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Association of systemic inflammation with survival in patients with cancer cachexia: results from a multicentre cohort study

BACKGROUND: Although systemic inflammation is an important feature of the cancer cachexia, studies on the association between systemic inflammation and prognostic of cancer cachexia are limited. The objective of this study is to evaluate whether the neutrophil‐to‐lymphocyte ratio (NLR) is associated...

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Autores principales: Zhang, Qi, Song, Meng‐Meng, Zhang, Xi, Ding, Jia‐Shan, Ruan, Guo‐Tian, Zhang, Xiao‐Wei, Liu, Tong, Yang, Ming, Ge, Yi‐Zhong, Tang, Meng, Li, Xiang‐Rui, Qian, Liang, Song, Chun‐Hua, Xu, Hong‐Xia, Shi, Han‐Ping
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8718079/
https://www.ncbi.nlm.nih.gov/pubmed/34337882
http://dx.doi.org/10.1002/jcsm.12761
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author Zhang, Qi
Song, Meng‐Meng
Zhang, Xi
Ding, Jia‐Shan
Ruan, Guo‐Tian
Zhang, Xiao‐Wei
Liu, Tong
Yang, Ming
Ge, Yi‐Zhong
Tang, Meng
Li, Xiang‐Rui
Qian, Liang
Song, Chun‐Hua
Xu, Hong‐Xia
Shi, Han‐Ping
author_facet Zhang, Qi
Song, Meng‐Meng
Zhang, Xi
Ding, Jia‐Shan
Ruan, Guo‐Tian
Zhang, Xiao‐Wei
Liu, Tong
Yang, Ming
Ge, Yi‐Zhong
Tang, Meng
Li, Xiang‐Rui
Qian, Liang
Song, Chun‐Hua
Xu, Hong‐Xia
Shi, Han‐Ping
author_sort Zhang, Qi
collection PubMed
description BACKGROUND: Although systemic inflammation is an important feature of the cancer cachexia, studies on the association between systemic inflammation and prognostic of cancer cachexia are limited. The objective of this study is to evaluate whether the neutrophil‐to‐lymphocyte ratio (NLR) is associated with outcome and quality of life for patients with cancer cachexia and investigated any interaction between NLR and the clinical parameters. METHODS: This is a multicentre cohort study of 2612 cancer patients suffering from cachexia diagnosed between June 2012 and December 2019. The main parameters measured were overall survival (OS) time and all‐cause mortality. The association between NLR and all‐cause mortality was evaluated using hazard ratios (HRs) and the restricted cubic spline model with a two‐sided P‐value. Optimal stratification was used to solve threshold points. We also evaluated the cross‐classification of NLR for each variable of survival. RESULTS: Of the 2612 participants diagnosed with cancer cachexia, 1533 (58.7%) were male, and the mean (SD) age was 58.7 (11.7) years. Over a median follow‐up of 4.5 years, we observed 1189 deaths. The overall mortality rate for patients with cancer cachexia during the first 12 months was 30.2% (95%CI: 28.4%–32.0%), resulting in a rate of 226.07 events per 1000 patient‐years. An increase in NLR had an inverted L‐shaped dose–response association with all‐cause mortality. The optimal cut‐off point for NLR as a predictor of mortality in cancer patients with cachexia was 3.5. An NLR of 3.5 or greater could independently predict OS (HR, 1.51, 95%CI: 1.33–1.71). These associations were consistent across subtypes of cancer. Several potential effect modifiers were identified including gender, BMI, tumour type, KPS score and albumin in content. Increasing NLRs were independently associated with a worsening in the majority of EORTC QLQ‐C30 domains. Elevated baseline NLR was associated with low response and poor survival in patients treated with immunotherapy. CONCLUSIONS: The baseline NLR status was found to be a significant negative prognostic biomarker for patients with cachexia; this effect was independent of other known prognostic factors.
