatory markers (C-reactive protein (CRP), absolute granulocyte count (AGC) and granulocyte-to-lymphocyte (G/L) ratio) and breast cancer (BCa) mortality in American women while accounting for adiposity. From the Third National Health and Nutrition Examination Survey (NHANES III) we selected all women aged 20+ without any known history of cancer (n = 7,780). Multivariable Cox regression models were used to assess CRP, AGC and G/L ratio in relation to mortality from BCa, all cancer, cardiovascular disease and all causes. Stratification analyses by body mass index (BMI) and waist circumference were performed to investigate the effect of adiposity on this association. During a mean follow-up of 167 months, 44 women died from BCa. After adjustments for BMI and waist circumference, only G/L ratio was associated to risk of BCa death (e.g. HR: 2.35, 95% CI: 1.36–4.06 for the 3rd compared to the 1st tertile, Ptrend = 0.01). Except for a borderline interaction between CRP categories and obesity by BMI, no statistically significant interaction between markers and categories of BMI or waist circumference was observed. All three markers were associated with mortality from cardiovascular disease and all causes. Our findings support a role of inflammation in BCa mortality which may involve mechanisms apart from obesity, and potential usefulness of GLR as a marker in assessing inflammation and cancer.
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38
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Gong C, Wei D, Wang Y, Ma J, Yuan C, Zhang W, Yu G, Zhao Y. A Meta-Analysis of C-Reactive Protein in Patients With Alzheimer's Disease. Am J Alzheimers Dis Other Demen 2016; 31:194-200. [PMID: 26340961 PMCID: PMC10852780 DOI: 10.1177/1533317515602087] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Inflammation may be associated with Alzheimer's disease (AD). This meta-analysis aimed to compare the level of C-reactive protein (CRP) in patients having AD to healthy controls. A total of 10 cross-sectional studies (n = 2093) were identified from PubMed and EMBASE after systematic searching and evaluation. The combined standardized mean difference (SMD) of CRP level between the disease and control group was analyzed. In the meta-analysis, there was no significant difference in serum between the CRP level of patients with AD and that of healthy controls (SMD: -0.400, 95% confidence interval [CI]: -0.827 to 0.027,P= .066). However, when we stratified the studies by Mini-Mental State Examination (MMSE) scores, the level of CRP in the mild and moderate dementia subgroup (MMSE ≥ 10) was significantly lower than that in the control group (SMD: -0.582, 95% CI: -0.957 to -0.208,P= .002). Therefore, the diagnostic value of CRP for mild and moderate AD may be useful in clinical practice.
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Affiliation(s)
- Changguo Gong
- School of Life Sciences, East China Normal University, Shanghai, PR China
| | - Daixin Wei
- School of Life Sciences, East China Normal University, Shanghai, PR China
| | - Ying Wang
- School of Life Sciences, East China Normal University, Shanghai, PR China
- Department of Physiology, Renji College, Wenzhou Medical University, Wenzhou, PR China
| | - Ji Ma
- School of Life Sciences, East China Normal University, Shanghai, PR China
| | - Chonggang Yuan
- School of Life Sciences, East China Normal University, Shanghai, PR China
| | - Wei Zhang
- School of Life Sciences, East China Normal University, Shanghai, PR China
| | - Guohua Yu
- School of Life Sciences, East China Normal University, Shanghai, PR China
| | - Yulan Zhao
- School of Life Sciences, East China Normal University, Shanghai, PR China
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39
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Agresti R, Meneghini E, Baili P, Minicozzi P, Turco A, Cavallo I, Funaro F, Amash H, Berrino F, Tagliabue E, Sant M. Association of adiposity, dysmetabolisms, and inflammation with aggressive breast cancer subtypes: a cross-sectional study. Breast Cancer Res Treat 2016; 157:179-89. [PMID: 27117160 DOI: 10.1007/s10549-016-3802-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/19/2016] [Indexed: 12/22/2022]
Abstract
