Strong association between hyperferritinaemia and metastatic disease in nasopharyngeal carcinoma

Ho, Stanley; Leung, Sing-fai; Leung, WK; Tsao, Sai‐Wah; Kwan, W. H.; Choi, Peter; Johnson, Philip J.

doi:10.1016/0964-1955(95)00084-4

Cited by 8 publications

(6 citation statements)

References 16 publications

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“…In addition, the median levels of serum ferritin and β 2 M did not change appreciably after RT despite the 100% complete response to RT, suggesting that these markers do not reflect tumor burden. We also recognized that other cut‐off values for CYFRA (i.e., ≥ 2 U/mL vs. < 2 U/mL or 2.5 ng/mL), β 2 M (i.e., ≥ 2 mg/mL or < 2 mg/mL), and ferritin (i.e., ≥ 535 ng/mL or < 535 ng/mL) were used in the statistical calculations of previous studies on patients with NPC8–10, 17, 19, 20 or with types of malignancies 16, 32. We repeated the analysis using these alternative cut‐off values and found that the statistical conclusions did not alter.…”

Section: Discussionmentioning

confidence: 99%

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Prospective validation of serum CYFRA 21‐1, β‐2‐microglobulin, and ferritin levels as prognostic markers in patients with nonmetastatic nasopharyngeal carcinoma undergoing radiotherapy

B.Y.

Leungm

Hui

et al. 2004

Cancer

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BACKGROUND Patients with undifferentiated nasopharyngeal carcinoma (NPC) have elevated serum levels of CYFRA 21‐1 (CYFRA), ferritin, and β‐2‐microglobulin (β2M) compared with healthy control individuals. The prognostic value of these markers has never been validated prospectively. METHODS Paired serum samples from 160 patients with newly diagnosed, nonmetastatic, undifferentiated NPC were collected before radiotherapy (RT) and at 4–6 weeks after the completion of RT. Pre‐RT and post‐RT levels of serum CYFRA, ferritin, and β2M were analyzed and correlated with overall survival (OS), progression‐free survival (PFS), time to locoregional recurrence, (TLR) and time to distant recurrence (TDR). The results of pre‐RT and post‐RT plasma Epstein–Barr virus (EBV) DNA levels available from a previous study were included in a Cox regression model together with age, tumor (T) classification, and lymph node (N) classification. RESULTS Sixty percent of patients had International Union Against Cancer Stage III–IV disease. At a median follow‐up of 116 weeks (range, 37–239 weeks), 38 patients had disease progression. On multivariate analysis, pre‐RT CYFRA and post‐RT EBV DNA levels were independent predictors of poor OS, post‐RT EBV DNA level and N classification predicted poor PFS and TDR; and only T classification predicted TLR. Patients who had pre‐RT CYFRA levels ≥ 1.5 U/mL were more likely to die (hazard ratio, 1.18; 95% confidence interval, 1.10–1.26) compared with patients who had pre‐RT CYFRA levels < 1.5 U/mL. There were no associations between age, post‐RT CYFRA levels and pre‐RT or post‐RT serum ferritin and β2M levels, and the survival and recurrence rates on multivariate analysis. CONCLUSIONS Serum CYFRA levels taken before RT predicted reduced survival in patients with nonmetastatic, undifferentiated NPC who underwent RT. Cancer 2004. © 2004 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

“…Serum markers, such as CYFRA 21‐1 (CYFRA), β‐2‐microglobulin (β 2 M), and ferritin, have shown promise as prognostic indicators for NPC in retrospective studies 8–10. CYFRA is a cytoplasmic protein fragment of cytokeratin 19 that is found in a variety of epithelial malignancies 11–16.…”

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confidence: 99%

Prospective validation of serum CYFRA 21‐1, β‐2‐microglobulin, and ferritin levels as prognostic markers in patients with nonmetastatic nasopharyngeal carcinoma undergoing radiotherapy

B.Y.

Leungm

Hui

et al. 2004

Cancer

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“…Serum ferritin is an extremely sensitive indicator of iron storage status, with hyperferritinemia occurring in the setting of numerous disorders associated with iron overload (hemochromatosis, 60 sickle cell disease, 61 and thalassemia 62 ). Additionally, hyperferritinemia serves as a nonspecific marker for a variety of neoplasms, [63][64][65] infectious diseases, 66-68 alcohol ingestion, 69 and a sedentary lifestyle. 70 While we examined self-reported data regarding a number of chronic diseases as well as recent alcohol ingestion experience, we were unable to explain dif- * Post-traumatic stress disorder was screened for by questionnaire using criteria reported in the Diagnostic and Statistical Manual of Mental Disorder, fourth edition.…”

Section: Resultsmentioning

confidence: 99%

Increased postwar symptoms and psychological morbidity among U.S. Navy Gulf War veterans.

