Abstract 903: Circulating inflammatory proteins associated with mortality from causes other than the index cancer in older adult cancer survivors in the atherosclerosis risk in communities study

Background: Inflammation is hypothesized to underlie premature mortality in cancer survivors, yet little is known about the inflammatory proteins and pathways involved.

Methods: 474 long-term (≥5 years) older adult survivors of prostate, breast, colorectal, endometrial or bladder cancers in the ARIC study were followed from visit 5 (2011-13) to 12/2018. At visit 5, 580 plasma inflammatory proteins were assayed using the SomaScan platform, a modified aptamer-based assay. We modeled sub-distribution hazards (sHR) of non-index cancer-related death per log2 increase in each protein, adjusting for age, sex, race, years since cancer diagnosis, renal function, anti-inflammatory drug use, and cancer/CVD shared risk factors. We also investigated these proteins with mortality in survivors of the two most common cancers, prostate and breast. To account for multiple testing, we used Bonferroni correction and false discovery rate. Using Ingenuity Pathway Analysis (Qiagen®) and principal components analysis, we identified protein pathways and upstream regulators most strongly associated with mortality.

Results: Survivors were 21% Black, 56% male, had a mean age of 77 yrs, and median time since diagnosis of 11 yrs. 95 non-cancer (50% CVD) and 34 non-index cancer deaths occurred in 2740 person-yrs of follow-up. After FDR correction, 49 proteins were significantly associated with risk of death. VEGF sR3, complement C1RL, CD9 antigen, insulin-like growth factor-binding protein 7 (IGFBP7), platelet-derived growth factor D (PDGFD) and interferon-induced protein (IFIT2) were most strongly positively associated, with sHR: 2.1-4.4 per two-fold increase. Transmembrane protein (TMEM230), plasminogen, TNFSF12, APOL1, serum amyloid P-component and von Willebrand factor (VWA2) were most strongly inversely associated, with sHR:0.34-0.42. Only IFIT2 remained significant after Bonferroni correction. Associations of some inflammatory proteins differed by cancer site survived. However, 2 proteins, telomeric repeat binding factor (TERF1) and toll-like receptor (TLR2), were associated with increased mortality in all, prostate, and breast cancer survivors. Proteins associated with mortality were enriched for 5 major signaling pathways - MSP-RON, IL-8, glioma/coagulation, glucocorticoid receptor, atherosclerosis, and hepatic fibrosis, and were activated or inhibited by upstream regulators: SOX7, ERG, MYC, and IL4.

Conclusion: Several circulating inflammatory proteins and signaling pathways were associated with premature death in cancer survivors independent of cancer/CVD risk factors. If confirmed, these proteins/pathways may warrant evaluation as potential biomarkers for screening for risk of premature mortality, and possibly as therapeutic targets to prolong lives of cancer survivors. Funding: NHLBI, NCI, NPCR

Citation Format: Chinenye C. Ugoji, Keenan A. Walker, Lorraine T. Dean, Alden Gross, Christie M. Ballantyne, Ken Butler, Ron C. Hoogeveen, Corinne Joshu, Thomas H. Mosley, Anna Prizment, A. Richey Sharrett, Adrienne Tin, Ravi Varadhan, Josef Coresh, Elizabeth A. Platz. Circulating inflammatory proteins associated with mortality from causes other than the index cancer in older adult cancer survivors in the atherosclerosis risk in communities study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 903.

Abstract PO-099: Racial differences in the association of circulating inflammatory proteins with mortality from causes other than the index cancer in older adult cancer survivors in the Atherosclerosis Risk in Communities (ARIC) study