Obesity and metabolic syndrome are risk and prognostic factors for breast cancer (BC) and are associated with chronic inflammation. We investigated the association between distinct BC subtypes and markers of adiposity, dysmetabolisms, and inflammation. We analyzed 1779 patients with primary invasive BC treated at a single institution, for whom anthropometric and clinical-pathological data were archived. BC subtypes were classified by immunohistochemical staining of ER, PR, HER2, and Ki67, and their relations with the study markers were assessed by multinomial logistic regression. Adjusted odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated taking luminal A as reference. All subtypes more aggressive than luminal A were significantly more frequent in younger (<45 years) than older women. Before menopause, luminal B HER2-negative tumors were positively associated with large waist (OR 2.55, 95 % CI 1.53-4.24) and insulin resistance (OR 1.90, 95 % CI 1.05-3.41); luminal B HER2-positive tumors with large waist (OR 2.11, 95 % CI 1.03-4.35) and triple-negative tumors with overweight (OR 3.04, 95 % CI 1.43-6.43) and high C-reactive protein (p trend = 0.026). In postmenopausal women aged <65, luminal B HER2-negative (OR 1.94, 95 % CI 1.16-3.24) and luminal B HER2-positive tumors (OR 2.48, 95 % CI 1.16-5.27) were positively related with metabolic syndrome. Dysmetabolisms and inflammation may be related to different BC subtypes. Before menopause, triple-negative cancers were related to obesity and chronic inflammation, and aggressive luminal subtypes to abdominal adiposity. After menopause, in women aged <65 these latter subtypes were related to metabolic syndrome. Control of adiposity and dysmetabolism can reduce the risk of aggressive BC subtypes, improving the prognosis.
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Affiliation(s)
- Roberto Agresti
- Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy
| | - Elisabetta Meneghini
- Analytic Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy.
| | - Paolo Baili
- Analytic Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy
| | - Pamela Minicozzi
- Analytic Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy
| | - Alberto Turco
- Analytic Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy
| | - Ilaria Cavallo
- Analytic Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy
| | - Francesco Funaro
- Analytic Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy
| | - Hade Amash
- Analytic Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy
| | - Franco Berrino
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy
| | - Elda Tagliabue
- Molecular Targeting Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy
| | - Milena Sant
- Analytic Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy
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Smith KF, Quinn RL, Rahilly LJ. Biomarkers for differentiation of causes of respiratory distress in dogs and cats: Part 2--Lower airway, thromboembolic, and inflammatory diseases. J Vet Emerg Crit Care (San Antonio) 2016; 25:330-48. [PMID: 26040815 DOI: 10.1111/vec.12317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 03/22/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To review the current veterinary and relevant human literature regarding biomarkers of respiratory diseases leading to dyspnea and to summarize the availability, feasibility, and practicality of using respiratory biomarkers in the veterinary setting. DATA SOURCES Veterinary and human medical literature: original research articles, scientific reviews, consensus statements, and recent textbooks. HUMAN DATA SYNTHESIS Numerous biomarkers have been evaluated in people for discriminating respiratory disease processes with varying degrees of success. VETERINARY DATA SYNTHESIS Although biomarkers should not dictate clinical decisions in lieu of gold standard diagnostics, their use may be useful in directing care in the stabilization process. Serum immunoglobulins have shown promise as an indicator of asthma in cats. A group of biomarkers has also been evaluated in exhaled breath. Of these, hydrogen peroxide has shown the most potential as a marker of inflammation in asthma and potentially aspiration pneumonia, but methods for measurement are not standardized. D-dimers may be useful in screening for thromboembolic disease in dogs. There are a variety of markers of inflammation and oxidative stress, which are being evaluated for their ability to assess the severity and type of underlying disease process. Of these, amino terminal pro-C-type natriuretic peptide may be the most useful in determining if antibiotic therapy is warranted. Although critically evaluated for their use in respiratory disorders, many of the biomarkers which have been evaluated have been found to be affected by more than one type of respiratory or systemic disease. CONCLUSION At this time, there are point-of-care biomarkers that have been shown to reliably differentiate between causes of dyspnea in dogs and cats. Future clinical research is warranted to understand of how various diseases affect the biomarkers and more bedside tests for their utilization.
