Ruan Guo-Tian, Yang Ming, Zhang Xiao-Wei, Song Meng-Meng, Hu Chun-Lei, Ge Yi-Zhong, Xie Hai-Lun, Liu Tong, Tang Meng, Zhang Qi, Zhang Xi, Zhang Kang-Ping, Li Xiang-Rui, Li Qin-Qin, Chen Yong-Bing, Yu Kai-Ying, Cong Ming-Hua, Wang Kun-Hua, Shi Han-Ping
Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People's Republic of China.
Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People's Republic of China.
J Inflamm Res. 2021 Oct 27;14:5527-5540. doi: 10.2147/JIR.S332408. eCollection 2021.
Systemic inflammation and cachexia are associated with adverse clinical outcomes in elderly patients with cancer. The survival outcomes of elderly patients with cancer cachexia (EPCC) with high inflammation and a high risk of mortality are unknown. This study aimed to investigate the impact of high inflammation on the prognosis of EPCC patients with high mortality.
This multicenter cohort study included 746 EPCC (age >65 years) with a mean age of 72.00 ± 5.24 years, of whom 489 (65.5%) were male. The cut-off value for the inflammation index was obtained using the optimal survival curve. The different inflammatory indicators were assessed using the concordance index (C-index), decision curve analysis (DCA), and prognostic receiver operating characteristic (ROC). The high mortality risk group of EPCC was defined by the 2011 Fearon Cancer Diagnostic Consensus. EPCC were divided into the high-risk group, which satisfies three diagnostic criteria, and a low-risk group, which satisfies only one or two diagnostic criteria.
The C-index, DCA, and prognostic ROC indicated the superiority of advanced lung cancer inflammation index (ALI) compared with other indicators, including neutrophil-lymphocyte ratio (NLR), prognostic nutritional index (PNI), systemic immune-inflammation index (SII), and platelet-lymphocyte ratio (PLR). Whether ALI was used as a continuous or a categorical variable, ALI had a better prognostic value in EPCC compared with other inflammatory indicators. In particular, patients with low ALI (<25.03) had a worse overall survival (OS) than patients with high ALI (≥25.03) ( < 0.001, HR [95% CI] = 2.092 [1.590-2.751]). The combination effect analysis showed that the risk of mortality of the patients in the low-ALI and high-risk groups was 3.095-fold higher than that of patients in the high-ALI and low-risk groups.
The prognostic and discriminative value of the inflammatory indicator ALI was better than that of NLR, PNI, SII, and PLR in EPCC. The high-risk group of EPCC with a low ALI would increase the death risk of OS.
全身炎症和恶病质与老年癌症患者的不良临床结局相关。炎症水平高且死亡风险高的老年癌症恶病质（EPCC）患者的生存结局尚不清楚。本研究旨在探讨高炎症对高死亡率的EPCC患者预后的影响。
这项多中心队列研究纳入了746例EPCC患者（年龄>65岁），平均年龄为72.00±5.24岁，其中489例（65.5%）为男性。使用最佳生存曲线获得炎症指数的临界值。使用一致性指数（C指数）、决策曲线分析（DCA）和预后性受试者工作特征曲线（ROC）评估不同的炎症指标。EPCC的高死亡风险组根据2011年费伦癌症诊断共识定义。EPCC分为满足三项诊断标准的高风险组和仅满足一或两项诊断标准的低风险组。
C指数、DCA和预后性ROC表明，与其他指标相比，晚期肺癌炎症指数（ALI）具有优越性，这些指标包括中性粒细胞与淋巴细胞比值（NLR）、预后营养指数（PNI）、全身免疫炎症指数（SII）和血小板与淋巴细胞比值（PLR）。无论ALI作为连续变量还是分类变量使用，与其他炎症指标相比，ALI在EPCC中具有更好的预后价值。特别是，低ALI（<25.03）的患者总生存期（OS）比高ALI（≥25.03）的患者更差（<0.001，HR[95%CI]=2.092[1.590-2.751]）。联合效应分析表明，低ALI和高风险组患者的死亡风险比高ALI和低风险组患者高3.095倍。
在EPCC中，炎症指标ALI的预后和鉴别价值优于NLR、PNI、SII和PLR。低ALI的EPCC高风险组会增加OS的死亡风险。
