Identification of the Best Prognostic Marker Among Immunonutritional Parameters Using Serum C-Reactive Protein and Albumin in Non-Small Cell Lung Cancer

Zhang

J cachexia sarcopenia muscle

et al. 2022

Backgrounds Malnutrition and systemic inflammatory responses are associated with poor overall survival (OS) in lung cancer patients, but it remains unclear which biomarkers are better for predicting their prognosis. This study tried to determine the best one among the existing common nutrition/inflammation-based indicators of OS for patients with lung cancer. Materials and methods There were 16 nutrition or systemic inflammation-based indicators included in this study. The cut-off points for the indicators were calculated using maximally selected rank statistics. The OS was evaluated using the Kaplan-Meier estimator, and univariate and multivariate Cox proportional hazard models were used to determine the relationship between the indicators and OS. A time-dependent receiver operating characteristic curves (time-ROC) and C-index were calculated to assess the predictive ability of the different indicators. Results There were 1772 patients with lung cancer included in this study. In univariate analysis, all 16 indicators were significantly associated with OS of the patients (all P < 0.001). Except for platelet-to-lymphocyte ratio, all other indicators were independent predictors of OS in multivariate analysis (all P < 0.05). Low advanced lung cancer inflammation index (ALI) was associated with higher mortality risk of lung cancer [hazard ratio, 1.30; 95% confidence interval (CI), 1.13-1.49]. The results of the time-AUC and C-index analyses indicated that the ALI (C-index: 0.611) had the best predictive ability on the OS in patients with lung cancer. In different sub-groups, the ALI was the best indicator for predicting the OS of lung cancer patients regardless of sex (C-index, 0.609 for men and 0.613 for women) or smoking status (C-index, 0.629 for non-smoker and 0.601 for smoker) and in patients aged <65 years (C-index, 0.613). However, the modified Glasgow prognostic score was superior to the other indicators in non-small cell lung cancer patients (C-index, 0.639) or patients aged ≥65 years (C-index, 0.610), and the glucose-to-lymphocyte ratio performed better prognostic ability in patients with small cell lung cancer (C-index, 0.601). Conclusions The prognostic ability of the ALI is superior to the other inflammation/nutrition-based indicators for all patients with lung cancer.

Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 53%

The advanced lung cancer inflammation index is the optimal inflammatory biomarker of overall survival in patients with lung cancer

Zhang

J cachexia sarcopenia muscle

et al. 2022

J Parenter Enteral Nutr

“…Serum albumin level is an indicator of nutrition status, disease severity, and liver synthesis function 38 . Serum albumin level can also be used as an indicator of inflammatory response, and hypoalbuminemia is a strong predictor of poor prognosis in patients with lung cancer 39,40 . The effect of serum albumin level in the prediction of lung cancer patients was highly significant, and its weight in the CONUT score was twice that of the other two indicators.…”

Section: Discussionmentioning

confidence: 99%

Value of the Controlling Nutritional Status score in predicting the prognosis of patients with lung cancer: A multicenter, retrospective study

Liu

Zhang

et al. 2022

Background The body's immune‐nutrition status affects prognosis in patients with lung cancer. The Controlling Nutritional Status (CONUT) score is an immune‐nutrition‒related index associated with prognosis in other tumors. We aimed to assess the value of CONUT scores in predicting prognosis in patients with lung cancer. Methods In this retrospective, multicenter study, 1339 patients with lung cancer were divided into low and high CONUT score groups. The relationship between CONUT scores and overall survival (OS) was assessed by survival curves and Cox proportional hazards regression modeling. A nomogram, including CONUT scores and other clinical variables, was established. Results There were 659 (49.2%; mean age, 59.91 years) low and 680 (50.8%; mean age, 62.23 years) high CONUT score patients. OS was significantly worse in patients with high than in those with low CONUT scores (P < 0.001), even after stratification by pathological types (non–small‐cell lung cancer and small‐cell lung cancer) and Tumor, Node, Metastasis (TNM) stages. A high CONUT score independently predicted risk in patients with lung cancer (adjusted hazard ratio, 1.48; 95% CI, 1.26‒1.73; P < 0.001). The CONUT‐based nomogram could predict prognosis well (C‐index, 0.701), with better resolution and accuracy than TNM staging for predicting OS at 1, 2, and 3 years (area under the receiver operating characteristic curve, 0.735 vs 0.678, 0.742 vs 0.696, and 0.768 vs 0.743, respectively). Conclusion The CONUT score can predict prognosis in patients with lung cancer. A CONUT‐based nomogram can improve the accuracy of survival prediction in such patients.

“…The association between albumin and nutritional status reflects the systemic inflammatory response and nutritional status of patients and has been confirmed [ 38 ]. In addition, Okamoto et al indicated that CAR may be the most useful prognostic indicator in postoperative immuno-nutritional parameters of non-small cell lung cancer [ 39 ]. Due to the low incidence of thymoma, the current research on these potentially effective prognostic markers is relatively limited.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of preoperative C-reactive protein to albumin ratio in patients with thymic epithelial tumors: a retrospective study

Huang

Liang

et al. 2022

BMC Cancer

Background The C-reactive protein to albumin ratio (CAR) is associated with poor prognosis in various cancers. However, its value in thymic epithelial tumors remains to be elucidated, we aimed to evaluate the prognostic significance of preoperative CAR in patients with surgically resected thymic epithelial tumors (TETs). Methods We retrospectively collected data from 125 patients with TETs who underwent thymoma resection at our center. The best cutoff values for the continuous variable, CAR, were obtained using X-tile software. Univariate and multivariate Cox regression analyses were used to evaluate CAR as an independent predictor of overall survival (OS) and recurrence-free survival (RFS). Kaplan–Meier analysis and log-rank tests were used to present risk stratification of patients based on CAR and the Glasgow-prognostic-score (GPS). The prognostic effect of CAR was assessed using a receiver operating characteristic curve. Results Patients were categorized into high (≥ 0.17) and low (< 0.17) CAR groups according to the optimal cutoff value of 0.17. Univariate and multivariate analyses showed that CAR was an independent predictor of prognosis. World health organization stage, CAR level, GPS score, and drinking history were important independent prognostic factors for OS (p < 0.05). T stage, CAR level, and drinking history were important independent prognostic factors for RFS (p < 0.05). The area under the curve value of CAR to predict prognosis was 0.734 for OS and 0.680 for RFS. Conclusions Elevated preoperative CAR was independently associated with poor OS and RFS after thymectomy. Therefore, CAR may be a valuable biomarker for the postoperative prognosis of TETs.