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Badakhshi H, Kaul D, Zhao KLE. Association between the inflammatory biomarker, C-reactive protein, and the response to radiochemotherapy in patients with esophageal cancer. Mol Clin Oncol 2016; 4:643-647. [PMID: 27073683 DOI: 10.3892/mco.2016.753] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 01/20/2016] [Indexed: 12/11/2022] Open
Abstract
Locally advanced esophageal cancer has been treated by a multimodality regimen encompassing combined radiochemotherapy (RCT). The tumor response to neoadjuvant RCT is a major determinant of further therapeutic strategies, whether surgery or a continuation of RCT, and therefore, also of the patient's overall prognosis. The present study included patients with histologically proven squamous cell esophageal carcinoma. The C-reactive protein (CRP) level was measured prior to and following the completion of neoadjuvant RCT. Only CRP measurements taken within 2 weeks of the start of RCT were analyzed. Further measurements were then taken at 6, 12, 18, 24, 30, 36 and 40 weeks following RCT. CRP levels were high prior to treatment; however, eventually decreased and normalized following the therapy. In univariate analysis, pre-therapeutic CRP levels had a significant influence on the response rate (P=0.033), whilst post-therapeutic CRP levels had no significant influence (P=0.383). Pre-therapeutic CRP levels, however, not post-therapeutic CRP levels were significantly correlated with the response rate (P=0.045 and P=0.444, respectively), and no association was observed between CRP levels and survival. This preliminary data indicated that the pre-therapeutic serum CRP level is a possible indicator of treatment response to RCT.
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Affiliation(s)
- Harun Badakhshi
- Department of Clinical Radiation Oncology, Ernst von Bergmann Medical Center, D-14467 Potsdam, Germany
| | - David Kaul
- Department of Clinical Radiation Oncology, Ernst von Bergmann Medical Center, D-14467 Potsdam, Germany
| | - Kuai-LE Zhao
- Department of Radiation Oncology, Fudan University, Shanghai Cancer Center, Shanghai 200240, P.R. China
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Frydenberg H, Thune I, Lofterød T, Mortensen ES, Eggen AE, Risberg T, Wist EA, Flote VG, Furberg AS, Wilsgaard T, Akslen LA, McTiernan A. Pre-diagnostic high-sensitive C-reactive protein and breast cancer risk, recurrence, and survival. Breast Cancer Res Treat 2016; 155:345-54. [PMID: 26740213 DOI: 10.1007/s10549-015-3671-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 12/25/2015] [Indexed: 12/31/2022]
Abstract
Inflammation may initiate and promote breast cancer development, and be associated with elevated circulating levels of inflammation markers. A total of eight 130 initially healthy women, participated in the population-based Tromsø study (1994-2008). Pre-diagnostic high-sensitivity C-reactive protein (hs-CRP) was assessed. During 14.6 years of follow-up, a total of 192 women developed invasive breast cancer. These cases were followed for additional 7.2 years. Detailed medical records were obtained. We observed an overall positive dose-response relationship between pre-diagnostic hs-CRP and breast cancer risk (hazard ratio (HR) = 1.06, 95 % CI 1.01-1.11). Postmenopausal women with above median levels of hs-CRP (>1.2 mg/l) had a 1.42 (95 % CI 1.01-2.00) higher breast cancer risk compared to postmenopausal women with hs-CRP below median. Postmenopausal women, who were hormone replacement therapy non-users, and were in the middle tertile (0.8-1.9 mg/l), or highest tertile of hs-CRP (>1.9 mg/l), had a 2.31 (95 % CI 1.31-4.03) and 2.08 (95 % CI 1.16-3.76) higher breast cancer risk, respectively, compared with women in the lowest tertile. For each unit increase in pre-diagnostic hs-CRP levels (mg/l), we observed an 18 % increase in disease-free interval (95 % CI 0.70-0.97), and a 22 % reduction in overall mortality (95 % CI 0.62-0.98). Our study supports a positive association between pre-diagnostic hs-CRP and breast cancer risk. In contrast, increased pre-diagnostic hs-CRP was associated with improved overall mortality, but our findings are based on a small sample size, and should be interpreted with caution.
