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Serum parathyroid hormone-related peptide level predictor of weight loss in cancer
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In patients with cancer, blood levels of parathyroid hormone-related peptide appear to be predictive of cachexia independent of hypercalcemia, inflammation, tumor burden and other comorbid conditions.
Yong-ho Lee, MD, PhD, of the department of internal medicine at Yonsei University College of Medicine in Korea, evaluated data from 624 adult patients from the SECRET cohort referred to an inpatient or outpatient oncology department at Severence Hospital, Yonsei College of Medicine, who had measured serum parathyroid hormone-related peptide level between November 2005 and June 2014. Baseline data analyzed were age, sex, BMI, types/site and stage of cancer, performance status, time since cancer diagnosis and comorbidities. Researchers used Cox hazard models to assess the value of parathyroid hormone-related peptide in predicting weight loss established by a consensus definition and BMI-adjusted grades. Median follow-up was 327 days.
Based on the consensus definition, the overall risk for weight loss was 34.4%.
Parathyroid hormone-related peptide levels at or higher than the median (5.7 pmol/L) were associated with more-advanced cancer stage, poor performance status, higher corrected calcium, elevated C-reactive protein and low serum albumin compared with those with undetectable levels and levels below the median.
Patients with levels above the median (52%) had an increased risk for weight loss compared with those with lower levels (38.9%) and undetectable levels (29.7%; P < .001). After adjusting for key predictors, including serum calcium concentration, C-reactive protein, albumin, cancer stage and performance status, parathyroid hormone-related peptide remained independently associated with increased weight loss risk (P = .005); this persisted after application of BMI-adjusted weight loss.
Although weight loss was seen in the study cohort overall, the percent weight loss was significantly different across parathyroid hormone-related peptide strata. A trend was seen toward an increased disparity between baseline and follow-up weight, varying from a 1.1% decrease in the parathyroid hormone-related peptide negative group to a 6.9% decrease in the parathyroid hormone-related peptide group (P = .01).
“Our study demonstrated that serum [parathyroid hormone-related peptide] levels predicted weight loss associated with cachexia in a range of cancer patients,” the researchers wrote. “This effect was independent of the presence of hypercalcemia, inflammation, tumor burden, or other comorbidities. [Parathyroid hormone-related peptide] as a potential mediator of cancer cachexia holds promise not only for better understanding the mechanisms of cachexia via fat browning, but also as a novel therapeutic target against cachexia, meriting further investigation.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
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