Palliative Care Unit, National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil.
Palliative Care Unit, National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil.
J Pain Symptom Manage. 2021 Nov;62(5):978-986. doi: 10.1016/j.jpainsymman.2021.04.009. Epub 2021 Apr 22.
Inflammatory biomarkers have prognostic value in cancer patients, but the feasibility of their use with terminal cancer patients and the related cutoff points are poorly explored.
To describe the percentiles values of inflammatory biomarkers; to identify their cutoff points in relation to death; and to determine the prognostic value of C-reactive protein (CRP), leukocytes, neutrophils, neutrophil/lymphocyte ratio (NLR), CRP/albumin ratio (CAR), and modified Glasgow Prognostic Score for death within 90 days, in terminal cancer patients receiving palliative care.
Prospective cohort study that included patients who received palliative care at the Palliative Care Unit of the National Cancer Institute (Brazil) between October 2019 and March 2020. Receiver operating characteristic curves were used to identify the optimal cutoff points of the inflammatory biomarkers for the prediction of death in 90 days. Kaplan-Meier curves and Cox regression were used to verify the prognostic value of these cutoff points and concordance statistic (C-statistic) was used to test their predictive accuracy.
A total 205 patients (mean age: 62.5 years; female: 59%) were included in the study. The optimal cutoff points were CRP ≥6.7mg/L, CAR ≥2.0, leukocytes ≥9300/μL, neutrophils ≥7426/μL and NLR ≥6.0. All biomarkers showed prognostic value and good predictive accuracy when their cutoff points were used, especially CAR, which presented excellent discrimination power (C-statistic: 0.80).
The inflammatory biomarkers analyzed are independent predictive factors for death within 90 days in terminal cancer patients. CAR appears to be the most useful parameter for predicting survival in these patients.
炎症生物标志物对癌症患者具有预后价值，但它们在终末期癌症患者中的应用可行性及其相关截断值仍未得到充分探索。
描述炎症生物标志物的百分位数值；确定其与死亡相关的截断值；并确定 C 反应蛋白（CRP）、白细胞、中性粒细胞、中性粒细胞/淋巴细胞比值（NLR）、CRP/白蛋白比值（CAR）和改良格拉斯哥预后评分在接受姑息治疗的终末期癌症患者中，预测 90 天内死亡的预后价值。
前瞻性队列研究，纳入 2019 年 10 月至 2020 年 3 月在巴西国家癌症研究所姑息治疗病房接受姑息治疗的患者。采用受试者工作特征曲线确定炎症生物标志物预测 90 天内死亡的最佳截断值。Kaplan-Meier 曲线和 Cox 回归用于验证这些截断值的预后价值，并使用一致性统计量（C 统计量）检验其预测准确性。
共有 205 例患者（平均年龄：62.5 岁；女性：59%）纳入本研究。CRP≥6.7mg/L、CAR≥2.0、白细胞≥9300/μL、中性粒细胞≥7426/μL 和 NLR≥6.0 是最佳截断值。所有标志物均具有预后价值，且使用其截断值时具有良好的预测准确性，尤其是 CAR，其具有出色的判别能力（C 统计量：0.80）。
分析的炎症生物标志物是终末期癌症患者 90 天内死亡的独立预测因素。CAR 似乎是预测这些患者生存的最有用参数。