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Affiliation(s)
- H Frydenberg
- Department of Oncology, The Cancer Centre, Ullevål, Oslo University Hospital HF, 0424, Oslo, Norway.
| | - I Thune
- Department of Oncology, The Cancer Centre, Ullevål, Oslo University Hospital HF, 0424, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - T Lofterød
- Department of Oncology, The Cancer Centre, Ullevål, Oslo University Hospital HF, 0424, Oslo, Norway
| | - E S Mortensen
- Molecular Pathology Research Group, Department of Medical Biology, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - A E Eggen
- Department of Community Medicine, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - T Risberg
- Department of Oncology, University Hospital of Northern Norway, Tromsø, Norway
| | - E A Wist
- Department of Oncology, The Cancer Centre, Ullevål, Oslo University Hospital HF, 0424, Oslo, Norway
| | - V G Flote
- Department of Oncology, The Cancer Centre, Ullevål, Oslo University Hospital HF, 0424, Oslo, Norway
| | - A-S Furberg
- Department of Community Medicine, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway.,Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
| | - T Wilsgaard
- Department of Community Medicine, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - L A Akslen
- Department of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, Norway
| | - A McTiernan
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Asegaonkar SB, Asegaonkar BN, Takalkar UV, Advani S, Thorat AP. C-Reactive Protein and Breast Cancer: New Insights from Old Molecule. Int J Breast Cancer 2015; 2015:145647. [PMID: 26693355 PMCID: PMC4674617 DOI: 10.1155/2015/145647] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 11/10/2015] [Indexed: 12/12/2022] Open
Abstract
Recently an association between breast cancer and inflammation has emerged as the seventh hallmark of cancer. Chronic inflammation is a key contributor in the development and progression of carcinogenesis. Inflammatory pathways play an important role in the causation of breast cancer. C-reactive protein (CRP) an acute-phase reactant inflammatory protein is synthesized in hepatocytes in response to cytokines that are released from leucocytes within the tumor microenvironment. Several epidemiological studies appraised an association of CRP with breast cancer risk with inconsistent findings. Elevated levels at the time of diagnosis of breast cancer indicate aggressiveness of the tumor. CRP is also a well-established independent prognostic marker. Breast cancer survivors with the state of chronic inflammation are at risk of recurrence and metabolic disturbances. CRP lowering agents along with chemotherapeutic drugs will improve the survival of breast cancer patients. Also, it is a risk predictor for subsequent cardiotoxicity in patients receiving chemotherapy. The present review is aimed at elucidating the role of C-reactive protein, as an inflammatory risk marker and prognostic predictor of breast cancer. It also focuses on conflicting views on the role of CRP in breast cancer and its impact on therapeutic interventions.
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Woo HD, Kim K, Kim J. Association between preoperative C-reactive protein level and colorectal cancer survival: a meta-analysis. Cancer Causes Control 2015; 26:1661-70. [PMID: 26376895 DOI: 10.1007/s10552-015-0663-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/03/2015] [Indexed: 01/01/2023]
Abstract
PURPOSE C-reactive protein (CRP) is widely known as a major nonspecific systemic inflammatory marker. A number of previous studies have suggested that elevated preoperative CRP is associated with poor prognosis in colorectal cancer. We aimed to explore the effects of preoperative CRP on colorectal cancer survival through a meta-analysis. METHODS A total of 21 studies, including a total of 3934 colorectal cancer patients, were eligible. The multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of selected studies were used to assess the summary estimates of the association between preoperative CRP and colorectal cancer survival. RESULTS The pooled HRs of elevated preoperative CRP for earlier stage patients were 2.04 (95% CI 1.45-2.86) for OS, 4.37 (95% CI 2.63-7.27) for CSS, and 1.88 (95% CI 0.97-3.67) for DFS. The pooled HRs of a higher Glasgow Prognostic Score (GPS)/modified GPS (mGPS) for earlier stage patients were 2.20 (95% CI 1.61-3.02) for OS and 1.80 (95% CI 1.37-2.37) for CSS. The association between elevated preoperative CRP and poor survival was observed in patients with advanced cancer. Elevated CRP and GPS/mGPS were significantly associated with poor survival. CONCLUSION Preoperative CRP and its related markers, GPS and mGPS, were significantly associated with the survival of colorectal cancer surgery patients. The HRs of GPS and mGPS were highly homogeneous across studies for all survival types. Thus, GPS and mGPS may serve as stable predictors of the survival of colorectal cancer surgery patients.
