The Influence of Tumor-Associated Systemic Inflammation on Vascular Remodeling in Oncohematological Patients Before Antitumor Therapy

Aim        To study the concentrations of routine markers of systemic inflammation (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), fibrinogen) and assess their correlation with the vascular morpho-functional parameters in patients with hemoblastosis before the start of polychemotherapy.

Material and methods    The study included 32 patients with a newly diagnosed oncohematological disease, with 18 (56.25%) men aged 56.87±17.06 years (95% confidence interval (CI): 50.50-63.24). For all patients, ESR, CRP, and fibrinogen concentrations were measured, and digital photoplethysmography and ultrasonic duplex scanning of the brachiocephalic arteries were performed.

Results  Increases in systemic inflammatory (SI) markers were found: median ESR was 25 [4.00; 45.00] mm/h (N<20), CRP was 7.5 [1.30; 17.10] mg/l (N<5), and fibrinogen was 4.30 [1.30; 8.30] g/l (N 1.8-4.0). Vascular remodeling was detected. In the large arteries: the median alternative large artery stiffness index (aSI) was 8.30 [6.10; 15.80] (N<8), phase shift (PS) value was 8.38±3.36 (95% CI: 7.10-9.66) ms (N>10), intima-media thickness (IMT) was 0.92 [0.85; 1.30] mm (N<0.90), and carotid-femoral pulse wave velocity (cfPWV) was 9.26±1.59 (95% CI: 8.49-10.59) m/s (N<10). In the microcirculation, the median occlusion index (OI) was 1.50 [0.90; 2.80] (N>1.8). According to the rank correlation analysis (Spearman rank correlation coefficient), significant direct corrlations were found between CRP and aSI (ρ=0.575; p=0.001), IMT (ρ=0.497; p=0.005); fibrinogen and aSI (ρ=0.662; p=0.001), IMT (ρ=0.678; p=0.001). Also, aSI and IMT were significantly worse in the groups with elevated CRP (ρ=0.001; p=0.042) and in patients with a more advanced tumor process according to the Ann-Abor staging system (ρ=0.002; p=0.001). However, the severity of SI and vascular remodeling did not differ in patients with different cardio-oncological risks.

Conclusion         Patients with hemoblastosis before the start of polychemotherapy have morpho-functional changes in blood vessels associated with cancer severity and SI intensity. These results may indicate the potential prognostic value of routine SI markers and evaluation of baseline vascular status for stratification of cardio-oncological risk. Further studies in larger patient samples and assessment of long-term outcomes are needed to clarify these findings.

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