Observational studyJournal of gastrointestinal cancer2025
Serum GFAP as a Potential Biomarker for Chemotherapy-Associated Cognitive Impairment in Elderly Patients with Gastrointestinal Cancers: An Exploratory Study.
Observational study in Journal of gastrointestinal cancer, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionChemotherapy-associated cognitive impairment (CACI) is a common yet underdiagnosed condition among elderly cancer patients. Glial fibrillary acidic protein (GFAP), a marker of astrocytic activation, has emerged as a potential indicator of neuroinflammation. MATERIALS AND
methodsThis observational case-control study included 41 elderly patients with stage II-III colon, gastric, or pancreatic cancer who received 12 cycles of adjuvant chemotherapy, and 30 age- and sex-matched healthy controls. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) at baseline, mid-treatment, and 3 months post-treatment. Quality of life was evaluated using the Functional Assessment of Cancer Therapy-General (FACT-G). Serum GFAP and C-reactive protein (CRP) levels were measured at baseline and follow-up.
resultsPost-treatment MMSE scores significantly declined in the patient group (mean = 24.87 ± 2.14 vs. baseline = 26.92 ± 0.99, p < 0.001), with 51% of patients showing cognitive impairment. GFAP levels increased significantly in cognitively impaired patients (from 374.64 ± 142.14 to 464.79 ± 181.94 ng/ml, p < 0.001), while ROC analysis identified a GFAP cut-off of 337 ng/ml with 94.74% sensitivity and 92.48% specificity for predicting CACI. Logistic regression showed that both elevated follow-up GFAP levels were independent predictors of CACI. DISCUSSION: Elevated serum follow-up GFAP levels are significantly associated with cognitive impairment following chemotherapy in elderly patients with gastrointestinal cancers, suggesting a role for astrocytic activation in CACI pathogenesis. GFAP may serve as a promising biomarker for risk stratification and early intervention.
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