Effects of systemic inflammation and frailty on survival in elderly cancer patients: Results from the INSCOC study
BackgroundFrailty and systemic inflammation are parameters, which are easy to evaluate, can be used to predict disease outcomes, and are potentially modifiable. The combination of frailty and inflammation-based data may help identify elderly cancer patients predisposed to adverse clinical outcomes....
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Frontiers Media S.A.
2023-02-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2023.936904/full |
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| author | Qi Zhang Qi Zhang Qi Zhang Qi Zhang Ziwen Wang Ziwen Wang Ziwen Wang Ziwen Wang Mengmeng Song Mengmeng Song Mengmeng Song Mengmeng Song Tong Liu Tong Liu Tong Liu Tong Liu Jiashan Ding Li Deng Li Deng Li Deng Li Deng Xi Zhang Xi Zhang Xi Zhang Xi Zhang Liang Qian Yizhong Ge Hailun Xie Hailun Xie Hailun Xie Hailun Xie Guotian Ruan Guotian Ruan Guotian Ruan Guotian Ruan Chunhua Song Qinghua Yao Hongxia Xu Haixing Ju Hanping Shi Hanping Shi Hanping Shi Hanping Shi |
| author_facet | Qi Zhang Qi Zhang Qi Zhang Qi Zhang Ziwen Wang Ziwen Wang Ziwen Wang Ziwen Wang Mengmeng Song Mengmeng Song Mengmeng Song Mengmeng Song Tong Liu Tong Liu Tong Liu Tong Liu Jiashan Ding Li Deng Li Deng Li Deng Li Deng Xi Zhang Xi Zhang Xi Zhang Xi Zhang Liang Qian Yizhong Ge Hailun Xie Hailun Xie Hailun Xie Hailun Xie Guotian Ruan Guotian Ruan Guotian Ruan Guotian Ruan Chunhua Song Qinghua Yao Hongxia Xu Haixing Ju Hanping Shi Hanping Shi Hanping Shi Hanping Shi |
| author_sort | Qi Zhang |
| collection | DOAJ |
| description | BackgroundFrailty and systemic inflammation are parameters, which are easy to evaluate, can be used to predict disease outcomes, and are potentially modifiable. The combination of frailty and inflammation-based data may help identify elderly cancer patients predisposed to adverse clinical outcomes. The aim of this study was to examine the association of systemic inflammation and frailty at admission, and to determine whether these risk factors interact and may predict the survival of elderly cancer patients.MethodsA prospective Investigation on Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) with 5,106 elderly cancer patients admitted from 2013 through 2020 was included in this study. The primary marker of inflammation was the neutrophil-to-lymphocyte ratio (NLR), with the reference group having NLR<3, which indicated no inflammation. Frailty was assessed using the FRAIL scale, and patients with≥3 positives out of a total of five components were assumed to be frail. The primary outcome was all-cause mortality. We classified participants according to the presence (or absence) of frailty and high inflammation and assessed their association with overall survival using the Cox proportional hazards models adjusted for demographic, tumor, and treatment factors.ResultsAmong the 5,106 patients enrolled in the study, 3396 individuals (66.51%) were male and the mean( ± SD) age at diagnosis was 70.92( ± 5.34). Over a median of 33.5 months follow-up, we observed 2,315 deaths. Increasing NLR was associated with frailty (compared with NLR<3, odds ratio=1.23, 95%CI=1.08-1.41 for NLR≥3). An NLR≥3 and frailty independently predicted the overall survival [hazard ratio(HR)=1.35, 95%CI=1.24-1.47 and HR=1.38, 95%CI=1.25-1.52, respectively). Patients with both frailty and NLR≥3 had the lowest overall survival(HR=1.83, 95%CI=1.59-2.04) than patients with no risk factors. The mortality rate increased with the presence of the frailty components.ConclusionsSystemic inflammation was positively associated with frailty. Frail elderly cancer patients with elevated systemic inflammation had low survival rate. |
| first_indexed | 2024-04-10T09:24:33Z |
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| issn | 1664-3224 |
| language | English |
| last_indexed | 2024-04-10T09:24:33Z |
| publishDate | 2023-02-01 |
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| series | Frontiers in Immunology |
