Abstract
To explore the incidence, clinical characteristics, diagnosis and treatment strategies, prognosis of patients with malignancy-associated hypercalcemia (MAH). The data of 115 patients with MAH who were treated at the Medical Oncology Department of Chinese PLA General Hospital from Jan., 2001 to Dec., 2010 was retrospectively reviewed. Survival analysis was performed using the Kaplan-Meier method and the Cox proportional hazard model with statistic software SPSS 18.0. The patients had blood calcium levels ranging from 2.77 to 4.87 mmol/L. Except for 9 cases who died or were discharged within 5 days after admission, all other patients recovered to normal blood calcium level after treatment with bisphosphonates or intravenous hydration and diuretics; their survival after occurrence of MAH was from 1 day to 4,051 days, and the median survival time was only 50 days. In the log-rank test, the male, renal metastasis, central nervous system symptoms and hypercalcemia occurring over 140 days after cancer diagnosis were predictors of poor survival (P=0.002, P=0.046, P=0.000, P=0.009). In the COX analysis, being male, central nervous system symptoms and hypercalcemia lasting over 140 days after cancer diagnosis were independent prognostic factors for survival time (RR=2.131, P=0.027; RR=3.054, P=0.002; RR=2.403, P=0.001). According to these factors, a score system was established to predict the patient prognosis and adjust the treatment. Cancer patients with MAH have an extremely poor median survival. Some independent factors indicate poor prognosis, including male gender, central nervous system symptoms and hypercalcemia lasting over 140 days after cancer diagnosis. The prognostic score can serve as a reference for MAH prognosis and treatment, worthy of further investigation.
Highlights
Malignancy-associated hypercalcemia (MAH), one of the most serious and common complications of malignancy at the advanced stage and with a prevalence around 3%~30% in all cancer patients, is not univocally correlated with the occurrence of bone metastasis (Grill et al, 2000; Stewart et al, 2005)
Except for 9 cases who died or were discharged within 5 days after admission, all other patients recovered to normal blood calcium level after treatment with bisphosphonates or intravenous hydration and diuretics; their survival after occurrence of malignancy-associated hypercalcemia (MAH) was from 1 day to 4,051 days, and the median survival time was only 50 days
In the log-rank test, the male, renal metastasis, central nervous system symptoms and hypercalcemia occurring over 140 days after cancer diagnosis were predictors of poor survival (P=0.002, P=0.046, P=0.000, P=0.009)
Summary
Malignancy-associated hypercalcemia (MAH), one of the most serious and common complications of malignancy at the advanced stage and with a prevalence around 3%~30% in all cancer patients, is not univocally correlated with the occurrence of bone metastasis (Grill et al, 2000; Stewart et al, 2005). And prolonged application of bisphosphonates in cancer patients with bone metastasis has, to some extent, decreased the frequency of MAH. Patients occurring MAH have a poor prognosis, with a median overall survival ranging from 60 to 90 days (Penel et al, 2008). Due to the severe effects of MAH on patients’ quality of life and survival, the data of 115 patients with hypercalcemia in 8 096 screened cancer patients was retrospectively reviewed, and the incidence, clinical characteristics, diagnosis and treatment and survival prognosis of MAH patients were analyzed in this study
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