Emerging markers of cachexia predict survival in cancer patients.
BACKGROUND
Cachexia may occur in 40% of cancer patients, representing the major cause of death in more than 20% of them. The aim of this study was to investigate the role of leptin, ghrelin and obestatin as diagnostic and predictive markers of cachexia in oncologic patients. Their impact on patient survival was also evaluated.


METHODS
140 adults with different cancer diagnoses were recruited. Thirty healthy volunteers served as control. Serum ghrelin, obestatin and leptin were tested at baseline and after a follow-up period of 18 months.


RESULTS
Ghrelin levels were significantly higher in cancer patients than in healthy subjects (573.31 ± 130 vs 320.20 ± 66.48 ng/ml, p < 0.0001), while obestatin (17.42 ± 7.12 vs 24.89 ± 5.54 ng/ml, p < 0.0001) and leptin (38.4 ± 21.2 vs 76.28 ± 17.48 ng/ml, p < 0.0001) values were lower. At ROC analyses the diagnostic profile of ghrelin (AUC 0.962; sensitivity 83%; specificity 98%), obestatin (AUC 0.798; sensitivity 74.5%; specificity 81.5%) and leptin (AUC 0.828; sensitivity 79%; specificity 73%) was superior to that of albumin (AUC 0.547; sensitivity 63%, specificity 69.4%) for detecting cachexia among cancer patients. On Cox multivariate analyses ghrelin (HR 1.02; 95% CI 1.01 - 1.03; p < 0.0001) and leptin (HR 0.94; 95% CI 0.92 - 0.96; p < 0.0001) were significant predictors of death even after correction for other known risk factors such as presence of metastasis and chronic kidney disease.


CONCLUSIONS
Ghrelin and leptin are promising biomarkers to diagnose cachexia and to predict survival in cancer patients.
Department of Human Pathology, University of Messina, Via Consolare Valeria, 98125 Messina, Italy. patriziamondello@hotmail.it.
Patrizia
P
Mondello
Antonio
A
Lacquaniti
Stefania
S
Mondello
Davide
D
Bolignano
Vincenzo
V
Pitini
Carmela
C
Aloisi
Michele
M
Buemi
D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002100:Cachexia / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D016022:Case-Control Studies; D002784:Cholesterol / Q000097:blood; D003920:Diabetes Mellitus / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D054439:Ghrelin / Q000097:blood*; D006333:Heart Failure / Q000097:blood; D006801:Humans; D053208:Kaplan-Meier Estimate; D020738:Leptin / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009369:Neoplasms / Q000097:blood* / Q000150:complications / Q000401:mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D012709:Serum Albumin / Q000378:metabolism; D015996:Survival Rate
D015415:Biomarkers; D054439:Ghrelin; D020738:Leptin; D012709:Serum Albumin; C505799:obestatin, human; D002784:Cholesterol