High activin A, myostatin levels predict death in elderly cancer patients

Elevated serum activin A and myostatin levels correlate with death risk in elderly patients with cancer, a recent study has shown.

Researchers collected serum samples from 138 elderly cancer patients (median age, 75 years; 72.5 percent male) prior to first-line chemotherapy. Enzyme-linked immunosorbent and Luminex multiplex assays were used to measure levels of C-reactive protein (CRP), activin A, myostatin and interleukin (IL)-6, among other biomarkers. All patients had metastatic solid tumours.

Seventy-three deaths were reported over a median follow-up duration of 13.8 months; the corresponding mortality rate was 52.9 percent. Univariate analysis identified CRP, activin A and myostatin as significant predictors of overall survival.

Categorizing participants into quartiles of biomarker concentrations, the researchers found that those in the highest vs lowest quartiles of activin A had shorter median overall survival (1.1 vs 4.9 month). This translated to a significantly elevated risk of death in the third (hazard ratio [HR], 2.63, 95 percent CI, 1.17–5.87; p=0.019) and fourth (HR, 2.86, 1.28–6.41; p=0.011) quartiles.

Elevated levels of myostatin had the same effect, such that those with concentrations above the median had shorter overall survival and had greater mortality risk (5.5 vs 14.7 months; HR, 2.12, 1.01–4.42; p=0.047).

Researchers then constructed a decision tree-based model to determine serum biomarkers that may predict early mortality before patients could make any treatment decisions. The early mortality rate was 22.5 percent (n=31). IL-6 emerged as the most important predictive factor, while CRP was found to be a useful second rule.

The obtained final model for early mortality prediction had an accuracy of 66.7 percent.