Project Details
Projekt
Perioperative immunological and biomarker profiles to predict elderly uro-oncologic patients with a high risk for postoperative functional deterioration
Applicant
Dr. Christian Fiebig
Subject Area
Reproductive Medicine, Urology
Term
from 2022 to 2024
Project identifier
Deutsche Forschungsgemeinschaft (DFG) - Project number 511980364
State of the art Geriatric cancer patients have a high risk of long lasting physical and cognitive impairments after surgical interventions. Severity of the impairment also depends on the individual patient’s resilience, which describes the ability to recover physical and cognitive function after a stressor event. Surgical interventions in cancer patients thereby act like a severe stressor for geriatric patients. We have established a geriatric assessment, called Erlangen Index (EI), based on professional questionnaires. It enables us to identify patients already preoperatively with a high risk of long-lasting postoperative functional deterioration (Activity of Daily Living - ADL). Still, the molecular mechanisms associated with a reduced functional deterioration remain unknown. Furthermore, laboratory biomarkers, that correlate with postoperative functional outcome are not established yet. In the literature, correlations of the immune system and senescence-associated biomarkers with the physical and cognitive outcome after oncologic operations are already described. Objectives We assume that functional deterioration is strongly associated with resilience of uro-oncologic patients during their clinical course. Our aim is to study immunological profiles and biomarker profiles to gain more insight into the immunological and molecular processes associated with resilience. Our hypotheses are: 1. Changes in immunological profiles are associated with “Activity of Daily Living” (ADL) and functional deterioration. 2. Changes in the levels of serum proteins, senescence-associated RNAs in PBMCs and circulating plasma miRNAs are associated with “Activity of Daily Living” (ADL) and functional deterioration. 3. Both sets of biomarkers (cellular and molecular) are able to predict the probability of functional deterioration during 6 months of follow-up of uro-oncologic patients after major surgical intervention. Work program We will include geriatric urologic patients undergoing a major surgical intervention, either cystectomy or nephrectomy. We recruit specifically patients with a high EI (≥ 4) and low EI (<4). Preoperatively we will estimate the ADL using the Barthel index and take blood samples to analyze an immunological profile and biomarkers. Postoperatively we will follow up the patients for 6 months, at four defined time points we will again determine the ADL and take blood to measure immunological profiles and biomarkers. The primary endpoints are functional deterioration and mortality. Prediction of functional deterioration may guide supportive therapy decisions in the clinical course of uro-oncologic patients. The identification of factors associated with resilience may help to improve outcome and survival in the future by targeted therapies of these patients.
DFG Programme
Research Grants
