Clinical implications and predictive value of the creatinine‑cystatin C ratio in patients with multiple myeloma and renal impairment

Sun,Yixuan; Zhao,Junfeng; Du,Jiachen; Li,Ying; Ding,Fangjie; Zhao,Wenbo

doi:10.3892/ol.2024.14267

Clinical implications and predictive value of the creatinine‑cystatin C ratio in patients with multiple myeloma and renal impairment

Authors:
- Yixuan Sun
- Junfeng Zhao
- Jiachen Du
- Ying Li
- Fangjie Ding
- Wenbo Zhao
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Affiliations: Department of Hematology, Shandong Provincial Hospital Affiliated with Shandong First Medical University, Jinan, Shandong 250021, P.R. China, Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China, Department of Breast and Thyroid Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, Shandong 250021, P.R. China, Department of Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China, Department of Radiation Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong First Medical University, Jinan, Shandong 250013, P.R. China
Published online on: January 31, 2024 https://doi.org/10.3892/ol.2024.14267
Article Number: 134
Copyright: © Sun et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The creatinine (Cr)‑cystatin C ratio (CCR) at the time of cancer diagnosis is associated with survival; however, to the best of our knowledge, the association between this ratio and mortality in patients with multiple myeloma and renal impairment (RI) is unclear. Therefore, the present study aimed to assess this association, as well as disease prognosis and the clinical significance of the CCR in patients with multiple myeloma and RI. The present retrospective study included 191 patients diagnosed with multiple myeloma and RI between 2012 and 2022. The predictive value of the CCR was evaluated using area under the receiver operating characteristic curve (AUC) values. The factors affecting overall survival (OS) were assessed using uni‑ and multivariate logistic regression analyses. The effect of the CCR on survival was evaluated using a Cox regression model and the Kaplan‑Meier method. There was a significant association between low CCR and poor progression‑free survival (PFS) and overall survival (OS). The 1‑, 2‑ and 3‑year PFS and OS rates in patients with a low CCR were significantly lower than those in patients with a high CCR. The 1‑, 2‑ and 3‑year AUC values of the CCR were 0.712, 0.764 and 0.746 respectively. Multivariate analysis revealed sex, age, Cr levels, CCR and C‑reactive protein levels as independent prognostic factors affecting OS rates. The CCR is a potential prognostic indicator in patients with multiple myeloma with RI and is associated with clinical stages.

