Originally published as JCO Early Release 10.1200/JCO.2008.18.8367 on December 15 2008

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Johansen, J. S. Articles by Nordestgaard, B. G. Search for Related Content PubMed PubMed Citation Articles by Johansen, J. S. Articles by Nordestgaard, B. G. Social Bookmarking                            What's this?

Elevated Plasma YKL-40 Predicts Increased Risk of Gastrointestinal Cancer and Decreased Survival After Any Cancer Diagnosis in the General Population

From the Departments of Rheumatology and Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen; Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, University of Copenhagen; The Copenhagen City Heart Study, Bispebjerg Hospital, Copenhagen University Hospital, University of Copenhagen; and the Department of Biology, University of California San Diego, La Jolla, CA.

Corresponding author: Julia S. Johansen, MD, DMSc, Department of Rheumatology Q107, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark; e-mail: julia.johansen{at}post3.tele.dk.

Purpose Elevated plasma YKL-40 is a biomarker of poor prognosis in cancer patients. We tested the hypotheses that elevated plasma YKL-40 predicts risk of cancer as well as survival after a cancer diagnosis in the general population.

Patients and Methods A prospective cohort study of 8,899 subjects (20 to 95 years) from the Danish general population, the Copenhagen City Heart Study, observed for 11 years for cancer incidence and 14 years for death: 1,432 participants had a first incident cancer, 968 of these died. Hazard ratios (HRs) for cancer events and death after events according to plasma YKL-40 in sex and 10 years age percentile categories: 0% to 33%, 34% to 66%, 67% to 90%, 91% to 95%, and 96% to 100%.

Results The cumulative incidence of gastrointestinal cancer increased with increasing YKL-40 (trend P < .0001). Multifactorially adjusted HRs for gastrointestinal cancer were 1.0 (95% CI, 0.7 to 1.5) for YKL-40 in category 34% to 66%, 1.5 for 67% to 90% (95% CI, 1.0 to 2.3), 2.4 for 91% to 95%, (95% CI, 1.3 to 4.6), and 3.4 for 96% to 100% (95% CI, 1.9 to 6.1) versus YKL-40 category 0% to 33% (P < .0001). Participants with any cancer event and YKL-40 category 91% to 100% had a median survival time after the diagnosis of 1 year versus 4 years in participants with YKL-40 category 0% to 33% (P < .0001). Corresponding values for gastrointestinal cancer were 6 months versus 1 year (P = .007). Multifactorially adjusted HRs for early death were 1.8 (95% CI, 1.3 to 2.5; P < .0001) after any cancer and 2.4 (95% CI, 1.3 to 4.3; P = .005) after gastrointestinal cancer in participants with YKL-40 category 91% to 100% versus 0% to 33%.

Conclusion In the general population, elevated plasma YKL-40 predicts increased risk of gastrointestinal cancer and decreased survival after any cancer diagnosis.

Supported by grants from "Overlæge Johan Boserup and Lise Boserups Fond", "Toyota-Fonden, Denmark", "The Research Council, Herlev Hospital", The Danish Heart Foundation and The Danish Medical Research Council. Quidel provided the study with YKL-40 enzyme-linked immunosorbent assay kits. The sponsors, including Quidel, had no role in the study design, statistical analysis, data interpretation, manuscript drafting, manuscript revision, or the decision to submit this manuscript for publication. The authors had full access to all the data in the study and had the final responsibility for the decision to submit the manuscript for publication.

Presented in part at the American Society of Clinical Oncology Gastrointestinal Cancers Symposium, January 25-28, 2008, Orlando, FL.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?