Circulating Activin A is predictive of survival of cancer patients - 23/03/16
on behalf of
King Albert II Cancer Institute of the Cliniques Universitaires St-Luc
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Résumé |
Introduction and aim |
We demonstrated that human cancer cachexia is associated with increased circulating concentrations of Activin A. Given the cachectic and anorectic effect of Activin A demonstrated in animal models, our observation suggests that Activin A might play a role in the development of human cancer cachexia. Indeed, circulating Activin A was correlated positively with weight loss and negatively with skeletal muscle density, two well-established prognosis factors in cancer patients. Our goal was to investigate the value of circulating Activin A as a marker of survival in cancer patients.
Material and methods |
Patients with colorectal or lung cancer were recruited at the time of diagnosis or at relapse and had clinical, nutritional (SNAQ score) and functional (ECOG, QLQC30) assessment. Body composition and skeletal muscle density were measured by CT-scan and plasma concentrations of Activin A were determined. Overall survival was estimated during 12 months (–1/+2 months) after inclusion.
Results |
Among 152 patients included in the study, survival data was available for 149 patients. Patients with high levels of Activin A (>665pg/mL) had lower overall survival (68%) than those with levels in the normal range (84%; P<0.01). Furthermore, compared to alive patients, patients who deceased during the year of follow-up exhibited at baseline higher plasma Activin A levels (589pg/mL [363–17660] vs. 415 [165–9402]; P<0.001), greater weight loss (6% [0–21] vs. 3% [0–25]; P<0.05), lower skeletal muscle density (24.6 UH [10.9–54.8] vs. 33.3 UH [0.2–62.2]; P<0.05) and higher prevalence of low muscularity (56% vs. 37%; P<0.05). These patients had also a more severe anorexia (P<0.05), more symptoms (P<0.0001) and poorer quality of life (P<0.05) and physical function (P<0.0001). As expected, lung cancer and invasive tumour, as assessed by N and M score, were more prevalent in this group.
Conclusion |
In cancer patients, a high circulating concentration of Activin A was associated with a shorter overall survival. Significant weight loss, low muscularity and low skeletal muscle density, were also associated with a poor prognosis.
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