Overall Survival Prediction of Advanced Cancer Patients by Selection of the Most Significant Baseline Serum Biomarker Combination

Abstract

Introduction: Consistent association between elevated baseline serum values and C-reactive protein (CRP), cross-linked fibrin degradation products (D-dimer), lactate dehydrogenase (LDH), decreased baseline serum albumin, absolute lymphocyte count to absolute monocyte count ratio (LMR), elevated absolute neutrophil count to absolute lymphocyte count ratio (NLR), elevated platelet count to absolute lymphocyte count ratio (PLR), and between some combinations of these biomarkers and the short overall survival of patients with malignant diseases has already been reported. These biomarkers are independent prognostic factors for cancer. Here, the most significant biomarker combination of these values was searched and studied in real-life advanced cancer patients of a single center.Methods: The authors retrospectively analyzed the association of the aforementioned biomarkers and their combination and OS of 75 consecutive cancer patients with locally advanced, recurrent, or metastatic diseases. Validated cut-off determination was used.Results: CRP, albumin, and PLR showed marked association with OS. Cut-off values for significant shorter OS were 30.65 mg/L (p < 0.001), 44.35 g/L (p < 0.001), and 168.20 (p < 0.001), respectively. Based on assessed biomarker cut-offs, four patient groups were created to determine whether biomarker values were out of range (ORV) compared to cut-off: 1) No ORV biomarkers (n = 24; OS = 26.07 months); 2) one ORV biomarker (n = 21; OS = 13.50 months); 3) two ORV biomarkers (n = 20; OS = 7.97 months), and 4) three ORV biomarkers (n = 10; OS = 3.91 months). Significant differences in OS were detected between the groups: For 1. vs. 2. hazard ratio (HR) = 3.0 (95% CI: 1.5–6.2), p = 0.003; for 1. vs. 3. HR = 4.1 (95% CI: 2.0–8.3), p < 0.001; and for 1. vs. 4. HR = 10.2 (95% CI: 4.2–24.6), p < 0.001.Conclusion: Based on our analysis, we can confirm that the complex monitoring of CRP, albumin, and PLR would provide a good estimation of OS. Large scale prospective studies are warranted to explore this and other useful combinations of prognostic biomarkers and their relationship to the well-established prognostic systems in real-life.

A vérképből meghatározott neutrophil-lymphocyta arány prognosztikai értéke daganatos betegségekben

“…Az alábbiakban a szerző bemutatja néhány metaanalízis és validációs vizsgálat alapján az emelkedett NLR és a rosszindulatú daganatos betegek rövidebb túlélése közötti összefüggést. Továbbá közli saját megfigyeléseit is a munkahelyén kezelt előrehaladott daganatos betegek adatai [9] alapján.…”

“…A szerző elemezte a korábbi retrospektív vizsgálata [9] alapját képező ugyanazon betegek adatainak eredményeit az NLR prognosztikai szerepének szempontjából.…”

“…Így az adatbázis lezárásáig 6 (8%) beteg volt életben. A betegek jellemzőit az 3. táblázat foglalja össze [9]. A medián utánkövetési idő 46,9 hónapja (95% CI 37,2-49,3) mellett a medián OS 12,1 hónap (tartomány: 0,06-48,89) volt (95% CI 7,8-18,3).…”

“…A korábbi retrospektív elemzés [9] ugyanazon 75 betege adatainak vizsgálatát elvégezte a szerző abból a szempontból, hogy az NLR-alapérték és a betegek rossz prognózisa közötti összefüggést bemutathassa. Szignifikáns különbséget kapott a vágóérték feletti és alatti csoportok között.…”

Performance of mid-upper arm circumference and other prognostic indices based on inflammation and nutrition in oncology outpatients: a tertiary cancer center study

“…There is growing evidence that a systemic inflammatory response is a major factor of muscle wasting and functional decline in patients with cachexia (4)(5)(6)(7)(8). One of the sensitive measures of the systemic inflammatory response is C-reactive protein (CRP), and various studies have demonstrated the prognostic value of CRP in patients with cancer (9)(10)(11). The Glasgow Prognostic Score (GPS) and modified GPS (mGPS) are the most widely studied inflammation-based prognostic indices incorporating CRP (12)(13)(14)(15).…”