- Volume 14 Issue 11
DOI QR Code
Analysis on Survival and Prognostic Factors for Cancer Patients with Malignancy-associated Hypercalcemia
- Zhang, Su-Jie (Department of Oncology, Chinese PLA General Hospital) ;
- Hu, Yi (Department of Oncology, Chinese PLA General Hospital) ;
- Cao, Jing (Pharmacy Department, The Second Artillery General Hospital of Chinese People's Liberation Army) ;
- Qian, Hai-Li (National Key Lab of Molecular Oncology, Cancer Institute &Hospital, CAMS) ;
- Jiao, Shun-Chang (Department of Oncology, Chinese PLA General Hospital) ;
- Liu, Zhe-Feng (Department of Oncology, Chinese PLA General Hospital) ;
- Tao, Hai-Tao (Department of Oncology, Chinese PLA General Hospital) ;
- Han, Lu (Department of Oncology, Chinese PLA General Hospital)
- Published : 2013.11.30
Objective: To explore the incidence, clinical characteristics, diagnosis and treatment strategies, prognosis of patients with malignancy-associated hypercalcemia (MAH). Methods: 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. Results: 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. Conclusion: 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.
Hypercalcemia;cancer;prognostic factor;gender;CNS symptoms
- Body JJ, Facon T, Coleman RE, et al (2006). A study of the biological receptor activator of nuclear factor-kappaB ligand inhibitor, denosumab, in patients with multiple myeloma or bone metastases from breast cancer. Clin Cancer Res, 12, 1221-8. https://doi.org/10.1158/1078-0432.CCR-05-1933
- Body JJ,.Lipton A,.Gralow J, et al (2010). Effects of denosumab in patients with bone metastases, with and without previous bisphosphonate exposure. J Bone Miner Res, 25, 440-6. https://doi.org/10.1359/jbmr.090810
- Buchner-Daley L, Brady-West D, McGrowder D (2012). Clinical and biochemical profile of monoclonal gammopathies in caribbean patients in a resource-limited setting. Asian Pac J Cancer Prev, 13, 6501-4. https://doi.org/10.7314/APJCP.2012.13.12.6501
- Clines GA (2011). Mechanisms and treatment of hypercalcemia of malignancy. Curr Opin Endocrinol Diabetes Obes, 18, 339-46. https://doi.org/10.1097/MED.0b013e32834b4401
- Croucher PI, Shipman CM, Lippitt J, et al (2001). Osteoprotegerin inhibits the development of osteolytic bone disease in multiple myeloma. Blood, 98, 3534-40. https://doi.org/10.1182/blood.V98.13.3534
- Ding H, Yang L, Du W, et al (2013). Bisphosphonates for osteoporosis in nonmetastatic prostate cancer patients receiving androgen-deprivation therapy: a systematic review and meta-analysis. Asian Pac J Cancer Prev, 14, 3337-43. https://doi.org/10.7314/APJCP.2013.14.5.3337
- Foussas SG,.Zairis MN,.Makrygiannis SS, et al (2007). The significance of circulating levels of both cardiac troponin I and high-sensitivity C reactive protein for the prediction of intravenous thrombolysis outcome in patients with ST-segment elevation myocardial infarction. Heart, 93, 952-6. https://doi.org/10.1136/hrt.2005.084954
- Grill V, Martin TJ (2000). Hypercalcemia of malignancy. Endocr Metab Disord, 1, 253-63. https://doi.org/10.1023/A:1026597816193
- Hassan BA, Yusoff ZB, Hassali MA, et al (2012). Impact of chemotherapy on hypercalcemia in breast and lung cancer patients. Asian Pac J Cancer Prev, 13, 4373-8. https://doi.org/10.7314/APJCP.2012.13.9.4373
- Lazaretti-Castro M, Kayath M, Jamnik S, et al (1993). Prevalence of hypercalcemia in patients with lung cancer. Rev Assoc Med Bras, 39, 83-7.
- Le Tinier F, Vanhuyse M, Penel N, et al (2011). Cancer-associated hypercalcaemia in squamous-cell malignancies: a survival and prognostic factor analysis. Int J Oral Maxillofac Surg, 40, 938-42. https://doi.org/10.1016/j.ijom.2010.11.028
- Li B, Ling Chau, JF, Wang X, et al (2011). Bisphosphonates, specific inhibitors of osteoclast function and a class of drugs for osteoporosis therapy. J Cell Biochem, 112, 1229-42. https://doi.org/10.1002/jcb.23049
- Lorch G, Viatchenko-Karpinski S, Ho HT, et al (2011). The calcium-sensing receptor is necessary for the rapid development of hypercalcemia in human lung squamous cell carcinoma. Neoplasia, 13, 428-38. https://doi.org/10.1593/neo.101620
- Lumachi F, Brunello A, Roma A, et al (2009). Cancer-induced hypercalcemia. Anticancer Res, 29, 1551-5.
