Evaluation of cystatin C in malignancy and comparability of estimates of GFR in oncology patients.
Evaluation of cystatin C in malignancy and comparability of estimates of GFR in oncology patients.
复制标题
在肿瘤患者中，在恶性肿瘤和GFR估计值的可比性中评估胱抑素C的评估。
DOI：
10.1016/j.plabm.2017.05.005
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发表时间：
2017-08
影响因子：
1.9
通讯作者：
Fitzgibbon MC
中科院分区：
文献类型：
--
作者：
Jones M;Denieffe S;Griffin C;Tinago W;Fitzgibbon MC
肌酐是用于评估肿瘤患者肾功能的首选生物标志物。然而，由于非肾脏因素（如肌肉质量）可能影响肌酐浓度，我们评估了胱抑素C作为替代生物标志物及其在肿瘤学环境中GFR估计公式中的纳入。在成人临床实践中很少测量GFR，因此依赖于计算的GFR进行患者评估。在开始化疗周期之前，对134例肿瘤患者的胱抑素C和肌酐浓度进行了评价。评价肌酐清除率（Cockroft-Gault）和GFR（使用Hoek、Jonsson、MDRD和CKD-EPI）的估计值。在60-89、45-59和≤44 mL/min/1.73 m2的GFR范围内，将基于胱抑素C的GFR估计值（使用CKD-EPI CysC和CKD-EPI SCr/CysC）与基于肌酐的GFR估计值（CG、MDRD和CKD-EPI SCr）进行比较。与参考人群相比，肿瘤患者在开始化疗前（F：P<0.01和M：P<0.0001）和治疗周期内（F：P<0.0001和M：P<0.01）的胱抑素C浓度显著较高。在接受评估的一部分女性患者中，胱抑素C浓度在化疗期间也显著升高（P<0.0001）。在研究的GFR范围内，CKD-EPI CysC和基于肌酐的GFR估计值之间的一致性较差（平均42%），当使用组合CKD-EPI SCr/CysC公式时，一致性提高（平均55%）。本研究证明了恶性肿瘤和治疗介导的对胱抑素C测量的影响，这可能混淆其在肿瘤患者中估计GFR的临床效用。
Creatinine is the biomarker of choice for use in estimates of kidney function in oncology patients. However as non-renal factors such as muscle mass can influence creatinine concentrations, we evaluated cystatin C as an alternative biomarker and its incorporation in GFR estimating formulae in an oncology setting. Measured GFR is infrequently undertaken in adult clinical practice with the consequent reliance on calculated GFR for patient assessment. Cystatin C and creatinine concentrations were evaluated from 134 oncology patients prior to commencing chemotherapeutic cycles. Estimates of creatinine clearance (Cockroft-Gault) and GFR (using Hoek, Jonsson, MDRD and CKD-EPI) were evaluated. Cystatin C-based GFR estimates (using CKD-EPI CysC and CKD-EPI SCr/CysC) were compared with the creatinine-based GFR estimates (CG, MDRD and CKD-EPI SCr) within the GFR ranges of 60–89, 45–59 and ≤44 mL/min/1.73 m2. Cystatin C concentrations were significantly higher in oncology patients both prior to commencing chemotherapy (F: P<0.01 and M: P<0.0001) and during cycles of treatment (F: P<0.0001 and M: P<0.01) when compared with a reference population. Cystatin C concentrations also increased significantly during chemotherapy (P<0.0001) in a subset of female patients evaluated. Poor agreement (average 42%) was demonstrated between CKD-EPI CysC and creatinine-based GFR estimates within the investigated GFR ranges, with improved agreement (average 55%) when using the combined CKD-EPI SCr/CysC formula. This study demonstrated a malignancy and treatment-mediated effect on cystatin C measures, which may confound its clinical utility in estimating GFR in oncology patients.