Background Inflammation is strongly hypothesized to underlie premature mortality in cancer survivors. However, little is known about racial differences in the associations of inflammatory proteins with premature mortality in cancer survivors. Methods 474 long-term (≥5 years) older adult survivors of prostate, breast, colorectal, endometrial and bladder cancers in the ARIC study were followed from visit 5 (2011-13) to December 2018. At visit 5, 5000 serum proteins were assayed using the high throughput SOMAscan technology. Using competing risks proportional hazards regression, we evaluated racial differences in the associations of 580 inflammatory proteins measured at visit 5 with deaths from causes other than the index cancer by modeling sub-distribution hazards (sHR) of deaths per log2 increase in each inflammatory protein in Black and White survivors. Models were adjusted for age, sex, race, years since cancer diagnosis, cancer/cardiovascular disease (CVD) shared risk factors such as smoking, history of CVD, diabetes, kidney function, and anti-inflammatory drug use, and included race-protein interaction terms. In a sensitivity analysis, we additionally adjusted for lifecourse SES and access to care. We accounted for multiple testing using Bonferroni correction and false discovery rate Q-values. Results Survivors were 21% Black, 56% male, had a mean age of 76.8 yrs, and median time since diagnosis of 11.4 yrs. 95 non-cancer (50% CVD) and 34 non- index cancer deaths occurred during 2740 person-years of follow-up. Thirty inflammatory proteins, 17 of these in the sensitivity analysis had significantly different (Q<0.05) qualitative or quantitative effects in Black and White survivors. Inflammatory proteins with the most significant racial differences in the sHR of mortality were CD69 (early activation antigen), which was associated with lower mortality in Whites (sHR per Δlog2 (95% CI): 0.47 (0.27,0.82)) and higher mortality in Blacks (2.96 (1.78,4.93), Pint = 1.24 × 10-6], and CCL18 (CC motif chemokine 18), which was associated with higher mortality in Whites (1.83 (1.02,3.28)) and lower mortality in Blacks (0.33 (0.12 0.94), Pint = 4.14 × 10-3). The differential effect of CD69 by race remained significant after Bonferroni correction in the main and sensitivity analysis. Conclusion Associations of some circulating inflammatory proteins with mortality differ in Black and White cancer survivors independent of lifestyle, medical, and social factor confounders. CD69 is upregulated by NF-κB signaling and regulates a variety of crucial immune pathways that depend on host metabolic factors. CCL18 is mainly produced by the innate immune system and genetic variations in encoding genes have been reported. Further studies are needed to evaluate whether racial differences in host metabolic factors or genetic differences modulate effects of these proteins on mortality in Black and White survivors. If confirmed these proteins may warrant focus for characterization as potential therapeutic targets.

Citation Format: Chinenye C. Ugoji, Lorraine T. Dean, Alden Gross, Elizabeth A. Platz. Racial differences in the association of circulating inflammatory proteins with mortality from causes other than the index cancer in older adult cancer survivors in the Atherosclerosis Risk in Communities (ARIC) study [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-099.

Abstract D099: Excess burden of major cancer risk factors in racial/ethnic minority adult cancer survivors in the United States (2005–2016)

Background: While major cancer risk factors (CRFs) are well documented in the US general population, their burden in 16.9 million US cancer survivors has not been described. Continued CRF exposure may contribute to recurrence, second cancers, and other chronic disease risks. Using US representative surveys, we previously reported high CRF prevalences in cancer survivors. To better target health-promoting interventions, sub-populations of survivors with higher CRF burdens need to be identified, especially racial/ethnic minorities who have higher cancer-specific and other chronic disease mortality rates. Thus, we quantified CRF prevalences and trends in cancer survivors by major US racial/ethnic minorities and compared with non-Hispanic Whites (NHW) over 12 years. Methods: We analyzed data for 455 non-Hispanic Black [NHB], 389 Hispanic, and 1739 NHW cancer survivors (self-reported MD diagnosis of cancer except non-melanoma skin) >20 years old who participated in the 2005-16 National Health and Nutrition Examination Surveys. We estimated unadjusted race/ethnicity-specific prevalences of major CRFs – current smoking, alcohol (>2 drinks/day), overweight/obesity (BMI>25 kg/m2), physical inactivity (<10 mins moderate activity/day), self-reported poor/fair diet, and diabetes history – and prevalence trends. We estimated age- and sex-adjusted CRF prevalence ratios and comparing NHB and Hispanic to NHW survivors using Poisson regression. Results: Median time since diagnosis (8 years) did not differ by race/ethnicity. Hispanic survivors were younger and more likely female compared to NHW and NHB survivors. Adjusting for age and sex, compared to NHW survivors, smoking prevalence was 35% higher in NHB survivors but did not differ in Hispanic survivors, and alcohol prevalence was 44% higher in Hispanic survivors, but did not differ in NHB survivors. In both NHB and Hispanic survivors, prevalences of overweight/obesity (NHB 12%, Hispanic 20%), physical inactivity (27%, 20%), poor/fair diet, (48%, 42%), and diabetes history (121%, 98%) were statistically significantly higher than in NHW survivors. CRF prevalences were significantly higher in NHB and Hispanic compared to NHW survivors over 12 years. Conclusions: CRF prevalences are disproportionately higher in Hispanics and NHB compared to NHW cancer survivors, accounting for age and sex, and these patterns have persisted over time. These US nationally representative data may be used to direct interventions for specific CRFs to specific racial/ethnic minority subpopulations of cancer survivors to increase wellbeing.

Citation Format: Chinenye C Ugoji, Lorraine T Dean, Elizabeth A Platz. Excess burden of major cancer risk factors in racial/ethnic minority adult cancer survivors in the United States (2005–2016) [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D099.