| spelling | doaj.art-99e0367b6f9a4712875ce76547bd472d2023-02-20T07:23:50ZengFrontiers Media S.A.Frontiers in Immunology1664-32242023-02-011410.3389/fimmu.2023.936904936904Effects of systemic inflammation and frailty on survival in elderly cancer patients: Results from the INSCOC studyQi Zhang0Qi Zhang1Qi Zhang2Qi Zhang3Ziwen Wang4Ziwen Wang5Ziwen Wang6Ziwen Wang7Mengmeng Song8Mengmeng Song9Mengmeng Song10Mengmeng Song11Tong Liu12Tong Liu13Tong Liu14Tong Liu15Jiashan Ding16Li Deng17Li Deng18Li Deng19Li Deng20Xi Zhang21Xi Zhang22Xi Zhang23Xi Zhang24Liang Qian25Yizhong Ge26Hailun Xie27Hailun Xie28Hailun Xie29Hailun Xie30Guotian Ruan31Guotian Ruan32Guotian Ruan33Guotian Ruan34Chunhua Song35Qinghua Yao36Hongxia Xu37Haixing Ju38Hanping Shi39Hanping Shi40Hanping Shi41Hanping Shi42Department of Colorectal Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital) Hangzhou, Zhejiang, ChinaKey Laboratory of Cancer Food for Special Medical Purposes (FSMP) for State Market Regulation, Beijing Shijitan Hospital, Beijing, ChinaBeijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing Shijitan Hospital, Beijing, ChinaIntegrated Traditional Chinese and Western Medicine Oncology Laboratory, Key Laboratory of Traditional Chinese Medicine of Zhejiang Province, Hangzhou, Zhejiang, ChinaKey Laboratory of Cancer Food for Special Medical Purposes (FSMP) for State Market Regulation, Beijing Shijitan Hospital, Beijing, ChinaBeijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing Shijitan Hospital, Beijing, ChinaDepartment of Cardiology, Geriatric Cardiovascular Disease Research and Treatment Center, the 82nd Group Army Hospital of PLA (252 Hospital of PLA), Baoding, Hebei, ChinaDepartment of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, ChinaKey Laboratory of Cancer Food for Special Medical Purposes (FSMP) for State Market Regulation, Beijing Shijitan Hospital, Beijing, ChinaBeijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing Shijitan Hospital, Beijing, ChinaDepartment of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, ChinaDepartment of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, ChinaKey Laboratory of Cancer Food for Special Medical Purposes (FSMP) for State Market Regulation, Beijing Shijitan Hospital, Beijing, ChinaBeijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing Shijitan Hospital, Beijing, ChinaDepartment of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, ChinaDepartment of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, ChinaDepartment of Obstetrics and Gynecology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, ChinaKey Laboratory of Cancer Food for Special Medical Purposes (FSMP) for State Market Regulation, Beijing Shijitan Hospital, Beijing, ChinaBeijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing Shijitan Hospital, Beijing, ChinaDepartment of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, ChinaDepartment of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, ChinaKey Laboratory of Cancer Food for Special Medical Purposes (FSMP) for State Market Regulation, Beijing Shijitan Hospital, Beijing, ChinaBeijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing Shijitan Hospital, Beijing, ChinaDepartment of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, ChinaDepartment of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, ChinaDepartment of Obstetrics and Gynecology, Hangzhou Women’s Hospital, Hangzhou Maternal and Child Health Hospital, Hangzhou First People’s Hospital Qianjiang, Hangzhou, China0Department of Oncology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, ChinaKey Laboratory of Cancer Food for Special Medical Purposes (FSMP) for State Market Regulation, Beijing Shijitan Hospital, Beijing, ChinaBeijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing Shijitan Hospital, Beijing, ChinaDepartment of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, ChinaDepartment of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, ChinaKey Laboratory of Cancer Food for Special Medical Purposes (FSMP) for State Market Regulation, Beijing Shijitan Hospital, Beijing, ChinaBeijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing Shijitan Hospital, Beijing, ChinaDepartment of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, ChinaDepartment of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China1Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China2Department of Integrated Chinese and Western Medicine, Cancer Hospital of University of Chinese Academy of Science, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China3Department