Association of Systemic Inflammation and Overall Survival in Elderly Patients with Cancer Cachexia – Results from a Multicenter Study

Ruan, Guo‐Tian; Yang, Ming; Zhang, Xiaowei; Song, Mengmeng; Hu, Chunlei; Ge, Yi‐Zhong; Xie, Hailun; Liu, Tong; Tang, Meng; Zhang, Qi; Zhang, Xi; Zhang, Kang‐Ping; Li, Xiangrui; Li, Qin‐Qin; Chen, Yongbing; Yu, Kefu; Ma, Cong; Wang, Kunhua; Shi, Hanping

doi:10.2147/jir.s332408

Cited by 13 publications

(15 citation statements)

References 48 publications

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“…Our multivariate survival analysis with different adjustment models showed that CRP, GNRI, ALI, and LCR all had significant survival predictive values in elderly patients with cancer. Similarly, previous studies have shown that CRP (11), GNRI (12), ALI (13), and LCR ( 14) can predict the prognosis of patients with cancer. Therefore, we developed and constructed SIPS, which consisted of CRP, GNRI, ALI, and LCR.…”

Section: Discussionsupporting

confidence: 59%

“…Blood samples were collected to measure serum markers, namely, CRP, neutrophils (N), lymphocytes (L), platelets (P), glucose (Glu), albumin (ALB), and globulin (GLB). These baseline inflammatory markers constituted the following ratios and indices: NLR (N/L ratio) ( 13 ), PLR (P/L ratio) ( 13 ), prognostic nutrition index (PNI), 10 × ALB + 0.005 × L) ( 13 ), systemic immune-inflammation index (SII), P × NLR) ( 13 ), ALI (BMI × ALB/NLR) ( 13 ), CAR (CRP/ALB ratio) ( 17 ), AGR (ALB/GLB ratio) ( 18 ), LCR (L/CRP ratio) ( 14 ), GNRI (1.489 × ALB + [Present body weight (PBW)/Ideal body weight (IBW)]) ( 12 ), mGNRI (modified GNRI, 1.489 × CRP + 41.7 × PBW/IBW) ( 12 ), and nutritional risk index (NRI), 1.519 × ALB + 41.7 × PBW/IBW) ( 19 ). IBW was evaluated using the Lorentz equation: men = height (cm) − 100 − [(height − 150)/4]; women = height (cm) − 100 − [(height − 150)/2.5] ( 20 ).…”

Section: Methodsmentioning

confidence: 99%

Section: Assessment Of Inflammatory Markersmentioning

confidence: 99%

“…Biomarkers in preoperative or pretreatment peripheral blood reflect the patient’s baseline inflammatory and immune status to a certain extent and are considered potential markers for predicting prognosis due to their high accessibility in clinical practice ( 9 ). Systemic inflammation can be assessed by various biochemical or blood markers routinely measured in routine blood tests or by ratios derived from these markers ( 10 ), such as CRP ( 11 ), neutrophil-to-lymphocyte ratio (NLR) ( 9 ), geriatric nutritional risk index (GNRI) ( 12 ), and advanced lung cancer inflammation index (ALI) ( 13 ). Some studies have combined known prognostic factors to establish new scoring systems to predict prognosis and guide clinical practice, such as the lymphocyte CRP score ( 14 ) and the Controlling Nutritional Status score ( 15 ).…”

