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Serum PTHrP Predicts Weight Loss in Cancer Patients Independent of Hypercalcemia, Inflammation, and Tumor Burden

 Namki Hong  ;  Hye-jin Yoon  ;  Yong-ho Lee  ;  Hye Ryun Kim  ;  Byung Wan Lee  ;  Yumie Rhee  ;  Eun Seok Kang  ;  Bong-Soo Cha  ;  Hyun Chul Lee 
 Journal of Clinical Endocrinology & Metabolism, Vol.101(3) : 1207-1214, 2016 
Journal Title
 Journal of Clinical Endocrinology & Metabolism 
Issue Date
Aged ; Cachexia/blood ; Cachexia/diagnosis* ; Cachexia/etiology ; Female ; Humans ; Hypercalcemia/blood* ; Hypercalcemia/complications ; Inflammation/blood* ; Inflammation/complications ; Longitudinal Studies ; Male ; Middle Aged ; Neoplasms/blood ; Neoplasms/complications ; Neoplasms/diagnosis* ; Parathyroid Hormone-Related Protein/blood* ; Prognosis ; Tumor Burden/physiology* ; Weight Loss*
CONTEXT: Recent animal studies showed that tumor-derived PTHrP induced cancer cachexia by fat browning with increased energy expenditure; however, clinical evidence from human data is insufficient. OBJECTIVE: We investigated whether serum PTHrP levels independently predicts weight loss (WL) in cancer patients. DESIGN, SETTING, AND PATIENTS: From a longitudinal observational cohort, body mass index (BMI) of patients with measured serum PTHrP levels (n = 624) was assessed (median follow-up of 327 d). MAIN OUTCOME MEASURES: Cox hazard models were used to examine the predictive value of PTHrP for WL defined by consensus definition (WL [consensus], percentage WL < -5% or percentage WL < -2% plus BMI < 20 kg/m(2)) and by BMI-adjusted grades (WL [BMI adjusted]). RESULTS: The overall risk of WL (consensus) was 34.4%. Compared with PTHrP-negative subjects, patients with higher PTHrP levels (PTHrP ≥ median 5.7 pmol/L) had more WL (percentage WL, -6.9% vs -1.1%, P = .010) at follow-up. A higher PTHrP level was associated with an increased loss of body weight (β = -2.73), muscle (β = -1.85), and fat (β = -2.52) after controlling for age, sex, and BMI. Kaplan-Meier analysis demonstrated that subjects with higher PTHrP had increased WL risk compared with lower PTHrP or PTHrP-negative groups (52.0% vs 38.9% vs 29.7%, P < .001). Serum PTHrP was independently associated with an increased WL risk (hazard ratio [HR]1.23, P = .005) adjusted for potent predictors including serum levels of calcium, C-reactive protein, albumin, cancer stage, and performance status of patients. Consistent results were observed when BMI-adjusted WL was applied. CONCLUSIONS: Serum PTHrP levels predicted cancer-associated WL independent of the presence of hypercalcemia, inflammation, tumor burden, and other comorbidities.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
강은석(Kang, Eun Seok) ORCID logo https://orcid.org/0000-0002-0364-4675
김혜련(Kim, Hye Ryun) ORCID logo https://orcid.org/0000-0002-1842-9070
이병완(Lee, Byung Wan) ORCID logo https://orcid.org/0000-0002-9899-4992
이용호(Lee, Yong Ho) ORCID logo https://orcid.org/0000-0002-6219-4942
이유미(Rhee, Yumie) ORCID logo https://orcid.org/0000-0003-4227-5638
이현철(Lee, Hyun Chul)
차봉수(Cha, Bong Soo) ORCID logo https://orcid.org/0000-0003-0542-2854
홍남기(Hong, Nam Ki) ORCID logo https://orcid.org/0000-0002-8246-1956
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