Gray¹,

Kaiser²,

Hawksworth³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

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Abstract. To investigate reports on war-related morbidity, 527 active-duty Gulf War veterans and 970 nondeployed veterans from 14 Seabee commands were studied in 1994 with a questionnaire, sera collection, handgrip strength, and pulmonary function testing. The questionnaire assessed postwar symptoms, war exposures, and screened for chronic fatigue syndrome, post-traumatic stress disorder, and psychological symptoms suggesting neurosis (Hopkins Symptom Checklist). Sera were tested with four nonspecific reactant assays: C-reactive protein, transferrin, ferritin, and haptoglobin. Gulf War veterans reported a higher prevalence for 35 of 41 symptoms, scored higher on psychological symptom scales, were more likely to screen for post-traumatic stress disorder, had lower handgrip strength, and had higher serum ferritin assay results. Numerous comparisons of these morbidity outcomes with 30 self-reported exposures demonstrated many associations, but no unique exposure or group of exposures were implicated. Morbidity data are consistent with other postwar observations, but the etiology for morbidity findings remains uncertain.

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“…Elevated SF levels have been recognized as a predictor of treatment response and are associated with poor prognosis in various malignancies, such as pancreatic cancer, non-small cell lung cancer, hepatocellular carcinoma and breast cancer [ 21 – 24 ]. However, there is rare study on the association between the levels of SF and DM in NPC patients [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Higher N stage and serum ferritin, but lower serum albumin levels are associated with distant metastasis and poor survival in patients with nasopharyngeal carcinoma following intensity-modulated radiotherapy

et al. 2017

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PurposeTo evaluate the potential risk factors for distant metastasis of nasopharyngeal carcinoma in Chinese patients following standard intensity-modulated radiotherapy and chemotherapy.MethodsThe potential risk factors for distant metastasis in 622 patients with newly-diagnosed primary nasopharyngeal carcinoma following standard radiotherapy and chemotherapy were evaluated retrospectively by stratification, univariate and multivariate analyses. The 5-year overall survival, distant metastasis-free survival, local recurrence-free survival and progression-free survival rates were determined.ResultsUnivariate and multivariate analyses indicated that N2-3 stage, serum ferritin > 300 μg/L and serum albumin < 42 g/L were independent risk factors for distant metastasis of nasopharyngeal carcinoma (P < 0.001, P = 0.013, P = 0.002, respectively). A risk prediction model was developed as follows: 1) low-risk group: 0-1 risk factor; and 2) high-risk group: 2-3 risk factors. Compared with low-risk group, the high-risk group had significantly lower 5-year distant metastasis-free survival (76.4% vs. 89.6%, P < 0.001), overall survival (76% vs. 85.9%,P < 0.001), local recurrence-free survival (88% vs. 92.4%, P = 0.029) and progression-free survival rates (68.2% vs. 83.7%, P < 0.001). In the high-risk group, patients with three risk factors had the lowest distant metastasis-free survival rate (P = 0.036).ConclusionsCombination of higher N stage, serum ferritin and lower serum albumin levels may be valuable for predicting distant metastasis of nasopharyngeal carcinoma patients following standard intensity-modulated radiotherapy and chemotherapy.

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Strong association between hyperferritinaemia and metastatic disease in nasopharyngeal carcinoma

Cited by 8 publications

References 16 publications

Prospective validation of serum CYFRA 21‐1, β‐2‐microglobulin, and ferritin levels as prognostic markers in patients with nonmetastatic nasopharyngeal carcinoma undergoing radiotherapy

Prospective validation of serum CYFRA 21‐1, β‐2‐microglobulin, and ferritin levels as prognostic markers in patients with nonmetastatic nasopharyngeal carcinoma undergoing radiotherapy

Increased postwar symptoms and psychological morbidity among U.S. Navy Gulf War veterans.

Higher N stage and serum ferritin, but lower serum albumin levels are associated with distant metastasis and poor survival in patients with nasopharyngeal carcinoma following intensity-modulated radiotherapy

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