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Affiliation(s)
- Hae Dong Woo
- Molecular Epidemiology Branch, Division of Cancer Epidemiology and Prevention, Research Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-Si, Gyeonggi-do, 410-769, Republic of Korea
| | - Kyeezu Kim
- Molecular Epidemiology Branch, Division of Cancer Epidemiology and Prevention, Research Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-Si, Gyeonggi-do, 410-769, Republic of Korea
| | - Jeongseon Kim
- Molecular Epidemiology Branch, Division of Cancer Epidemiology and Prevention, Research Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-Si, Gyeonggi-do, 410-769, Republic of Korea.
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Hurwitz HI, Uppal N, Wagner SA, Bendell JC, Beck JT, Wade SM, Nemunaitis JJ, Stella PJ, Pipas JM, Wainberg ZA, Manges R, Garrett WM, Hunter DS, Clark J, Leopold L, Sandor V, Levy RS. Randomized, Double-Blind, Phase II Study of Ruxolitinib or Placebo in Combination With Capecitabine in Patients With Metastatic Pancreatic Cancer for Whom Therapy With Gemcitabine Has Failed. J Clin Oncol 2015; 33:4039-47. [PMID: 26351344 DOI: 10.1200/jco.2015.61.4578] [Citation(s) in RCA: 214] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Patients with advanced pancreatic adenocarcinoma have a poor prognosis and limited second-line treatment options. Evidence suggests a role for the Janus kinase (JAK)/signal transducer and activator of transcription pathway in the pathogenesis and clinical course of pancreatic cancer. PATIENTS AND METHODS In this double-blind, phase II study, patients with metastatic pancreatic cancer who had experienced treatment failure with gemcitabine were randomly assigned 1:1 to the JAK1/JAK2 inhibitor ruxolitinib (15 mg twice daily) plus capecitabine (1,000 mg/m(2) twice daily) or placebo plus capecitabine. The primary end point was overall survival (OS); secondary end points included progression-free survival, clinical benefit response, objective response rate, and safety. Prespecified subgroup analyses evaluated treatment heterogeneity and efficacy in patients with evidence of inflammation. RESULTS In the intent-to-treat population (ruxolitinib, n = 64; placebo, n = 63), the hazard ratio was 0.79 (95% CI, 0.53 to 1.18; P = .25) for OS and was 0.75 (95% CI, 0.52 to 1.10; P = .14) for progression-free survival. In a prespecified subgroup analysis of patients with inflammation, defined by serum C-reactive protein levels greater than the study population median (ie, 13 mg/L), OS was significantly greater with ruxolitinib than with placebo (hazard ratio, 0.47; 95% CI, 0.26 to 0.85; P = .011). Prolonged survival in this subgroup was supported by post hoc analyses of OS that categorized patients by the modified Glasgow Prognostic Score, a systemic inflammation-based prognostic system. Grade 3 or greater adverse events were observed with similar frequency in the ruxolitinib (74.6%) and placebo (81.7%) groups. Grade 3 or greater anemia was more frequent with ruxolitinib (15.3%; placebo, 1.7%). CONCLUSION Ruxolitinib plus capecitabine was generally well tolerated and may improve survival in patients with metastatic pancreatic cancer and evidence of systemic inflammation.
