Background N-terminal pro-brain natriuretic peptide (NT-proBNP) is a cardiac biomarker associated with the risk of heart failure and death in the general population but has not been explored in cancer survivors. Methods Using a US nationally representative sample of adults ≥20 years from the National Health and Nutrition Examination Survey from 1999 to 2004, this study compared NT-proBNP levels between non-cancer adults (n = 12574) and cancer survivors (n = 787) and examined the association of NT-proBNP with all-cause and cause-specific mortality among cancer survivors. Results Cancer survivors had higher NT-proBNP levels than non-cancer adults (median: 125.4 [IQR, 52.4 to 286.0] vs 43.2 [IQR, 20.3-95.0]). In particular, survivors of breast, prostate, and colorectal cancers had higher NT-proBNP levels than non-cancer adults (multivariable-adjusted P<.05). 471 survivors died (cancer: 141; cardiac disease: 95) during a median follow-up of 13.4 years (9,393 person-years). Among cancer survivors, higher NT-proBNP levels were statistically associated with increased risks of all-cause (HR, 1.31 [95% CI, 1.18-1.46]) and cardiac (HR, 1.55 [95% CI, 1.21-2.00) mortality but not with death due to cancer (HR, 1.10 [95% CI, 0.92-1.32]). Higher NT-proBNP levels were associated with elevated overall mortality in survivors of prostate (HR, 1.45 [95% CI, 1.17-1.79]) and colorectal (HR, 1.78 [95% 1.12-2.85]) cancers (P-interaction = 0.169). Non-linear dose-response relationships were observed between NT-proBNP and mortality, with statistically significant relationships emerging above 125 pg/ml. Conclusions Cancer survivors had higher NT-proBNP than non-cancer adults, and elevated NT-proBNP levels were associated with higher risks of all-cause and cardiac mortality in cancer survivors.

中文翻译：

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N 端脑钠肽前体与美国癌症幸存者生存的关系

背景 N 末端脑钠肽前体 (NT-proBNP) 是一种心脏生物标志物，与普通人群心力衰竭和死亡风险相关，但尚未在癌症幸存者中进行研究。方法 本研究使用 1999 年至 2004 年国家健康和营养检查调查中 20 岁以上成年人的全国代表性样本，比较非癌症成年人 (n = 12574) 和癌症幸存者 (n = 787) 之间的 NT-proBNP 水平并检查了 NT-proBNP 与癌症幸存者的全因和特定原因死亡率的关系。结果癌症幸存者的 NT-proBNP 水平高于非癌症成年人（中位数：125.4 [IQR，52.4 至 286.0] vs 43.2 [IQR，20.3-95.0]）。特别是，乳腺癌、前列腺癌和结直肠癌的幸存者比非癌症成年人具有更高的 NT-proBNP 水平（多变量调整 P<.05）。在中位随访 13.4 年（9,393 人年）期间，有 471 名幸存者死亡（癌症：141 人；心脏病：95 人）。在癌症幸存者中，较高的 NT-proBNP 水平与全因死亡率（HR，1.31 [95% CI，1.18-1.46]）和心脏死亡率（HR，1.55 [95% CI，1.21-2.00]）死亡率增加存在统计学相关性，但不因癌症死亡（HR，1.10 [95% CI，0.92-1.32]）。 NT-proBNP 水平较高与前列腺癌（HR，1.45 [95% CI，1.17-1.79]）和结直肠癌（HR，1.78 [95% 1.12-2.85]）幸存者总体死亡率升高相关（P 交互作用 = 0.169） ）。 NT-proBNP 与死亡率之间观察到非线性剂量反应关系，超过 125 pg/ml 时出现统计学上显着的关系。结论 癌症幸存者的 NT-proBNP 水平高于非癌症成年人，并且 NT-proBNP 水平升高与癌症幸存者全因死亡和心源性死亡的风险较高相关。