Association Between Plasma Brain Natriuretic Peptide and Overall Survival in Patients With Advanced Cancer: Preliminary Findings

David Hui, Jane Naberhuis, Seyedeh Dibaj, Mujtaba Naqvi, Diane Liu, Eduardo Bruera

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)465-471
Number of pages7
JournalJournal of pain and symptom management
Volume58
Issue number3
DOIs
StatePublished - Sep 2019

Keywords

  • Atrial natriuretic factor
  • brain
  • natriuretic peptide
  • neoplasms
  • palliative care
  • prognosis

ASJC Scopus subject areas

  • General Nursing
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

MD Anderson CCSG core facilities

  • Biostatistics Resource Group

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