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Affiliation(s)
- Herbert I Hurwitz
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE.
| | - Nikhil Uppal
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - Stephanie A Wagner
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - Johanna C Bendell
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - J Thaddeus Beck
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - Seaborn M Wade
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - John J Nemunaitis
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - Philip J Stella
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - J Marc Pipas
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - Zev A Wainberg
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - Robert Manges
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - William M Garrett
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - Deborah S Hunter
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - Jason Clark
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - Lance Leopold
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - Victor Sandor
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - Richard S Levy
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
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Hurwitz HI, Uppal N, Wagner SA, Bendell JC, Beck JT, Wade SM, Nemunaitis JJ, Stella PJ, Pipas JM, Wainberg ZA, Manges R, Garrett WM, Hunter DS, Clark J, Leopold L, Sandor V, Levy RS. Randomized, Double-Blind, Phase II Study of Ruxolitinib or Placebo in Combination With Capecitabine in Patients With Metastatic Pancreatic Cancer for Whom Therapy With Gemcitabine Has Failed. J Clin Oncol 2015. [PMID: 26351344 DOI: 10.1200/jco.2015.61] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Patients with advanced pancreatic adenocarcinoma have a poor prognosis and limited second-line treatment options. Evidence suggests a role for the Janus kinase (JAK)/signal transducer and activator of transcription pathway in the pathogenesis and clinical course of pancreatic cancer. PATIENTS AND METHODS In this double-blind, phase II study, patients with metastatic pancreatic cancer who had experienced treatment failure with gemcitabine were randomly assigned 1:1 to the JAK1/JAK2 inhibitor ruxolitinib (15 mg twice daily) plus capecitabine (1,000 mg/m(2) twice daily) or placebo plus capecitabine. The primary end point was overall survival (OS); secondary end points included progression-free survival, clinical benefit response, objective response rate, and safety. Prespecified subgroup analyses evaluated treatment heterogeneity and efficacy in patients with evidence of inflammation. RESULTS In the intent-to-treat population (ruxolitinib, n = 64; placebo, n = 63), the hazard ratio was 0.79 (95% CI, 0.53 to 1.18; P = .25) for OS and was 0.75 (95% CI, 0.52 to 1.10; P = .14) for progression-free survival. In a prespecified subgroup analysis of patients with inflammation, defined by serum C-reactive protein levels greater than the study population median (ie, 13 mg/L), OS was significantly greater with ruxolitinib than with placebo (hazard ratio, 0.47; 95% CI, 0.26 to 0.85; P = .011). Prolonged survival in this subgroup was supported by post hoc analyses of OS that categorized patients by the modified Glasgow Prognostic Score, a systemic inflammation-based prognostic system. Grade 3 or greater adverse events were observed with similar frequency in the ruxolitinib (74.6%) and placebo (81.7%) groups. Grade 3 or greater anemia was more frequent with ruxolitinib (15.3%; placebo, 1.7%). CONCLUSION Ruxolitinib plus capecitabine was generally well tolerated and may improve survival in patients with metastatic pancreatic cancer and evidence of systemic inflammation.
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Affiliation(s)
- Herbert I Hurwitz
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE.
| | - Nikhil Uppal
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - Stephanie A Wagner
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - Johanna C Bendell
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - J Thaddeus Beck
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - Seaborn M Wade
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - John J Nemunaitis
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - Philip J Stella
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - J Marc Pipas
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - Zev A Wainberg
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - Robert Manges
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - William M Garrett
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - Deborah S Hunter
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - Jason Clark
