TY - JOUR
T1 - Association Between Plasma Brain Natriuretic Peptide and Overall Survival in Patients With Advanced Cancer
T2 - Preliminary Findings
AU - Hui, David
AU - Naberhuis, Jane
AU - Dibaj, Seyedeh
AU - Naqvi, Mujtaba
AU - Liu, Diane
AU - Bruera, Eduardo
N1 - Publisher Copyright:
© 2019 American Academy of Hospice and Palliative Medicine
PY - 2019/9
Y1 - 2019/9
N2 - Context: Atrial and brain natriuretic peptides (ANP and BNP) are established diagnostic and prognostic markers in heart failure, but their utility in patients with advanced cancer is unclear. Objectives: Our objective was to examine the association between plasma natriuretic peptides and survival in patients with advanced cancer without clinical evidence of heart failure. Methods: This exploratory analysis of a multicenter, randomized clinical trial of cancer patients receiving hospice care assessed the association between elevated plasma ANP, BNP, or Pro-BNP (cutoffs of >77, 100, and 900 pg/mL, respectively) and overall survival. Time-to-event analyses, including multivariate Cox regression, were conducted. Results: Among 97 patients, the mean age was 67.2 years and the overall survival was 16 days (95% CI, 13–23 days). ANP, BNP, and Pro-BNP were elevated in 29 of 36 (81%), nine of 23 (39%), and 32 of 38 (84%) patients, respectively. Elevated ANP, BNP, or Pro-BNP was associated with worse survival (median 14 vs. 21 days; P = 0.02). BNP or Pro-BNP was inversely associated with overall survival (hazard ratio = 2.27; 95% CI, 1.29–3.97) in univariate Cox regression analysis, and remained significant in multivariate Cox regression analysis (hazard ratio = 3.09; 95% CI, 1.40–6.84) after adjusting for treatment group and known prognostic variables such as performance status, albumin, creatinine, delirium, dyspnea, and anorexia. Elevated ANP alone was not significantly associated with survival (P = 0.17). Conclusion: Our preliminary findings suggest that BNP or Pro-BNP may be a novel objective prognostic marker in cancer patients without heart failure. Further research is needed to confirm these findings.
AB - Context: Atrial and brain natriuretic peptides (ANP and BNP) are established diagnostic and prognostic markers in heart failure, but their utility in patients with advanced cancer is unclear. Objectives: Our objective was to examine the association between plasma natriuretic peptides and survival in patients with advanced cancer without clinical evidence of heart failure. Methods: This exploratory analysis of a multicenter, randomized clinical trial of cancer patients receiving hospice care assessed the association between elevated plasma ANP, BNP, or Pro-BNP (cutoffs of >77, 100, and 900 pg/mL, respectively) and overall survival. Time-to-event analyses, including multivariate Cox regression, were conducted. Results: Among 97 patients, the mean age was 67.2 years and the overall survival was 16 days (95% CI, 13–23 days). ANP, BNP, and Pro-BNP were elevated in 29 of 36 (81%), nine of 23 (39%), and 32 of 38 (84%) patients, respectively. Elevated ANP, BNP, or Pro-BNP was associated with worse survival (median 14 vs. 21 days; P = 0.02). BNP or Pro-BNP was inversely associated with overall survival (hazard ratio = 2.27; 95% CI, 1.29–3.97) in univariate Cox regression analysis, and remained significant in multivariate Cox regression analysis (hazard ratio = 3.09; 95% CI, 1.40–6.84) after adjusting for treatment group and known prognostic variables such as performance status, albumin, creatinine, delirium, dyspnea, and anorexia. Elevated ANP alone was not significantly associated with survival (P = 0.17). Conclusion: Our preliminary findings suggest that BNP or Pro-BNP may be a novel objective prognostic marker in cancer patients without heart failure. Further research is needed to confirm these findings.
KW - Atrial natriuretic factor
KW - brain
KW - natriuretic peptide
KW - neoplasms
KW - palliative care
KW - prognosis
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U2 - 10.1016/j.jpainsymman.2019.05.006
DO - 10.1016/j.jpainsymman.2019.05.006
M3 - Article
C2 - 31128228
AN - SCOPUS:85067701167
SN - 0885-3924
VL - 58
SP - 465
EP - 471
JO - Journal of pain and symptom management
JF - Journal of pain and symptom management
IS - 3
ER -