Section: Introductionmentioning

confidence: 99%

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A Novel Systemic Inflammation Prognostic Score to Stratify Survival in Elderly Patients With Cancer

et al. 2022

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BackgroundElderly patients with cancer face the challenge of systemic inflammation, which can lead to a poor prognosis. Existing inflammatory indices cannot fully reflect the immune-inflammatory status of patients. This study aimed to develop a new scoring system to predict the survival of elderly patients with cancer using inflammatory indices, namely, the systemic inflammation prognostic score (SIPS).Materials and MethodsThis prospective multicenter study included a total of 1,767 patients with cancer, with a mean age of 70.97 ± 5.49 years, of whom 1,170 (66.2%) were men. We performed the least absolute shrinkage and selection operator (LASSO) regression to screen inflammatory indicators to include in constructing SIPS. Prognostic analysis of SIPS was performed using univariate and multivariate survival analyzes. The prognostic value of SIPS and its components were compared using the prognostic receiver operating characteristic curve and concordance index. The population was divided into the training cohort and the validation cohort in a 7:3 ratio and a SIPS prognostic analysis was performed.ResultsThe LASSO regression selected C-reactive protein (CRP) (≤ 9.81, “0”; > 9.81, “1”), geriatric nutritional risk index (GNRI) (≤ 93.85, “1”; 93.85, “0”), advanced lung cancer inflammation index (ALI) (≤ 23.49, “1”; > 23.49, “0”), and lymphocyte to C-reactive protein ratio (LCR) (≤ 2523.81, “1”; > 2523.81, “0”) to develop SIPS. Patients were divided into the three groups based on the total SIPS: low-risk (0), moderate-risk (1–2), and high-risk (3–4). On the multivariate survival analysis, patients in the moderate-risk [P < 0.001, hazard ratio (HR) = 1.79, 95% CI: 1.47–2.17] and high-risk groups (P < 0.001, HR = 2.40, 95% CI: 1.98–2.92) showed a worse prognosis than those in the low-risk group. The total cohort, training cohort, and validation cohort all showed that SIPS had better survival prediction than CRP, GNRI, ALI, and LCR. The HRs were 2.81 times higher in patients in the high-risk group with malnutrition than in patients in the low-risk group without malnutrition.ConclusionSIPS was an independent prognostic indicator in elderly patients with cancer. Malnutrition in the high-risk group increased the mortality risk.

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Section: Discussionsupporting

confidence: 59%

Section: Methodsmentioning

confidence: 99%

Section: Assessment Of Inflammatory Markersmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Novel Systemic Inflammation Prognostic Score to Stratify Survival in Elderly Patients With Cancer

et al. 2022

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“…Recently, more and more researchers focus on the relations between the immune-nutritional status and cancer ( 14 ). The controlling nutritional status (CONUT), as an immune-nutritional index deriving from peripheral blood variables of albumin (ALB), lymphocyte (LYM), and total cholesterol (TC), has been reported to be related to prognosis in various cancers, including ESCC ( 15 – 17 ).…”

Section: Introductionmentioning

confidence: 99%

The usefulness of pretreatment controlling nutritional status score for predicting recurrence in patients with esophageal squamous cell carcinoma undergoing neoadjuvant immunochemotherapy: A real-world study

et al. 2022

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BackgroundThe controlling nutritional status (CONUT) score, as an immune-nutritional index, has been reported to be related to prognosis in several cancers. Neoadjuvant immunochemotherapy (nICT) is an emerging pattern for cancer treatment in recent years. However, the usefulness of CONUT in esophageal squamous cell carcinoma (ESCC) with nICT has not been reported so far. This study attempted to clarify the usefulness of CONUT in predicting disease-free survival (DFS) in ESCC with nICT.MethodsTwo hundred sixteen ESCC patients receiving nICT between 2019 and 2021 were retrospectively enrolled. Based on CONUT, the patients were divided into two groups: low groups (score ≤ 2) and high (score ≥ 3) groups. The relationships between CONUT and clinical characteristics were estimated. Cox regression analyses with hazard ratios (HRs) and 95% confidence intervals (CIs) were also performed to evaluate the prognostic factors of DFS.ResultsFifty-nine (27.3%) patients achieved pathologic complete response (pCR), and 30 (13.9%) cases had a recurrence. There were 150 cases (69.4%) in low CONUT group and 66 cases (30.6%) in high CONUT group, respectively. The results revealed that vessel invasion (P = 0.037), postoperative pneumonia (P = 0.001), advanced ypT stage (P = 0.011), cTNM stage (P = 0.007), and ypTNM stage (P < 0.001) were significantly related to patients with a high CONUT score. A high pCR rate was found in patients with a low CONUT score (33.3% vs. 13.6%, P = 0.003), and a high recurrence rate was found in patients with a high CONUT score (24.2% vs. 9.3%, P = 0.004), respectively. Patients with a low CONUT score had a better 1-year DFS than those with a high CONUT score (90.7% vs. 75.8%, P = 0.004). Multivariate analyses indicated that the pretreatment CONUT score was an independent predictor regarding DFS (HR = 2.221, 95% CI: 1.067–4.625, P = 0.033).ConclusionA better response and a lower recurrence were found in ESCC patients with a lower pretreatment CONUT. As a useful index for immune-nutritional status, the CONUT might be a reliable prognostic indicator in ESCC patients with nICT.

