Significance of serum ferritin as a prognostic factor in advanced hepatobiliary cancer patients treated with Korean medicine: a retrospective cohort study

Abstract

BackgroundAdvanced hepatobiliary cancers are highly lethal cancers that require precise prediction in clinical practice. Serum ferritin level increases in malignancy and high serum ferritin level is associated with poor survival in various cancers. This study aimed to identify whether serum ferritin could independently predict the overall survival (OS) of patients with advanced hepatobiliary cancers.MethodsThe retrospective cohort study was performed by reviewing medical records of patients with advanced hepatobiliary cancers from June 2006 to September 2016. The demographic and clinicopathological characteristics as well as the biochemical markers were evaluated at the initiation of Korean medicine (KM) treatment. The OS was calculated using Kaplan-Meier estimates. The Cox proportional hazard model was used to identify the independent prognostic significance of serum ferritin for survival.ResultsThe median OS of all subjects was 5.1 months (range, 0.5–114.9 months). The median OS of group with low ferritin levels and that with high ferritin levels was 7.5 months (range, 0.7–114.9 months) and 2.8 months (range, 0.5–22.8 months), respectively (P < 0.001). The results of the univariate analysis showed that the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) (P = 0.002), tumor type (P = 0.001), prior treatment (P = 0.023), serum ferritin (P < 0.001), hemoglobin (P = 0.002), total bilirubin (P = 0.002), gamma-glutamyl transpeptidase (P = 0.007), albumin (P = 0.013), white blood cell (P = 0.002), and C-reactive protein (CRP) (P < 0.001) were significant factors for the patients’ survival outcome. On multivariate analysis controlling confounding factors, ferritin (P = 0.041), CRP (P = 0.010), ECOG-PS (P = 0.010), and tumor type (P = 0.018) were identified as independent prognostic factors for survival.ConclusionsThese results indicate that serum ferritin is a valid clinical biochemical marker to predict survival of patients with advanced hepatobiliary cancers.

Comprehensive analysis of ferritin subunits expression and positive correlations with tumor-associated macrophages and T regulatory cells infiltration in most solid tumors

“…Upregulation of ferritin has been shown to correlate with poor prognosis in several cancers, including HNSC, non-small cell lung cancer, and liver cancer [ 24 , 25 ]. Nevertheless, apart from two studies showing that FTL is elevated in GBM and colorectal cancer [ 26 , 27 ], little is known about the expressions of FTL and FTH1 in cancer.…”

Prognostic value of pretreatment C-reactive protein/albumin ratio in nasopharyngeal carcinoma

“…[ 36 – 38 ] Albumin is an important indicator reflecting the patients’ nutritional status and has been used for prognostic assessment of patients with ovarian cancer, advanced hepatobiliary cancer, and NPC. [ 16 , 39 , 40 ] The CAR was initially used to assess the outcome of patients with acute medical admissions and sepsis. [ 41 , 42 ] Moreover, previous studies have demonstrated that CAR is superior prognostically for various cancers than are the established inflammation-based prognostic indices Glasgow prognostic score (GPS), modified GPS, and prognostic nutritional index.…”

Iron Metabolism in Cancer

“…Ferritin is an iron-containing protein with multiple functions in iron delivery, cell proliferation, angiogenesis, and immunosuppression. Under the case of cancer, ferritin is detected in high concentration in plasma in many patients, and its higher level correlates with higher clinical tumor stage and poorer patients’ outcome [23,24]. Iron–sulfur biogenesis is another common form of iron utilization.…”