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spelling pubmed-87180792022-01-07 Association of systemic inflammation with survival in patients with cancer cachexia: results from a multicentre cohort study Zhang, Qi Song, Meng‐Meng Zhang, Xi Ding, Jia‐Shan Ruan, Guo‐Tian Zhang, Xiao‐Wei Liu, Tong Yang, Ming Ge, Yi‐Zhong Tang, Meng Li, Xiang‐Rui Qian, Liang Song, Chun‐Hua Xu, Hong‐Xia Shi, Han‐Ping J Cachexia Sarcopenia Muscle Original Articles BACKGROUND: Although systemic inflammation is an important feature of the cancer cachexia, studies on the association between systemic inflammation and prognostic of cancer cachexia are limited. The objective of this study is to evaluate whether the neutrophil‐to‐lymphocyte ratio (NLR) is associated with outcome and quality of life for patients with cancer cachexia and investigated any interaction between NLR and the clinical parameters. METHODS: This is a multicentre cohort study of 2612 cancer patients suffering from cachexia diagnosed between June 2012 and December 2019. The main parameters measured were overall survival (OS) time and all‐cause mortality. The association between NLR and all‐cause mortality was evaluated using hazard ratios (HRs) and the restricted cubic spline model with a two‐sided P‐value. Optimal stratification was used to solve threshold points. We also evaluated the cross‐classification of NLR for each variable of survival. RESULTS: Of the 2612 participants diagnosed with cancer cachexia, 1533 (58.7%) were male, and the mean (SD) age was 58.7 (11.7) years. Over a median follow‐up of 4.5 years, we observed 1189 deaths. The overall mortality rate for patients with cancer cachexia during the first 12 months was 30.2% (95%CI: 28.4%–32.0%), resulting in a rate of 226.07 events per 1000 patient‐years. An increase in NLR had an inverted L‐shaped dose–response association with all‐cause mortality. The optimal cut‐off point for NLR as a predictor of mortality in cancer patients with cachexia was 3.5. An NLR of 3.5 or greater could independently predict OS (HR, 1.51, 95%CI: 1.33–1.71). These associations were consistent across subtypes of cancer. Several potential effect modifiers were identified including gender, BMI, tumour type, KPS score and albumin in content. Increasing NLRs were independently associated with a worsening in the majority of EORTC QLQ‐C30 domains. Elevated baseline NLR was associated with low response and poor survival in patients treated with immunotherapy. CONCLUSIONS: The baseline NLR status was found to be a significant negative prognostic biomarker for patients with cachexia; this effect was independent of other known prognostic factors. John Wiley and Sons Inc. 2021-08-02 2021-12 /pmc/articles/PMC8718079/ /pubmed/34337882 http://dx.doi.org/10.1002/jcsm.12761 Text en © 2021 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Articles
Zhang, Qi
Song, Meng‐Meng
Zhang, Xi
Ding, Jia‐Shan
Ruan, Guo‐Tian
Zhang, Xiao‐Wei
Liu, Tong
Yang, Ming
Ge, Yi‐Zhong
Tang, Meng
Li, Xiang‐Rui
Qian, Liang
Song, Chun‐Hua
Xu, Hong‐Xia
Shi, Han‐Ping
Association of systemic inflammation with survival in patients with cancer cachexia: results from a multicentre cohort study
title Association of systemic inflammation with survival in patients with cancer cachexia: results from a multicentre cohort study
title_full Association of systemic inflammation with survival in patients with cancer cachexia: results from a multicentre cohort study
title_fullStr Association of systemic inflammation with survival in patients with cancer cachexia: results from a multicentre cohort study
title_full_unstemmed Association of systemic inflammation with survival in patients with cancer cachexia: results from a multicentre cohort study
title_short Association of systemic inflammation with survival in patients with cancer cachexia: results from a multicentre cohort study
title_sort association of systemic inflammation with survival in patients with cancer cachexia: results from a multicentre cohort study
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8718079/
https://www.ncbi.nlm.nih.gov/pubmed/34337882
http://dx.doi.org/10.1002/jcsm.12761
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