Association Between Plasma Brain Natriuretic Peptide and Overall Survival in Patients With Advanced Cancer: Preliminary Findings

Abstract

Context: Atrial and brain natriuretic peptides (ANP and BNP) are established diagnostic and prognostic markers in heart failure, but their utility in patients with advanced cancer is unclear.

Objectives: Our objective was to examine the association between plasma natriuretic peptides and survival in patients with advanced cancer without clinical evidence of heart failure.

Methods: This exploratory analysis of a multicenter, randomized clinical trial of cancer patients receiving hospice care assessed the association between elevated plasma ANP, BNP, or Pro-BNP (cutoffs of >77, 100, and 900 pg/mL, respectively) and overall survival. Time-to-event analyses, including multivariate Cox regression, were conducted.

Results: Among 97 patients, the mean age was 67.2 years and the overall survival was 16 days (95% CI, 13-23 days). ANP, BNP, and Pro-BNP were elevated in 29 of 36 (81%), nine of 23 (39%), and 32 of 38 (84%) patients, respectively. Elevated ANP, BNP, or Pro-BNP was associated with worse survival (median 14 vs. 21 days; P = 0.02). BNP or Pro-BNP was inversely associated with overall survival (hazard ratio = 2.27; 95% CI, 1.29-3.97) in univariate Cox regression analysis, and remained significant in multivariate Cox regression analysis (hazard ratio = 3.09; 95% CI, 1.40-6.84) after adjusting for treatment group and known prognostic variables such as performance status, albumin, creatinine, delirium, dyspnea, and anorexia. Elevated ANP alone was not significantly associated with survival (P = 0.17).

Conclusion: Our preliminary findings suggest that BNP or Pro-BNP may be a novel objective prognostic marker in cancer patients without heart failure. Further research is needed to confirm these findings.

Keywords: Atrial natriuretic factor; brain; natriuretic peptide; neoplasms; palliative care; prognosis.

Figure 1.

Association of elevated atrial (ANP) and brain (BNP) natriuretic peptides (panel A; ANP, BNP or Pro-BNP; median [95% CI] survival of 14 [8-17] vs. 21 [13-37] d), BNP or Pro-BNP (panel B; median [95% 20 CI] survival of 13 [7-16] vs. 21 [12-34] d), and ANP (panel C; median [95% CI] of 17 [7-27] vs. 38 [8-109] d) with overall survival. Elevations in natriuretic peptide concentrations were defined according to published criteria for acutely decompensated heart failure as > 100 and 900 pg/mL for BNP and Pro-BNP, respectively.(15) As no clear diagnostic cutoff has been established for ANP, elevated ANP was defined per the laboratory upper limit of > 77 pg/mL.(16)