Subclinical involvement of the liver is associated with prognosis in treatment naïve cancer patients

BACKGROUND: Routinely tested liver biomarkers as alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyltransferase (GGT), butyryl-cholinesterase (BChE), albumin and bilirubin are altered in distinct malignancies and hepatic metastases. This study aimed to investigate whether al...

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Autores principales: Pavo, Noemi, Raderer, Markus, Goliasch, Georg, Wurm, Raphael, Strunk, Guido, Cho, Anna, Novak, Johannes F., Gisslinger, Heinz, Steger, Günther G., Hejna, Michael, Köstler, Wolfgang, Zöchbauer-Müller, Sabine, Marosi, Christine, Kornek, Gabriela, Auerbach, Leo, Schneider, Sven Thorben, Parschalk, Bernhard, Scheithauer, Werner, Pirker, Robert, Kiesewetter, Barbara, Pacher, Richard, Zielinski, Christoph, Hülsmann, Martin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Impact Journals LLC 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5655279/
https://www.ncbi.nlm.nih.gov/pubmed/29113384
http://dx.doi.org/10.18632/oncotarget.17131
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author Pavo, Noemi
Raderer, Markus
Goliasch, Georg
Wurm, Raphael
Strunk, Guido
Cho, Anna
Novak, Johannes F.
Gisslinger, Heinz
Steger, Günther G.
Hejna, Michael
Köstler, Wolfgang
Zöchbauer-Müller, Sabine
Marosi, Christine
Kornek, Gabriela
Auerbach, Leo
Schneider, Sven Thorben
Parschalk, Bernhard
Scheithauer, Werner
Pirker, Robert
Kiesewetter, Barbara
Pacher, Richard
Zielinski, Christoph
Hülsmann, Martin
author_facet Pavo, Noemi
Raderer, Markus
Goliasch, Georg
Wurm, Raphael
Strunk, Guido
Cho, Anna
Novak, Johannes F.
Gisslinger, Heinz
Steger, Günther G.
Hejna, Michael
Köstler, Wolfgang
Zöchbauer-Müller, Sabine
Marosi, Christine
Kornek, Gabriela
Auerbach, Leo
Schneider, Sven Thorben
Parschalk, Bernhard
Scheithauer, Werner
Pirker, Robert
Kiesewetter, Barbara
Pacher, Richard
Zielinski, Christoph
Hülsmann, Martin
author_sort Pavo, Noemi
collection PubMed
description BACKGROUND: Routinely tested liver biomarkers as alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyltransferase (GGT), butyryl-cholinesterase (BChE), albumin and bilirubin are altered in distinct malignancies and hepatic metastases. This study aimed to investigate whether all liver parameters have the ability to predict long-term mortality in treatment naïve cancer patients but without a malignant hepatic involvement. METHODS: We prospectively enrolled 555 consecutive patients with primary diagnosis of cancer without prior anticancer therapy. BChE, albumin, AST, ALT, GGT and bilirubin as well as the inflammatory makers C-reactive protein (CRP), serum amyloid A (SAA) and interleukin-6 (IL-6) were determined. All-cause mortality was defined as primary endpoint. RESULTS: During a median follow-up of 25 (IQR16-31) months 186 (34%) patients died. All liver parameters were significantly associated with all-cause mortality (p < 0.001 for all). However, for patients without a malignant primary or secondary hepatic involvement (82%) only the functional parameters BChE and albumin remained significantly associated with the primary endpoint (crude HR per 1-IQR increase 0.61, 95%CI:0.49-0.77; p < 0.001 for BChE and 0.58, 95%CI:0.47-0.70; p < 0.001 for albumin). This e ect was persistent after multivariate adjustment (adj.HR per 1-IQR increase 0.65, 95%CI:0.50-0.86; p = 0.002 for BChE and 0.63, 95%CI:0.50-0.79; p < 0.001 for albumin). BChE and albumin correlated inversely with CRP (r = -0.21, p < 0.001 and r = -0.36, p < 0.001), SAA (r = -0.19, p < 0.001 and r = -0.33, p < 0.001) and IL-6 (r = -0.13, p = 0.009 and r = -0.17, p = 0.001). CONCLUSIONS: Decreased serum BChE and albumin levels are associated with increased all-cause mortality in treatment-naïve cancer patients without a manifest malignant hepatic involvement irrespective of tumor entity or stage. This association may reflect progressing systemic inflammation and metabolic derangement with subclinical involvement of the liver.
