Preoperative Inflammatory Markers as a Predictor of Three-Year Overall Survival in Older Cancer Patients Undergoing Oncologic Surgery

Abstract

Oncologic surgery results in substantially higher morbidity and mortality rates in older patients compared to younger patients, yet little is known about the relation between the preoperative inflammatory state and postoperative outcome in the specific group of older cancer patients. The aim of this study was to examine whether preoperative inflammatory markers could be a predictor of overall survival in older patients undergoing elective surgery for a solid malignant tumor. Patients 65 years and older undergoing surgery for a solid malignant tumor were included in a prospective cohort study. Inflammatory markers C-reactive protein (CRP), interleukin-1 beta (IL-1β), IL-6, IL10, IL-12 and tumor necrosis factor-alpha (TNF-α) were measured in plasma samples preoperatively. The main outcome was overall survival three years after surgery. Between 2010 and 2016, 328 patients with a median age of 71.5 years (range 65–89) were included. A significantly higher mortality rate three years after surgery, was found in patients with high preoperative plasma levels of CRP and IL-6 (p = 0.013 and p = 0.046, respectively). In multivariate analysis, corrected for variables such as age, disease stage, frailty, comorbidities, type of surgery and complications, a preoperative plasma level of CRP ≥ 10 mg/L was an independent prognostic factor for inferior overall survival three years after surgery (multivariate hazard ratio 1.50, 95% confidence interval 1.04–2.16, p = 0.031). Also, for the specific group of patients with colorectal cancer, a preoperative plasma level of CRP ≥ 10 mg/L was a prognostic factor for inferior survival three years after surgery (multivariate hazard ratio 2.40, 95% confidence interval 1.20–4.81, p = 0.014). Preoperative elevated plasma level of CRP is an independent unfavorable prognostic factor for overall survival three years after oncologic surgery. This gives more insight into the relationship between inflammation and survival in older cancer patients, and might contribute to risk stratification for poor outcome after surgery in older cancer patients.

Does Inflammation Contribute to Cancer Incidence and Mortality during Aging? A Conceptual Review

“…In this special issue of Cancers , Brattinga et al, report a significantly higher mortality rate three years after surgery in patients (median age 71.5) with pre-operative higher CRP or IL-6 plasma levels. This association was independent of age, disease stage, comorbidities, type of surgery and complications [ 52 ].…”

Timed Up and Go test and long term survival in older adults after oncologic surgery

“…The data for this study concerns the long-term follow-up of three prospective observational cohort studies [17,[20][21][22][23][24][25][26][27][28].…”

“…Data collection was conducted according to the revised version of the Declaration of Helsinki (October 2013, Brazil). Patients from the PICNIC, PICNIC B-HAPPY and PREOP cohorts were described earlier [17,[20][21][22][23][24][25][26][27][28]. From all individual participants included in the study, informed consent was obtained in accord with the ethical standard of the local ethics committees in the participating centers.…”

Association between inflammation-based prognostic markers and mortality of non-cardiac surgery

“…Recently, increasing evidence has indicated that combining various markers of systemic inflammatory response or nutritional condition could better reflect clinical prognosis [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. A number of combinations using inflammation-based and nutritional biomarkers such as C-reactive protein (CRP)-to-albumin ratio (CAR) [10,16,17], neutrophil-to-lymphocyte ratio (NLR) [11], platelet-to-lymphocyte ratio (PLR) [12], and modified Glasgow Prognostic Score (mGPS) [13] have been proposed to reflect poor prognosis at higher levels.…”