Serum creatinine and cystatin C-based index is a prognostic factor in patients with nonmetastatic breast cancer after surgery

IF 2.6 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2025-09-23 DOI:10.1016/j.clnesp.2025.09.019

Ruoyu Wang , Zhe Wang , Yiou Wang , Jianing Jiang , Jinming Zhu , Simiao Tian

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引用次数: 0

Abstract

Background

Sarcopenia is an important prognostic factor of breast cancer (BC). The serum creatinine/cystatin C ratio (CCR) and the serum creatinine × cystatin C-based glomerular filtration rate (SCr × eGFR_cys) index are novel screening tools for sarcopenia; but to date, has not been studied in Chinese patients with BC. We aimed to explore and investigate their prognostic values for overall survival (OS) and recurrence-free survival (RFS) in patients with BC undergoing surgery.

Methods

This cohort study Chinese women who were diagnosed with primary nonmetastatic BC (T1-4N0-3M0) and underwent surgery at our Hospital between January 2011 and December 2017. Preoperative laboratory data, clinicopathological feature and postoperative adjuvant treatment details were collected from medical records. Patients were divided into SCr × eGFR_cys index or CCR quartiles. Kaplan–Meier survival was performed to estimate rate difference of outcomes of interest for each quartile of these two indices, and cox regression analyses were used examine their associations, respectively. The cutoff value of the SCr × eGFR_cys index was determined using receiver operating characteristic curves.

Results

Among 697 nonmetastatic BC women included in total, 6.6 % (46/697) of death and 60 (8.61 %) recurrence occurred after a median follow-up of 76 months (interquartile range, 67–88 months). Kaplan–Meier analysis showed significant differences in OS rates for SCr × eGFR_cys index quartiles (log-rank P = 0.031), but not for CCR quartiles (log-rank P = 0.27). The higher SCr × eGFR_cys index quartiles was an independent prognostic factor for OS in multivariate analysis, with a decreased mortality risk (hazard ratio [HR], 0.29; 95 % confidence interval, 0.09–0.92 when the 4th SI quartile vs. the lowest) after adjusting for preoperative clinicopathological features, but the significant association was not found with CCR quartiles. Furthermore, subgroup analysis revealed that the prognostic ability of SCr × eGFR_cys index was only held in patients with low prognostic nutritional index, early TNM stage, normal-weight, and those without chemoradiotherapy.

Conclusions

Higher SCr × eGFR_cys index is associated with a favourable long-term prognosis of BC, and SCr × eGFR_cys index may be considered as pragmatic biomarker for clinicians when managing patients with BC in daily clinical practice.

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血清肌酐和胱抑素c指数是非转移性乳腺癌术后患者的预后因素。

背景：肌肉减少症是乳腺癌（BC）的重要预后因素。血清肌酐/胱抑素C比值（CCR）和基于血清肌酐×胱抑素C的肾小球滤过率（SCr×eGFRcys）指数是肌少症的新型筛查工具；但到目前为止，尚未在中国BC患者中进行研究。我们的目的是探索和研究它们对接受手术的BC患者的总生存期（OS）和无复发生存期（RFS）的预后价值。方法：本队列研究于2011年1月至2017年12月在我院接受手术的原发性非转移性BC （T1-4N0-3M0）的中国女性。术前实验室数据、临床病理特征和术后辅助治疗细节从医疗记录中收集。将患者分为SCr×eGFRcys指数或CCR四分位数。采用Kaplan-Meier生存期来估计这两个指标中每个四分位数的相关结果的比率差异，并分别使用cox回归分析来检验它们的相关性。利用受试者工作特征曲线确定SCr×eGFRcys指标的截止值。结果：在总共697名非转移性BC女性中，6.6%（46/697）的死亡和60（8.61%）的复发发生在中位随访76个月后（四分位数范围为67-88个月）。Kaplan-Meier分析显示SCr×eGFRcys指数四分位数的OS率有显著差异（log-rank P = 0.031），但CCR四分位数无显著差异（log-rank P = 0.27）。在多变量分析中，较高的SCr×eGFRcys指数四分位数是OS的独立预后因素，在调整术前临床病理特征后，其死亡风险降低（风险比[HR]为0.29；95%置信区间为0.09-0.92，当第4 SI四分位数与最低四分位数时），但与CCR四分位数未发现显著相关性。此外，亚组分析显示，SCr×eGFRcys指数的预后能力仅适用于预后营养指数低、TNM早期、体重正常和未进行放化疗的患者。结论：较高的SCr×eGFRcys指数与良好的BC长期预后相关，SCr×eGFRcys指数可作为临床医生在日常临床实践中管理BC患者的实用生物标志物。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.