Endocrinol Metab.  2018 Mar;33(1):97-104. 10.3803/EnM.2018.33.1.97.

Effects of Serum Albumin, Calcium Levels, Cancer Stage and Performance Status on Weight Loss in Parathyroid Hormone-Related Peptide Positive or Negative Patients with Cancer

• Lee JY
• Hong N
• Kim HR
• Lee BW
• Kang ES
• Cha BS
• Lee YH

• KMID: 2407126
• DOI: http://doi.org/10.3803/EnM.2018.33.1.97

Abstract

BACKGROUND
A recent animal study showed that parathyroid hormone-related peptide (PTHrP) is associated with cancer cachexia by promoting adipose tissue browning, and we previously demonstrated that PTHrP predicts weight loss (WL) in patients with cancer. In this study, we investigated whether prediction of WL by PTHrP is influenced by clinical factors such as serum albumin, corrected calcium levels, cancer stage, and performance status (PS).
METHODS
A cohort of 219 patients with cancer whose PTHrP level was measured was enrolled and followed for body weight (BW) changes. Subjects were divided into two groups by serum albumin (cutoff value, 3.7 g/dL), corrected calcium (cutoff value, 10.5 mg/dL), cancer stage (stage 1 to 3 or 4), or PS (Eastern Cooperative Oncology Group 0 to 1 or 2 to 4), respectively. Clinically significant WL was defined as either percent of BW change (% BW) <−5% or % BW <−2% plus body mass index (BMI) < 20 kg/m².
RESULTS
After a median follow-up of 327 days, 74 patients (33.8%) experienced clinically significant WL. A positive PTHrP level was associated with a 2-fold increased risk of WL after adjusting for age, baseline BMI, serum albumin, corrected calcium level, cancer stage, and PS. The effect of PTHrP on WL remained significant in patients with low serum albumin, stage 4 cancer, and good PS. Regardless of calcium level, the effect of PTHrP on WL was maintained, although there was an additive effect of higher calcium and PTHrP levels.
CONCLUSION
Early recognition of patients with advanced cancer who are PTHrP positive with hypercalcemia or hypoalbuminemia is needed for their clinical management.

Keyword

Parathyroid hormone-related peptide; Weight loss; Cachexia

MeSH Terms

Adipose Tissue
Animals
Body Mass Index
Body Weight
Cachexia
Calcium*
Cohort Studies
Follow-Up Studies
Humans
Hypercalcemia
Hypoalbuminemia
Parathyroid Hormone-Related Protein*
Serum Albumin*
Weight Loss*
Calcium
Parathyroid Hormone-Related Protein
Serum Albumin

Figure

• 

  Fig. 1 Body weight changes from baseline to follow-up (FU) by subgroup. Patients are grouped by serum parathyroid hormone-related peptide (PTHrP) and (A) corrected calcium, (B) albumin, (C) cancer stage, (D) performance status. Data are expressed as box and range bar plots representing the mean and 95% confidence interval (CI). Black and gray plots represent the PTHrP negative group and PTHrP positive group, respectively. Mean % change was calculated as ([FU weight-baseline weight]/baseline weight×100) for each group. Base, baseline; ECOG, Eastern Cooperative Oncology Group. aP values by paired t test <0.05; bP values by paired t test <0.005.

• 

  Fig. 2 Cumulative Kaplan-Meier curves for weight loss (WL)-free probability by parathyroid hormone-related peptide levels. Patients with (A) serum albumin ≥3.7 g/dL, (B) serum albumin <3.7 g/dL, (C) corrected calcium <10.5 mg/dL, (D) corrected calcium ≥10.5 mg/dL, (E) cancer stage 1 to 3, (F) cancer stage 4, (G) Eastern Cooperative Oncology Group (ECOG) 0 to 1, (H) ECOG 2 to 4. HR, hazard ratio; CI, confidence interval. aLog rank P<0.05; bLog rank P<0.005.

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