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Triceps skinfold–albumin index significantly predicts the prognosis of cancer cachexia: A multicentre cohort study

Yin

Cui

Lin

et al. 2022

J cachexia sarcopenia muscle

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BackgroundThe fat mass and nutritional status play important roles in the onset and progression of cancer cachexia. The present study evaluated the joint prognostic value of the fat mass, as indicated by the triceps skinfold thickness (TSF), and the serum albumin level, for mortality in patients with cancer cachexia. Methods We performed a multicentre cohort study including 5134 patients with cancer cachexia from January 2013 to April 2019. The sum of the TSF (mm) and serum albumin (g/L) was defined as the triceps skinfold-albumin index (TA). Harrell's C index, a time-dependent receiver operating characteristic (ROC) curve analysis and the area under the curve (AUC) were used to evaluate the prognostic performance of the TA and other indices. Optimal stratification was used to identify the thresholds to define a low TA, and the association of the TA with all-cause mortality was evaluated using Kaplan-Meier analysis and Cox proportional hazard regression models. ResultsThe study enrolled 2408 women and 2726 men with a median age of 58.6 years and a median follow-up of 44 months. A total of 607 women (TA < 49.9) and 817 men (TA < 45.6) were classified as having a low TA. The TA showed better discrimination performance (C index = 0.621, 95% confidence interval [CI] = 0.607-0.636) to predict mortality in patients with cancer cachexia than the handgrip strength, the nutritional risk index, the prognostic nutritional index, the controlling nutritional status index, the systemic immune-inflammation index, the modified Glasgow prognostic score, and the TSF or albumin alone in the study population (all P < 0.05). The 1-, 3-and 5-year timedependent ROC analyses (AUC = 0.647, 0.625 and 0.630, respectively) showed that the TA had the highest prognostic value among all indices investigated (all P < 0.05). Univariate analysis showed that a lower TA was associated with an increased death hazard (hazard ratio [HR] = 1.859, 95% CI = 1.677-2.062), regardless of the sex and cancer type. Multivariable survival analysis showed that a lower TA was independently associated with an increased death hazard (HR = 1.381, 95% CI = 1.223-1.560). This association was significantly strengthened in patients who did not receive curative chemotherapy (

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Association of Systemic Inflammation and Overall Survival in Elderly Patients with Cancer Cachexia – Results from a Multicenter Study

Cited by 13 publications

References 48 publications

A Novel Systemic Inflammation Prognostic Score to Stratify Survival in Elderly Patients With Cancer

A Novel Systemic Inflammation Prognostic Score to Stratify Survival in Elderly Patients With Cancer

The usefulness of pretreatment controlling nutritional status score for predicting recurrence in patients with esophageal squamous cell carcinoma undergoing neoadjuvant immunochemotherapy: A real-world study

Triceps skinfold–albumin index significantly predicts the prognosis of cancer cachexia: A multicentre cohort study

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