Pretreatment Plasma IL-6 and YKL-40 and Overall Survival after Surgery for Metastatic Bone Disease of the Extremities.

Michala Skovlund Sørensen,Klaus Hindsø,Thomas Colding-Rasmussen,Michael Mørk Petersen,Christian Dehlendorff,Julia Sidenius Johansen,Peter Frederik Horstmann

doi:10.3390/cancers13112833

Michala Skovlund Sørensen, Klaus Hindsø + Show 5 more

Open Access

https://doi.org/10.3390/cancers13112833

Copy DOI

Abstract

Simple SummaryEstimating postoperative survival in patients undergoing surgery for metastatic bone disease of the extremities is important in order to choose an implant that will outlive the patient. The present study suggests that plasma IL-6, reflecting the inflammatory state of the patient, is predictive for postoperative overall survival (OS).Background: Plasma IL-6 and YKL-40 are prognostic biomarkers for OS in patients with different types of solid tumors, but they have not been studied in patients before surgery of metastatic bone disease (MBD) of the extremities. The aim was to evaluate the prognostic value of plasma IL-6 and YKL-40 in patients undergoing surgery for MBD of the extremities. Patients and Methods: A prospective study included all patients undergoing surgery for MBD in the extremities at a tertiary referral center during the period 2014–2018. Preoperative blood samples from index surgery were included. IL-6 and YKL-40 concentrations in plasma were determined by commercial ELISA. A total of 232 patients (median age 66 years, IQR 58–74; female 51%) were included. Results: Cox regression analysis was performed to identify independent prognostic factors for OS. IL-6 correlated with YKL-40 (rho = 0.46, p < 0.01). In univariate analysis (log2 continuous variable) IL-6 (HR = 1.26, 95% CI 1.16–1.37), CRP (HR = 1.20, 95% CI 1.12–1.29) and YKL-40 (HR = 1.25, 95% CI 1.15–1.37) were associated with short OS. In multivariable analysis, adjusted for known risk factors for survival, only log2(IL-6) was independently associated with OS (HR = 1.24, 95% CI 1.08–1.43), whereas CRP and YKL-40 were not. Conclusion: High preoperative plasma IL-6 is an independent biomarker of short OS in patients undergoing surgery for MBD.

Highlights

Surgical treatment strategy for metastatic bone disease (MBD), especially in the appendicular skeleton, depends to some degree upon the residual estimated life expectancy, enabling the orthopedic surgeon to provide patient-specific surgical solutions [1]
During the study period 321 surgeries for MBD of the extremities were performed at our institution
The present prospective study of 232 patients with MBD in the extremities from various primary cancer types showed that elevated plasma IL-6, but not C-reactive protein (CRP) and YKL-40, was an independent prognostic parameter for short overall survival (OS)

Summary

Introduction

Surgical treatment strategy for metastatic bone disease (MBD), especially in the appendicular skeleton, depends to some degree upon the residual estimated life expectancy, enabling the orthopedic surgeon to provide patient-specific surgical solutions [1]. There is a need for objective prognostic variables for prediction of survival in patients undergoing surgery for MBD. Several studies [10,11,12,13] have demonstrated that high circulating IL-6 and YKL-40 levels in patients with different types of solid cancer are associated with short overall survival (OS) [14,15]. Plasma IL-6 and YKL-40 are prognostic biomarkers for OS in patients with different types of solid tumors, but they have not been studied in patients before surgery of metastatic bone disease (MBD) of the extremities. The aim was to evaluate the prognostic value of plasma IL-6 and YKL-40 in patients undergoing surgery for MBD of the extremities. Conclusion: High preoperative plasma IL-6 is an independent biomarker of short

Methods

Results

Conclusion