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - Lance Leopold
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - Victor Sandor
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
| | - Richard S Levy
- Herbert I. Hurwitz, Duke University Medical Center, Durham, NC; Nikhil Uppal, New York University Langone Arena Oncology, Lake Success, NY; Stephanie A. Wagner, Indiana University Melvin and Bren Simon Cancer Center; Robert Manges, Investigative Clinical Research of Indiana, Indianapolis, IN; Johanna C. Bendell, Sarah Cannon Research Institute, Nashville, TN; J. Thaddeus Beck, Highlands Oncology Group, Fayetteville, AR; Seaborn M. Wade III, Virginia Cancer Institute, Richmond, VA; John J. Nemunaitis, Mary Crowley Medical Research Center, Dallas, TX; Philip J. Stella, St Joseph Mercy Health System, Alexander Cancer Care Center, Ann Arbor, MI; J. Marc Pipas, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH; Zev A. Wainberg, University of California, Los Angeles, Los Angeles, CA; and William M. Garrett, Deborah S. Hunter, Jason Clark, Lance Leopold, Victor Sandor, and Richard S. Levy, Incyte Corporation, Wilmington, DE
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Chan DS, Bandera EV, Greenwood DC, Norat T. Circulating C-Reactive Protein and Breast Cancer Risk—Systematic Literature Review and Meta-analysis of Prospective Cohort Studies. Cancer Epidemiol Biomarkers Prev 2015. [DOI: 10.1158/1055-9965.epi-15-0324] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Bosco C, Wulaningsih W, Melvin J, Santaolalla A, De Piano M, Arthur R, Van Hemelrijck M. Metabolic serum biomarkers for the prediction of cancer: a follow-up of the studies conducted in the Swedish AMORIS study. Ecancermedicalscience 2015; 9:555. [PMID: 26284119 PMCID: PMC4531132 DOI: 10.3332/ecancer.2015.555] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Indexed: 12/18/2022] Open
Abstract
The Swedish Apolipoprotein MOrtality RISk study (AMORIS) contains information on more than 500 biomarkers collected from 397,443 men and 414,630 women from the greater Stockholm area during the period 1985–1996. Using a ten-digit personal identification code, this database has been linked to Swedish national registries, which provide data on socioeconomic status, vital status, cancer diagnosis, comorbidity, and emigration. Within AMORIS, 18 studies assessing risk of overall and site-specific cancers have been published, utilising a range of serum markers representing glucose and lipid metabolism, immune system, iron metabolism, liver metabolism, and bone metabolism. This review briefly summarises these findings in relation to more recently published studies and provides an overview of where we are today and the challenges of observational studies when studying cancer risk prediction. Overall, more recent observational studies supported previous findings obtained in AMORIS, although no new results have been reported for serum fructosamine and inorganic phosphate with respect to cancer risk. A drawback of using serum markers in predicting cancer risk is the potential fluctuations following other pathological conditions, resulting in non-specificity and imprecision of associations observed. Utilisation of multiple combination markers may provide more specificity, as well as give us repeated instead of single measurements. Associations with other diseases may also necessitate further analytical strategies addressing effects of serum markers on competing events in addition to cancer. Finally, delineating the role of serum metabolic markers may generate valuable information to complement emerging clinical studies on preventive effects of drugs and supplements targeting metabolic disorders against cancer.
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Affiliation(s)
- Cecilia Bosco
- King's College London, Division of Cancer Studies, Cancer Epidemiology Group, Research Oncology, 3rd floor, Bermondsey wing, Guy's Hospital, London SE1 9RT, UK ; Both authors contributed equally
| | - Wahyu Wulaningsih
- King's College London, Division of Cancer Studies, Cancer Epidemiology Group, Research Oncology, 3rd floor, Bermondsey wing, Guy's Hospital, London SE1 9RT, UK ; Both authors contributed equally
| | - Jennifer Melvin
- King's College London, Division of Cancer Studies, Cancer Epidemiology Group, Research Oncology, 3rd floor, Bermondsey wing, Guy's Hospital, London SE1 9RT, UK
| | - Aida Santaolalla
- King's College London, Division of Cancer Studies, Cancer Epidemiology Group, Research Oncology, 3rd floor, Bermondsey wing, Guy's Hospital, London SE1 9RT, UK
| | - Mario De Piano
- King's College London, Division of Cancer Studies, Cancer Epidemiology Group, Research Oncology, 3rd floor, Bermondsey wing, Guy's Hospital, London SE1 9RT, UK
| | - Rhonda Arthur
