1
|
Lippitz BE, Harris RA. Cytokine patterns in cancer patients: A review of the correlation between interleukin 6 and prognosis. Oncoimmunology 2016; 5:e1093722. [PMID: 27467926 PMCID: PMC4910721 DOI: 10.1080/2162402x.2015.1093722] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 09/08/2015] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVE In tumor patients, IL-6 appears to be one component of a consistent cancer-associated cytokine network resulting in both a systemic immune stimulation and a microenvironment of cancer-induced immune suppression that ultimately protects the cancer cells. IL-6 has been associated with prognosis in cancer patients, but so far a systemical analysis has not been carried out. METHODS The present meta-analysis studies the relation between IL-6 serum levels and the prognosis of cancer patients in the available clinical literature of 100 articles published between 1993 and 2013 comprising 11,583 patients. RESULTS The IL-6 serum level was described as significantly correlating with survival in 82/101 series comprising 85.6% of patients (9917/11,583) with 23 different cancer types. A total of 64 studies dichotomized patient cohorts according to various cut-off IL-6 serum levels: in 59/64 of these series corresponding to 94.5% of the reported patients (7694/8142) significant correlations between IL-6 serum level and survival were seen. The median survival of cancer patients had been determined above various cut-off levels of serum IL-6 in 24 dichotomized studies (26 cohorts). There was a highly significant inverse correlation between median survival of the cohorts with IL-6 serum level above cut-off (1272 patients) and their corresponding IL-6 cut-off values (Spearman R -0,48 p= < 0.001) following a linear regression when both parameters were log-transformed (p < 0.001). A significant correlation between increasing serum IL-6 and tumor stage or metastases was described in 39/44 studies and 91% of published patients (4221/4636) where clinical parameters had been specified. CONCLUSIONS Closely associated with the patient's clinical condition and independent of the cancer histology, the increased IL-6 serum level uniformly appears to correlate with survival as paraneoplastic condition in later cancer stages independent of the cancer type. Modifications of this paraneoplastic immune reaction may offer new therapeutic options in cancer.
Collapse
Affiliation(s)
- Bodo E Lippitz
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Sjukhuset, Karolinska Institutet , Stockholm, Sweden
| | - Robert A Harris
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Sjukhuset, Karolinska Institutet , Stockholm, Sweden
| |
Collapse
|
2
|
Saeed K, Dale AP, Leung E, Cusack T, Mohamed F, Lockyer G, Arnaudov S, Wade A, Moran B, Lewis G, Dryden M, Cecil T, Cepeda JA. Procalcitonin levels predict infectious complications and response to treatment in patients undergoing cytoreductive surgery for peritoneal malignancy. Eur J Surg Oncol 2015; 42:234-43. [PMID: 26560024 DOI: 10.1016/j.ejso.2015.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/05/2015] [Accepted: 10/16/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Cytoreductive-surgery for peritoneal-malignancy (PM) involves extensive intra-abdominal surgery and a massive post-operative systemic-inflammatory-response (SIRS). It is often challenging to differentiate SIRS that are solely surgery-associated from those of post-operative infections. White-Cell-Counts (WCC) and C-Reactive-Protein (CRP) are routinely used as markers for infection, but are non-specific and their elevation is often delayed in PM cases. Other markers need to be evaluated to assist early identification/prediction of post-operative infections. METHODOLOGY Prospective evaluation of serum procalcitonin (PCT), CRP and WCC in 50 patients pre-operatively (Day0), and on post-operative days (POD) 1, 3 & 6, following cytoreductive-surgery with or without splenectomy. RESULTS Day0 PCT, CRP and WCC values were within normal limits, but increasing physiologically in post-operative period without infection, with noticeable higher PCT in splenectomized patients. In our cohort post-operative infections were diagnosed in 14 patients, often within 48 h. There was a trend for faster rise in serum PCT on POD1 compared to CRP and WCC, and faster PCT decline following appropriate therapy on POD3 and POD6 when infected cases were clinically resolving while WCC and CRP continued to rise, particularly in non-spelenectomised patients. The AUC on POD1 was significantly higher for PCT (0.689) vs. WCC (0.476) and CRP (0.477) (p = 0.04). Sensitivity, specificity, positive-predictive-value and negative-predictive-values for PCT ranged between (57%-100%), (22%-74%), (33%-47%) & (81%-100%), for CRP (28%-78%), (5.5%-86%), (18%-44.4%) & (40%-75.5%) and for WCC (14%-26.5%), (65.5-80.5%), (22%-25%), (67%-70%) respectively. CONCLUSION PCT, like WCC and CRP, needs to be interpreted with extreme cautions in the context of infections post-cytoreductive-surgery and should only be used in association with other clinical and investigational findings.
Collapse
Affiliation(s)
- K Saeed
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trusts (Basingstoke and Winchester), Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK; University of Southampton Medical School, Tremona Road, Southampton, SO16 6YD, UK.
