Evaluation of a prognostic scoring system based on the systemic inflammatory and nutritional status of patients with locally advanced non-small-cell lung cancer treated with chemoradiotherapy

Abstract

Systemic inflammation and poor nutritional status have a negative effect on the outcomes of cancer. Here, we analyzed the effects of the pretreatment inflammatory and nutritional status on clinical outcomes of locally advanced non-small-cell lung cancer (NSCLC) patients treated with chemoradiotherapy. We retrospectively reviewed 89 patients with locally advanced NSCLC treated with chemoradiotherapy between July 2006 and June 2013. Serum C-reactive protein (CRP) was assessed as an inflammatory marker, and serum albumin, body mass index (BMI) and skeletal mass index were assessed as nutritional status markers. The relationships between these markers and overall survival (OS) were assessed. The median OS was 24.6 months [95% confidence interval (CI): 19.4–39.3 months]. During follow-up, 58 patients (65%) had disease recurrence and 52 patients (58%) died. In multivariate Cox hazard analysis, CRP levels and BMI approached but did not achieve a significant association with OS (P = 0.062 and 0.094, respectively). Recursive partitioning analysis identified three prognostic groups based on hazard similarity (CRP-BMI scores): 0 = CRP < 0.3 mg/dl, 1 = CRP ≥ 0.3 mg/dl and BMI ≥ 18.5 kg/m2, and 2 = CRP ≥ 0.3 mg/dl and BMI < 18.5 kg/m2. The CRP-BMI score was significantly associated with OS (P = 0.023). Patients with scores of 0, 1 and 2 had median OS of 39.3, 24.5 and 14.5 months, respectively, and the scores also predicted the probability of receiving salvage treatment after recurrence. The CRP-BMI score is thus a simple and useful prognostic marker of clinical outcome for patients with locally advanced NSCLC treated with chemoradiotherapy.

Body Mass Index (BMI), BMI Change, and Overall Survival in Patients With SCLC and NSCLC: A Pooled Analysis of the International Lung Cancer Consortium

“…6,[12][13][14][15][16][17][18][19] In studies covering both resectable and metastatic lung cancers, the worst outcomes were observed in underweight patients as defined by having a body mass index (BMI) less than 18.5 kg/m 2 . 6,[12][13][14][15][20][21][22][23][24][25][26][27][28][29] Being severely underweight may be an indicator of cancer cachexia, which is a well-described marker of poor outcome on cancer mortality. [30][31][32][33][34][35] Weight in the years before lung cancer diagnosis has also been assessed.…”

Albumin‐to‐alkaline phosphatase ratio: A novel prognostic index for patients with driver mutation‐negative advanced non‐small cell lung cancer

“…Compared with the tissue marker, serum markers are preponderance, which is easily acquisitive and convenient monitoring. Recent studies found some serum markers, which reflected systemic inflammation and nutritional status, affected the prognosis of NSCLC 15,16 . For example, NSCLC patients in the early stage, especially those with pulmonary fibrosis, low preoperative serum ALB level is an unfavorable indicator regarding postoperative survival 17 …”

Sarcopenia as Prognostic Factor in Lung Cancer Patients: A Systematic Review and Meta-analysis

“…and follow-up in lung cancer patients and offers an elegant way to simultaneously assess sarcopenia by calculating the skeletal muscle mass index (5,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”