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1	Kazandjian D: Multiple myeloma epidemiology and survival: A unique malignancy. Semin Oncol. 43:676–681. 2016. View Article : Google Scholar : PubMed/NCBI
2	Röllig C, Knop S and Bornhäuser M: Multiple myeloma. Lancet. 385:2197–2208. 2015. View Article : Google Scholar : PubMed/NCBI
3	Rajkumar SV and Kumar S: Multiple myeloma: Diagnosis and treatment. Mayo Clin Proc. 91:101–119. 2016. View Article : Google Scholar : PubMed/NCBI
4	Attal M, Lauwers-Cances V, Hulin C, Leleu X, Caillot D, Escoffre M, Arnulf B, Macro M, Belhadj K, Garderet L, et al: Lenalidomide, bortezomib, and dexamethasone with transplantation for myeloma. N Engl J Med. 376:1311–1320. 2017. View Article : Google Scholar : PubMed/NCBI
5	Moreau P, Attal M, Hulin C, Arnulf B, Belhadj K, Benboubker L, Béné MC, Broijl A, Caillon H, Caillot D, et al: Bortezomib, thalidomide, and dexamethasone with or without daratumumab before and after autologous stem-cell transplantation for newly diagnosed multiple myeloma (Cassiopeia): A randomised, open-label, phase 3 study. Lancet. 394:29–38. 2019. View Article : Google Scholar : PubMed/NCBI
6	Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, Kumar S, Hillengass J, Kastritis E, Richardson P, et al: International myeloma working group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 15:e538–e548. 2014. View Article : Google Scholar : PubMed/NCBI
7	Moreau P, San Miguel J, Sonneveld P, Mateos MV, Zamagni E, Avet-Loiseau H, Hajek R, Dimopoulos MA, Ludwig H, Einsele H, et al: Multiple myeloma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 28 (Suppl 4):iv52–iv61. 2017. View Article : Google Scholar : PubMed/NCBI
8	Rodriguez-Otero P, Paiva B and San-Miguel JF: Roadmap to cure multiple myeloma. Cancer Treat Rev. 100:1022842021. View Article : Google Scholar : PubMed/NCBI
9	San Miguel JF and García-Sanz R: Prognostic features of multiple myeloma. Best Pract Res Clin Haematol. 18:569–583. 2005. View Article : Google Scholar : PubMed/NCBI
10	Sathick IJ, Drosou ME and Leung N: Myeloma light chain cast nephropathy, a review. J Nephrol. 32:189–198. 2019. View Article : Google Scholar : PubMed/NCBI
11	Ludwig H, Drach J, Graf H, Lang A and Meran JG: Reversal of acute renal failure by bortezomib-based chemotherapy in patients with multiple myeloma. Haematologica. 92:1411–1414. 2007. View Article : Google Scholar : PubMed/NCBI
12	Duncan L, Heathcote J, Djurdjev O and Levin A: Screening for renal disease using serum creatinine: Who are we missing? Nephrol Dial Transplant. 16:1042–1046. 2001. View Article : Google Scholar : PubMed/NCBI
13	Baxmann AC, Ahmed MS, Marques NC, Menon VB, Pereira AB, Kirsztajn GM and Heilberg IP: Influence of muscle mass and physical activity on serum and urinary creatinine and serum cystatin C. Clin J Am Soc Nephrol. 3:348–354. 2008. View Article : Google Scholar : PubMed/NCBI
14	Prigent A: Monitoring renal function and limitations of renal function tests. Semin Nucl Med. 38:32–46. 2008. View Article : Google Scholar : PubMed/NCBI
15	Stevens PE and Levin A; Kidney Disease, : Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members: Evaluation and management of chronic kidney disease: Synopsis of the kidney disease: Improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 158:825–830. 2013. View Article : Google Scholar : PubMed/NCBI
16	Kim SW, Jung HW, Kim CH, Kim KI, Chin HJ and Lee H: A new equation to estimate muscle mass from creatinine and cystatin C. PLoS One. 11:e01484952016. View Article : Google Scholar : PubMed/NCBI
17	He L, Li J, Zhan J, Yi F, Fan X, Wei Y and Zhang W: The value of serum cystatin C in early evaluation of renal insufficiency in patients undergoing chemotherapy: A systematic review and meta-analysis. Cancer Chemother Pharmacol. 83:561–571. 2019. View Article : Google Scholar : PubMed/NCBI
18	Kashani KB, Frazee EN, Kukrálová L, Sarvottam K, Herasevich V, Young PM, Kashyap R and Lieske JC: Evaluating muscle mass by using markers of kidney function: Development of the sarcopenia index. Crit Care Med. 45:e23–e29. 2017. View Article : Google Scholar : PubMed/NCBI
19	Tang T, Zhuo Y, Xie L, Wang H and Yang M: Sarcopenia index based on serum creatinine and cystatin C is associated with 3-year mortality in hospitalized older patients. Sci Rep. 10:12602020. View Article : Google Scholar : PubMed/NCBI
20	Zheng C, Wang E, Li JS, Xie K, Luo C, Ge QY, Hu LW and Shen Y: Serum creatinine/cystatin C ratio as a screening tool for sarcopenia and prognostic indicator for patients with esophageal cancer. BMC Geriatr. 22:2072022. View Article : Google Scholar : PubMed/NCBI
21	Rule AD, Bailey KR and Turner ST: What is the goal with endogenous filtration markers-estimation of GFR or prediction of kidney outcomes? Am J Kidney Dis. 58:865–867. 2011. View Article : Google Scholar : PubMed/NCBI
22	Patel SS, Molnar MZ, Tayek JA, Ix JH, Noori N, Benner D, Heymsfield S, Kopple JD, Kovesdy CP and Kalantar-Zadeh K: Serum creatinine as a marker of muscle mass in chronic kidney disease: Results of a cross-sectional study and review of literature. J Cachexia Sarcopenia Muscle. 4:19–29. 2013. View Article : Google Scholar : PubMed/NCBI
23	Bukabau JB, Sumaili EK, Cavalier E, Pottel H, Kifakiou B, Nkodila A, Makulo JRR, Mokoli VM, Zinga CV, Longo AL, et al: Performance of glomerular filtration rate estimation equations in Congolese healthy adults: The inopportunity of the ethnic correction. PLoS One. 13:e01933842018. View Article : Google Scholar : PubMed/NCBI
24	Mulaomerović A, Halilbasić A, Cickusić E, Zavasnik-Bergant T, Begić L and Kos J: Cystatin C as a potential marker for relapse in patients with non-Hodgkin B-cell lymphoma. Cancer Lett. 248:192–197. 2007. View Article : Google Scholar : PubMed/NCBI
25	Kos J, Krasovec M, Cimerman N, Nielsen HJ, Christensen IJ and Brünner N: Cysteine proteinase inhibitors stefin A, stefin B, and cystatin C in sera from patients with colorectal cancer: Relation to prognosis. Clin Cancer Res. 6:505–511. 2000.PubMed/NCBI
26	Zhang J, Jiang Y, Guo D, Liu HY, Hong L, Qi J and Huang H: The role of cystatin C in multiple myeloma. Int J Lab Hematol. 44:135–141. 2022. View Article : Google Scholar : PubMed/NCBI
27	Nückel H, Langer C, Herget-Rosenthal S, Wichert M, Assert R, Döhner H, Dührsen U and Liebisch P: Prognostic significance of serum cystatin C in multiple myeloma. Int J Hematol. 95:545–550. 2012. View Article : Google Scholar : PubMed/NCBI
28	Terpos E, Katodritou E, Tsiftsakis E, Kastritis E, Christoulas D, Pouli A, Michalis E, Verrou E, Anargyrou K, Tsionos K, et al: Cystatin-C is an independent prognostic factor for survival in multiple myeloma and is reduced by bortezomib administration. Haematologica. 94:372–379. 2009. View Article : Google Scholar : PubMed/NCBI
29	Jung CY, Kim HW, Han SH, Yoo TH, Kang SW and Park JT: Creatinine-cystatin C ratio and mortality in cancer patients: A retrospective cohort study. J Cachexia Sarcopenia Muscle. 13:2064–2072. 2022. View Article : Google Scholar : PubMed/NCBI
30	Chen Z, Zha L, Ma X, Xu J, Huang D, Wu W, Chen L, Yang F, Liao W and Wang W: Serum creatinine/cystatin C ratio as a predictor of in-hospital mortality in patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Lung. 200:609–617. 2022. View Article : Google Scholar : PubMed/NCBI
31	Gao S, Xie H, Wei L, Liu M, Liang Y, Wang Q, Tang S and Gan J: Serum creatinine/cystatin C ratio as a prognostic indicator for patients with colorectal cancer. Front Oncol. 13:11555202023. View Article : Google Scholar : PubMed/NCBI
32	Kwon WS, Kim TS, Nahm CH, Moon Y and Kim JJ: Aberrant cystatin-C expression in blood from patients with breast cancer is a suitable marker for monitoring tumor burden. Oncol Lett. 16:5583–5590. 2018.PubMed/NCBI