- Morony S, Warmington K, Adamu S, et al (2005). The inhibition of RANKL causes a greater suppression of bone resorption and hypercalcemia compared with bisphosphonates in two models of humoral hypercalcemia in malignancy. Endocrinology, 146, 3235-43. https://doi.org/10.1210/en.2004-1583
- Neville-Webbe HL, Coleman RE, et al (2010). Bisphosphonates and RANK ligand inhibitors for the treatment and prevention of metastatic bone disease. Eur J Cancer, 46, 1211-22. https://doi.org/10.1016/j.ejca.2010.02.041
- Neville-Webbe, HL, Coleman, RE (2010). Bisphosphonates and RANK ligand inhibitors for the treatment and prevention of metastatic bone disease. Eur J Cancer, 46, 1211-22. https://doi.org/10.1016/j.ejca.2010.02.041
- Penel N, Dewas S, Doutrelant P, et al (2008). Cancer-associated hypercalcemia treated by intravenous diphosphonates: a survival and prognostic factor analysis. Support Care Cancer, 16, 387-92. https://doi.org/10.1007/s00520-007-0322-z
- Penel N, Dewas S, Doutrelant P, et al (2008). Cancer-associated hypercalcemia treated with intravenous diphosphonates: a survival and prognostic factor analysis. Support Care Cancer, 16, 387-92. https://doi.org/10.1007/s00520-007-0322-z
- Sato K, Onuma E, Yocum RC, et al (2003). Treatment of malignancy-associated hypercalcemia and cachexia with humanized anti-parathyroid hormone-related protein antibody. Semin Oncol, 30, 167-73. https://doi.org/10.1053/j.seminoncol.2003.08.019
- Schwartz AG, Prysak GM, Murphy V, et al (2005). Nuclear estrogen receptor beta in lung cancer: expression and survival differences by sex. Clin Cancer Res, 11, 7280-7. https://doi.org/10.1158/1078-0432.CCR-05-0498
- Shi Y, Dai GH, Jiao SC (2008). Clinical characteristics and prognostic factors of 22 malignant hypercalcemia cases. Chin Clin Oncol, 13, 12.
- Sookprasert A, Pugkhem A, Khuntikeo N, et al (2012). Evaluation of efficacy, safety and tolerability of high dose-intermittent calcitriol supplementation to advanced intrahepatic cholangiocarcinoma patients - a pilot study. Asian Pac J Cancer Prev, 13, 161-7.
- Stewart, AF (2005). Clinical Practice. Hypercalcemia associated with cancer. N Engl J Med, 352, 373-9. https://doi.org/10.1056/NEJMcp042806
- Stopeck A, de Boer R, Fujiwara Y, et al (2009). A Comparison of Denosumab Versus Zoledronic Acid for the Prevention of Skeletal-Related Events in Breast Cancer Patients with Bone Metastases. 32nd San Antonio Breast Cancer Symposium, abs. 22.
- Tanaka S, Nakamura K, Takahasi N, et al (2005). Role of RANKL in physiological and pathological bone resorption and therapeutics targeting the RANKL-RANK signaling system. Immunol Rev,.208, 30-49. https://doi.org/10.1111/j.0105-2896.2005.00327.x
- Teo M, Dhadda A, Gunn J (2008). Paraneoplastic hypercalcaemia in squamous cell carcinoma of the anus: first reported case. Clin Oncol (RCollRadiol), 20, 718.
- Truong NU, deB Edwardes MD, Papavasiliou V, et al (2003). Parathyroid hormone-related peptide and survival with cancer and hypercalcemia. Am J Med, 115, 115-21. https://doi.org/10.1016/S0002-9343(03)00310-3
- Vallet S, Smith MR, Raje N (2010). Novel bone-targeted strategies in oncology. Clin Cancer Res, 16, 4084-93. https://doi.org/10.1158/1078-0432.CCR-10-0600
- Xie CY, Hu YD, Wang LL, et al (2006). Clinical analysis of 13 patients diagnosed lung cancer with hypercalcemia. J Third Milit Med Univ, 28, 2.
- Hypercalcemia of Malignancy in Thymic Carcinoma: Evolving Mechanisms of Hypercalcemia and Targeted Therapies vol.2017, pp.2090-651X, 2017, https://doi.org/10.1155/2017/2608392