| | - A P Dale
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trusts (Basingstoke and Winchester), Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK
| | - E Leung
- Department of Surgery and Pseudomixoma Surgery, Hampshire Hospitals NHS Foundation Trusts, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK
| | - T Cusack
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trusts (Basingstoke and Winchester), Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK
| | - F Mohamed
- Department of Surgery and Pseudomixoma Surgery, Hampshire Hospitals NHS Foundation Trusts, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK
| | - G Lockyer
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trusts (Basingstoke and Winchester), Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK
| | - S Arnaudov
- Department of Surgery and Pseudomixoma Surgery, Hampshire Hospitals NHS Foundation Trusts, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK
| | - A Wade
- Department of Intensive Care Unit, Hampshire Hospitals NHS Foundation Trusts, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK
| | - B Moran
- Department of Surgery and Pseudomixoma Surgery, Hampshire Hospitals NHS Foundation Trusts, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK
| | - G Lewis
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trusts (Basingstoke and Winchester), Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK
| | - M Dryden
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trusts (Basingstoke and Winchester), Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK; University of Southampton Medical School, Tremona Road, Southampton, SO16 6YD, UK
| | - T Cecil
- Department of Surgery and Pseudomixoma Surgery, Hampshire Hospitals NHS Foundation Trusts, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK
| | - J A Cepeda
- Department of Microbiology, Kingston Hospital NHS Foundation Trust, Kingston Upon Thames, Surrey, KT2 7QB, UK
| |
Collapse
|
3
|
Silvestre J, Rebanda J, Lourenço C, Póvoa P. Diagnostic accuracy of C-reactive protein and procalcitonin in the early detection of infection after elective colorectal surgery - a pilot study. BMC Infect Dis 2014; 14:444. [PMID: 25132018 PMCID: PMC4143543 DOI: 10.1186/1471-2334-14-444] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 08/12/2014] [Indexed: 02/06/2023] Open
Abstract
Background Colorectal surgery is associated with postoperative infectious complications in up to 40% of cases, but the diagnosis of these complications is frequently misleading, delaying its resolution. Several biomarkers have been shown to be useful in infection diagnosis. Methods We conducted a single-centre, prospective, observational study segregating patients submitted to elective colorectal surgery with primary anastomosis, CRP and PCT were measured daily. We compared infected and non-infected patients. Results From October 2009 to June 2011, a total of 50 patients were included. Twenty-one patients developed infection. PCT and CRP before surgery were equally low in patients with or without postoperative infectious complications. After surgery, both PCT and CRP increased markedly. CRP time-course from the day of surgery onwards was significantly different in infected and non-infected patients (P = 0.001) whereas, PCT time-course was almost parallel in both groups (P = 0.866). Multiple comparisons between infected and non-infected patients from 5th to 9th postoperative days (POD) were performed and CRP concentration was significantly different (P < 0.01, Bonferroni correction), on the 6th, 7th and 8th POD. A CRP concentration > 5.0 mg/dl at the D6 was predictive of infection with a sensitivity of 85% and a specificity of 62% (positive likelihood ratio 2.2, negative likelihood ratio 0.2). Conclusions After a major elective surgical insult both CRP and PCT serum levels increased independently of the presence of infection. Besides serum CRP time-course showed to be useful in the early detection of an infectious complication whereas PCT was unhelpful. Electronic supplementary material The online version of this article (doi:10.1186/1471-2334-14-444) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Joana Silvestre
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, CHLO, Lisbon, Portugal.
| | | | | | | |
Collapse
|
4
|
Lin ZY, Xu PB, Yan SK, Meng HB, Yang GJ, Dai WX, Liu XR, Li JB, Deng XM, Zhang WD. A metabonomic approach to early prognostic evaluation of experimental sepsis by (1)H NMR and pattern recognition. NMR IN BIOMEDICINE 2009; 22:601-608. [PMID: 19322815 DOI: 10.1002/nbm.1373] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This study proposes an NMR-based metabonomic approach to early prognostic evaluation of sepsis. Forty septic rats receiving cecal ligation and puncture (CLP) were divided into the surviving group and nonsurviving group on day 6, while 20 sham-operated rats served as the control group. Serum samples were collected from septic and sham-operated rats at 12 h after surgery and analyzed using (1)H NMR spectroscopy. Orthogonal partial least squares (OPLS) were applied and showed clustering according to predefined groups, indicating that NMR-based metabolic profiling could reveal pathologic characteristics in the serum of sham-operated, surviving, and nonsurviving septic rats. In addition, six characteristic metabolites including lactate, alanine, acetate, acetoacetate, hydroxybutyrate, and formate, which are mainly involved in energy metabolism, changed markedly in septic rats, especially in the nonsurvivors. Using these metabolites, a predictive model for prognostic evaluation of sepsis was constructed using a radial basis function neural network (RBFNN) with a prediction accuracy of about 87% by test samples. The results indicated that the NMR-based metabonomic approach is a potential technique for the early prognostic evaluation of sepsis.
Collapse
Affiliation(s)
- Zhong-ying Lin
- School of Pharmacy, Second Military Medical University, Shanghai, P. R. China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Novotny A, Emmanuel K, Matevossian E, Kriner M, Ulm K, Bartels H, Holzmann B, Weighardt H, Siewert JR. Use of procalcitonin for early prediction of lethal outcome of postoperative sepsis. Am J Surg 2007; 194:35-9. [PMID: 17560906 DOI: 10.1016/j.amjsurg.2006.10.026] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2006] [Revised: 10/04/2006] [Accepted: 10/04/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND To develop strategies for the prediction of sepsis outcome systemic procalcitonin (PCT) levels were correlated with various clinical parameters. METHODS PCT levels and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were assessed on the day of sepsis diagnosis in a large series (n = 160) of patients developing sepsis after major visceral surgery. RESULTS In multivariate analysis, systemic PCT and the APACHE II score could be identified as independent early predictive indicators of lethal sepsis. Combining both indicators at sepsis onset, a prognosis score could be calculated using binary logistic regression analysis allowing the identification of high- and low-risk groups. While 71% of the high-risk patients died of sepsis, 77% of patients assigned to the low-risk group survived the septic complication (sensitivity 71%, specificity 77%). CONCLUSION Calculation of the prognosis-score allowed for an early prediction of the septic course with high sensitivity and specificity. This information could aid in deciding on adequate treatment strategies.
Collapse
Affiliation(s)
- Alexander Novotny
- Department of Surgery, Klinikum rechts der Isar, Technische Universität, Ismaninger Str. 22, 81675 Munich, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|