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spelling pubmed-56552792017-11-06 Subclinical involvement of the liver is associated with prognosis in treatment naïve cancer patients Pavo, Noemi Raderer, Markus Goliasch, Georg Wurm, Raphael Strunk, Guido Cho, Anna Novak, Johannes F. Gisslinger, Heinz Steger, Günther G. Hejna, Michael Köstler, Wolfgang Zöchbauer-Müller, Sabine Marosi, Christine Kornek, Gabriela Auerbach, Leo Schneider, Sven Thorben Parschalk, Bernhard Scheithauer, Werner Pirker, Robert Kiesewetter, Barbara Pacher, Richard Zielinski, Christoph Hülsmann, Martin Oncotarget Clinical Research Paper BACKGROUND: Routinely tested liver biomarkers as alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyltransferase (GGT), butyryl-cholinesterase (BChE), albumin and bilirubin are altered in distinct malignancies and hepatic metastases. This study aimed to investigate whether all liver parameters have the ability to predict long-term mortality in treatment naïve cancer patients but without a malignant hepatic involvement. METHODS: We prospectively enrolled 555 consecutive patients with primary diagnosis of cancer without prior anticancer therapy. BChE, albumin, AST, ALT, GGT and bilirubin as well as the inflammatory makers C-reactive protein (CRP), serum amyloid A (SAA) and interleukin-6 (IL-6) were determined. All-cause mortality was defined as primary endpoint. RESULTS: During a median follow-up of 25 (IQR16-31) months 186 (34%) patients died. All liver parameters were significantly associated with all-cause mortality (p < 0.001 for all). However, for patients without a malignant primary or secondary hepatic involvement (82%) only the functional parameters BChE and albumin remained significantly associated with the primary endpoint (crude HR per 1-IQR increase 0.61, 95%CI:0.49-0.77; p < 0.001 for BChE and 0.58, 95%CI:0.47-0.70; p < 0.001 for albumin). This e ect was persistent after multivariate adjustment (adj.HR per 1-IQR increase 0.65, 95%CI:0.50-0.86; p = 0.002 for BChE and 0.63, 95%CI:0.50-0.79; p < 0.001 for albumin). BChE and albumin correlated inversely with CRP (r = -0.21, p < 0.001 and r = -0.36, p < 0.001), SAA (r = -0.19, p < 0.001 and r = -0.33, p < 0.001) and IL-6 (r = -0.13, p = 0.009 and r = -0.17, p = 0.001). CONCLUSIONS: Decreased serum BChE and albumin levels are associated with increased all-cause mortality in treatment-naïve cancer patients without a manifest malignant hepatic involvement irrespective of tumor entity or stage. This association may reflect progressing systemic inflammation and metabolic derangement with subclinical involvement of the liver. Impact Journals LLC 2017-04-16 /pmc/articles/PMC5655279/ /pubmed/29113384 http://dx.doi.org/10.18632/oncotarget.17131 Text en Copyright: © 2017 Pavo et al. http://creativecommons.org/licenses/by/3.0/ This article is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/) (CC-BY), which permits unrestricted use and redistribution provided that the original author and source are credited.
spellingShingle Clinical Research Paper
Pavo, Noemi
Raderer, Markus
Goliasch, Georg
Wurm, Raphael
Strunk, Guido
Cho, Anna
Novak, Johannes F.
Gisslinger, Heinz
Steger, Günther G.
Hejna, Michael
Köstler, Wolfgang
Zöchbauer-Müller, Sabine
Marosi, Christine
Kornek, Gabriela
Auerbach, Leo
Schneider, Sven Thorben
Parschalk, Bernhard
Scheithauer, Werner
Pirker, Robert
Kiesewetter, Barbara
Pacher, Richard
Zielinski, Christoph
Hülsmann, Martin
Subclinical involvement of the liver is associated with prognosis in treatment naïve cancer patients
title Subclinical involvement of the liver is associated with prognosis in treatment naïve cancer patients
title_full Subclinical involvement of the liver is associated with prognosis in treatment naïve cancer patients
title_fullStr Subclinical involvement of the liver is associated with prognosis in treatment naïve cancer patients
title_full_unstemmed Subclinical involvement of the liver is associated with prognosis in treatment naïve cancer patients
title_short Subclinical involvement of the liver is associated with prognosis in treatment naïve cancer patients
title_sort subclinical involvement of the liver is associated with prognosis in treatment naïve cancer patients
topic Clinical Research Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5655279/
https://www.ncbi.nlm.nih.gov/pubmed/29113384
http://dx.doi.org/10.18632/oncotarget.17131
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