Association Between Systemic Inflammation and Malnutrition With Survival in Patients With Cancer Sarcopenia—A Prospective Multicenter Study

Abstract

ObjectiveSystemic inflammation and malnutrition are correlated with cancer sarcopenia and have deleterious effects on oncological outcomes. However, the combined effect of inflammation and malnutrition in patients with cancer sarcopenia remains unclear.MethodsWe prospectively collected information on 1,204 patients diagnosed with cancer sarcopenia. the mean (SD) age was 64.5 (11.4%) years, and 705 (58.60%) of the patients were male. The patients were categorized into the high advanced lung cancer inflammation index (ALI) group (≥18.39) and the low ALI group (<18.39) according to the optimal survival cut-off curve. We selected the optimal inflammation marker using the C-index, decision curve analysis (DCA), and a prognostic receiver operating characteristic curve. Univariate and multivariate survival analyses were performed to determine the prognostic value of the optimal inflammation indicator. We also analyzed the association between inflammation and malnutrition in patients with cancer.ResultsThe C-index, DCA, and prognostic area under the curve of ALI in patients with cancer sarcopenia were higher or better than those of neutrophil-lymphocyte ratio (NLR), prognostic nutritional index (PNI), systemic immune-inflammation index (SII), and platelet-lymphocyte ratio (PLR). The prognosis for patients in the low ALI group was worse than that of patients in the high ALI group [HR (95%CI) = 1.584 (1.280–1.959), P < 0.001]. When the ALI was divided into quartiles, we observed that decreased ALI scores strongly correlated with decreased overall survival (OS). Patients with both a low ALI and severe malnutrition (vs. patients with high ALI and well-nourished) had a 2.262-fold death risk (P < 0.001). Subgroup analysis showed a significant interactive association between the ALI and death risk in terms of TNM stage (P for interaction = 0.030).ConclusionsThe inflammation indicator of the ALI was better than those of the NLR, PNI, SII, and PLR in patients with cancer sarcopenia. Inflammation combined with severe malnutrition has a nearly 3-fold death risk in patients with cancer sarcopenia, suggesting that reducing systemic inflammation, strengthening nutritional intervention, and improving skeletal muscle mass are necessary.

Combined systemic inflammatory immunity index and prognostic nutritional index scores as a screening marker for sarcopenia in patients with locally advanced gastric cancer

“…A previous retrospective study found that sarcopenia was significantly associated with neutrophil-to-lymphocyte Ratio (NLR) in elderly patients with esophageal squamous cell carcinoma (ESCC), and both were independent prognostic factors in ESCC patients ( 21 ). Another multicentre prospective study found that NLR, PNI, SII and platelet lymphocyte ratio (PLR) were all good predictors of sarcopenia, with ALI [BMI (kg/m 2 ) × albumin (g/dl)/NLR] being the best predictor ( 20 , 21 ). These studies have shown that all of these indicators based on inflammation can be used as markers to predict sarcopenia.…”

“…Recent studies have found that high levels of inflammatory factors promote muscle atrophy, stimulate increased proteolytic metabolism and inhibit muscle synthesis, so inflammatory factors are negatively associated with muscle strength and mass ( 20 , 21 , 42 – 44 ). Similarly, other studies have found that increased inflammatory factors can also lead to insulin resistance and muscle wastage through activation of the ubiquitin-proteasome protein hydrolysis pathway, and that muscle wastage itself further exacerbates insulin resistance ( 45 ).…”

“…In recent years, an increasing number of studies have found that inflammatory factors in the body promote muscle atrophy, stimulate protein catabolism and inhibit muscle synthesis ( 20 , 21 ). A meta-analysis by Bano et al ( 22 ) of 17 studies included on the relationship between sarcopenia and the inflammatory response showed that C-reactive protein (CRP) levels were significantly higher in those with sarcopenia than in those in the non-sarcopenic group.…”

A Novel Inflammation and Insulin Resistance Related Indicator to Predict the Survival of Patients With Cancer

“…Cancer is an inflammatory disease, and systemic inflammation is a hallmark of patients with cancer ( 5 ). Inflammation is involved in the occurrence and progression of cancer, and systemic inflammatory state is considered to be the seventh hallmark of cancer formation through host-tumor interactions ( 6 , 7 ). The inflammatory state is the main driving force behind the metabolic alterations in patients with cancer ( 8 ).…”

Sarcopenia defined by skeletal muscle mass index at the third lumbar vertebra is a prognostic factor for extensive-stage small cell lung cancer patients: a retrospective study

“…Sarcopenia, defined as loss of muscle mass and function, has been shown to be related to patient prognosis in several types of cancers ( 7 , 8 ). In general, the evaluation of skeletal muscle mass is based on computed tomography (CT).…”