Pre-diagnostic biomarkers of metabolic dysregulation and cancer mortality
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Tomi Akinyemiju1,2,3, Justin Xavier Moore1,2, Suzanne E. Judd4, Maria Pisu2,5, Michael Goodman6, Virginia J. Howard1, Leann Long4, Monika Safford7, Susan C. Gilchrist8 and Mary Cushman9
1Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
2Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
3Department of Epidemiology, University of Kentucky, Lexington, KY, USA
4Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
5Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
6Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
7Department of Medicine, Weill Cornell Medical College, New York, NY, USA
8Department of Clinical Cancer Prevention and Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
9Department of Medicine and Vermont Cancer Center, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
Tomi Akinyemiju, email: email@example.com
Keywords: metabolic biomarkers; cancer mortality; racial disparities; metabolism
Received: January 18, 2018 Accepted: February 12, 2018 Epub: February 23, 2018 Published: March 23, 2018
INTRODUCTION: The obesogenic milieu is a pro-tumorigenic environment that promotes tumor initiation, angiogenesis and metastasis. In this prospective cohort, we examined the association between pre-diagnostic metabolic biomarkers, plasma adiponectin, resistin, leptin and lipoprotein (a), and the risk of cancer mortality.
METHODS: Prospective data was obtained from the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort of Blacks and Whites followed from 2003 through 2012 for cancer mortality. We determined the association between metabolism biomarkers (log-transformed and tertiles) and risk of cancer mortality using Cox Proportional Hazards models with robust sandwich estimators to calculate the 95% confidence intervals (CIs), and adjusted for baseline covariates, including age, gender, income, education, physical activity, BMI, smoking status, alcohol use, and comorbidity score.
RESULTS: Among 1764 participants with available biomarker data, each SD higher log-leptin was associated with a 54% reduced risk of total cancer mortality (HR: 0.46, 95% CI: 0.23 – 0.92) and obesity-related cancer mortality (HR: 0.55, 95% CI: 0.39-0.79). Among Blacks only, each SD higher log-resistin was associated with a nearly 7-fold increased risk of cancer mortality (adjusted HR: 6.68, 95% CI: 2.10 – 21.21). There were no significant associations of adiponectin or Lp(a) and cancer mortality.
CONCLUSIONS: Leptin is involved in long-term regulation of energy balance, while resistin is involved in chronic inflammation and LDL production. These findings highlight the biological mechanisms linking metabolic dysregulation with cancer mortality, and the influence of resistin on cancer mortality only among Blacks suggests that this hormone may be a useful biomarker of racial differences in cancer mortality that deserves further study.
IMPACT: Our observed increased risk of cancer mortality associated with higher serum resistin levels among Blacks suggests that if validated in larger cohorts, clinical strategies focused on resistin control may be a promising cancer prevention strategy.
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