- King's College London, Division of Cancer Studies, Cancer Epidemiology Group, Research Oncology, 3rd floor, Bermondsey wing, Guy's Hospital, London SE1 9RT, UK
| | - Mieke Van Hemelrijck
- King's College London, Division of Cancer Studies, Cancer Epidemiology Group, Research Oncology, 3rd floor, Bermondsey wing, Guy's Hospital, London SE1 9RT, UK
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Li X, Tian F, Wang F, Li Y. Serum C-reactive protein and overall survival of patients with osteosarcoma. Tumour Biol 2015; 36:5663-6. [PMID: 25986475 DOI: 10.1007/s13277-015-3240-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 02/09/2015] [Indexed: 01/29/2023] Open
Abstract
Increased level of serum C-reactive protein (CRP) has been identified as an important prognostic factor in several types of cancers. However, the prognostic significance of serum CRP levels in patients with osteosarcoma was still unclear. A retrospective cohort study of 85 patients was performed to assess the prognostic significance of serum CRP level in osteosarcoma. Both log-rank test and multivariable analysis by Cox regression model were used to assess the impact of serum CRP levels on the overall survival in patients with osteosarcoma. Among those 85 patients, 28 (32.9 %) had high serum CRP level (>1 mg/dL), while the other 57 (67.1 %) patients had normal serum CRP level (≤ 1 mg/dL). There was no obvious difference in the baseline characteristics between high CRP group and normal CRP group. Kaplan-Meier product-limit method showed that patients with high serum CRP levels had significantly poorer overall survival than those patients with normal serum CRP levels (log-rank test P = 0.0008). Multivariable analysis by Cox regression model further showed that high serum CRP level was an independent predictor of poor overall survival (hazard ratio [HR] = 2.39; 95 % confidence interval [95 % CI] 1.22-4.67, P = 0.01). Thus, serum CRP level has an important prognostic significance in patients with osteosarcoma, and high CRP level is associated with worse overall survival.
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Affiliation(s)
- Xiaochuan Li
- Department of Hand & Foot Surgery, Shengjing Hospital of China Medical University, Shenyang, 110001, People's Republic of China,
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Stevens L, Pathak S, Nunes QM, Pandanaboyana S, Macutkiewicz C, Smart N, Smith AM. Prognostic significance of pre-operative C-reactive protein and the neutrophil-lymphocyte ratio in resectable pancreatic cancer: a systematic review. HPB (Oxford) 2015; 17:285-91. [PMID: 25431369 PMCID: PMC4368390 DOI: 10.1111/hpb.12355] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 09/22/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Better pre-operative risk stratification may improve patient selection for pancreatic resection in pancreatic cancer. C-reactive protein (CRP) and the neutrophil-lymphocyte ratio (NLR) have demonstrated prognostic value in some cancers. The role of CRP and NLR in predicting outcome in pancreatic cancer after curative resection is not well established. METHODS An electronic search of MEDLINE, EMBASE and CINAHL was performed to identify studies assessing survival in patients after pancreatic cancer resection with high or low pre-operative CRP or NLR. Systematic review was undertaken using the PRISMA protocol. RESULTS In total, 327 studies were identified with 10 reporting on survival outcomes after a pancreatic resection in patients with high or low CRP, NLR or both. All but one paper showed a trend of lower inflammatory markers in patients with longer survival. Three studies from six showed low CRP to be independently associated with increased survival and two studies of eight showed the same for NLR. All studies were retrospective cohort studies of low to moderate quality. DISCUSSION Inflammatory markers might prove useful guides to the management of resectable pancreatic cancer but, given the poor quality of evidence, further longitudinal studies are required before incorporating pre-operative inflammatory markers into clinical decision making.
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Affiliation(s)
- Lewis Stevens
- Department of Surgery, St James' University HospitalLeeds, Merseyside, UK
| | - Samir Pathak
- Department of Surgery, St James' University HospitalLeeds, Merseyside, UK
| | - Quentin M Nunes
- Royal Liverpool University HospitalLiverpool, Merseyside, UK
| | | | | | - Neil Smart
- Exeter Surgical Health Services Research Unit (HESRU), Royal Devon and Exeter NHS Foundation TrustExeter, UK
| | - Andrew M Smith
- Department of Surgery, St James' University HospitalLeeds, Merseyside, UK,Correspondence, Andrew Smith, St James' University Hospital, Beckett Street, Leeds LS9 7TF, UK. Tel: +44 0113 243 3144. Fax: 01132448182. E-mail:
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