Background:Better prognostic biomarkers are needed in older adults with cancer. There are established links between N-terminal pro-B-type Natriuretic Peptide (NT-proBNP) and sarcopenia, and sarcopenia is associated with poorer cancer survival. However, there are limited data regarding baseline NT-proBNP as a biomarker of cancer outcome. The GO2 trial recruited older and/or frail United Kingdom (UK) patients with advanced gastroesophageal cancer and investigated the role of chemotherapy dose de-escalation. Using the GO2 database, we sought to investigate the prognostic role of NT-proBNP as well as the interaction between NT-proBNP and frailty.Methods:This was a post-hoc analysis of a completed clinical trial. Frailty measures included ECOG performance status (PS) and GO2 frailty grouping (based on an assessment of nine geriatric domains). A corrected NT-proBNP (cBNP) was calculated for each patient, adjusting for the upper limit of normal (ULN) reference from each centre.Results:A total of 241 patients were eligible to be included in the analysis. The median age was 76 (range 52–89), 187 (77.6%) were male and 211 (87.6%) had adenocarcinoma. Eighty (33.2%) patients had a baseline NT-proBNP above the local ULN. There was no association between cBNP and ECOG PS (p= 0.36) or the GO2 frailty group (p= 0.58). Those with the highest cBNP (n= 59) had significantly inferior median overall survival: 5.3 months (mos.) vs. 6.8 mos. (medium,n= 120) vs. 8.2 mos. (low,n= 61); HR 1.57 (95% CI; 1.04–2.37),p= 0.031. This was maintained on a Cox regression analysis (HR 1.69,p= 0.01) accounting for the GO2 trial stratification factors. There was no clear association between frailty and NT-proBNP.Conclusions:In this study, NT-proBNP appeared to be prognostic-independent of other factors. Further investigation and validation are needed to confirm our findings and to determine the potential beneficial role of cardioprotective therapy in at-risk patients with cancer identified in this manner.
背景：老年癌症患者需要更佳的预后生物标志物。N末端B型利钠肽原（NT-proBNP）与肌肉减少症存在明确关联，而肌肉减少症与较差的癌症生存率相关。然而，关于基线NT-proBNP作为癌症预后生物标志物的数据有限。GO2试验招募了英国老年和/或体弱的晚期胃食管癌患者，并研究了化疗剂量递减的作用。利用GO2数据库，我们旨在探讨NT-proBNP的预后作用及其与衰弱之间的交互关系。 方法：本研究为一项已完成临床试验的事后分析。衰弱评估指标包括ECOG体能状态（PS）和GO2衰弱分组（基于九项老年综合评估领域）。为每位患者计算校正后的NT-proBNP（cBNP），根据各中心正常值上限（ULN）参考值进行调整。 结果：共241例患者符合分析条件。中位年龄76岁（范围52-89岁），男性187例（77.6%），腺癌211例（87.6%）。80例（33.2%）患者基线NT-proBNP高于当地ULN。cBNP与ECOG PS（p=0.36）或GO2衰弱分组（p=0.58）均无显著关联。cBNP最高组（n=59）的中位总生存期显著较差：5.3个月 vs. 6.8个月（中位组，n=120）vs. 8.2个月（低位组，n=61）；风险比1.57（95% CI：1.04-2.37），p=0.031。在纳入GO2试验分层因素的Cox回归分析中，该结果保持稳定（HR 1.69，p=0.01）。衰弱与NT-proBNP之间未发现明确关联。 结论：本研究中NT-proBNP显示出独立于其他因素的预后价值。需要进一步研究和验证以确认我们的发现，并确定心脏保护治疗对此类方式识别出的癌症高危患者的潜在获益作用。
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