of Clinical Nutrition, Daping Hospital, Army Medical University, Chongqing, ChinaDepartment of Colorectal Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital) Hangzhou, Zhejiang, ChinaKey Laboratory of Cancer Food for Special Medical Purposes (FSMP) for State Market Regulation, Beijing Shijitan Hospital, Beijing, ChinaBeijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing Shijitan Hospital, Beijing, ChinaDepartment of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, ChinaDepartment of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, ChinaBackgroundFrailty and systemic inflammation are parameters, which are easy to evaluate, can be used to predict disease outcomes, and are potentially modifiable. The combination of frailty and inflammation-based data may help identify elderly cancer patients predisposed to adverse clinical outcomes. The aim of this study was to examine the association of systemic inflammation and frailty at admission, and to determine whether these risk factors interact and may predict the survival of elderly cancer patients.MethodsA prospective Investigation on Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) with 5,106 elderly cancer patients admitted from 2013 through 2020 was included in this study. The primary marker of inflammation was the neutrophil-to-lymphocyte ratio (NLR), with the reference group having NLR<3, which indicated no inflammation. Frailty was assessed using the FRAIL scale, and patients with≥3 positives out of a total of five components were assumed to be frail. The primary outcome was all-cause mortality. We classified participants according to the presence (or absence) of frailty and high inflammation and assessed their association with overall survival using the Cox proportional hazards models adjusted for demographic, tumor, and treatment factors.ResultsAmong the 5,106 patients enrolled in the study, 3396 individuals (66.51%) were male and the mean( ± SD) age at diagnosis was 70.92( ± 5.34). Over a median of 33.5 months follow-up, we observed 2,315 deaths. Increasing NLR was associated with frailty (compared with NLR<3, odds ratio=1.23, 95%CI=1.08-1.41 for NLR≥3). An NLR≥3 and frailty independently predicted the overall survival [hazard ratio(HR)=1.35, 95%CI=1.24-1.47 and HR=1.38, 95%CI=1.25-1.52, respectively). Patients with both frailty and NLR≥3 had the lowest overall survival(HR=1.83, 95%CI=1.59-2.04) than patients with no risk factors. The mortality rate increased with the presence of the frailty components.ConclusionsSystemic inflammation was positively associated with frailty. Frail elderly cancer patients with elevated systemic inflammation had low survival rate.https://www.frontiersin.org/articles/10.3389/fimmu.2023.936904/fullfrailtysystematic inflammationneutrophil to lymphocyte ratiocancerelderly |
| spellingShingle | Qi Zhang Qi Zhang Qi Zhang Qi Zhang Ziwen Wang Ziwen Wang Ziwen Wang Ziwen Wang Mengmeng Song Mengmeng Song Mengmeng Song Mengmeng Song Tong Liu Tong Liu Tong Liu Tong Liu Jiashan Ding Li Deng Li Deng Li Deng Li Deng Xi Zhang Xi Zhang Xi Zhang Xi Zhang Liang Qian Yizhong Ge Hailun Xie Hailun Xie Hailun Xie Hailun Xie Guotian Ruan Guotian Ruan Guotian Ruan Guotian Ruan Chunhua Song Qinghua Yao Hongxia Xu Haixing Ju Hanping Shi Hanping Shi Hanping Shi Hanping Shi Effects of systemic inflammation and frailty on survival in elderly cancer patients: Results from the INSCOC study Frontiers in Immunology frailty systematic inflammation neutrophil to lymphocyte ratio cancer elderly |
| title | Effects of systemic inflammation and frailty on survival in elderly cancer patients: Results from the INSCOC study |
| title_full | Effects of systemic inflammation and frailty on survival in elderly cancer patients: Results from the INSCOC study |
| title_fullStr | Effects of systemic inflammation and frailty on survival in elderly cancer patients: Results from the INSCOC study |
| title_full_unstemmed | Effects of systemic inflammation and frailty on survival in elderly cancer patients: Results from the INSCOC study |
| title_short | Effects of systemic inflammation and frailty on survival in elderly cancer patients: Results from the INSCOC study |
| title_sort | effects of systemic inflammation and frailty on survival in elderly cancer patients results from the inscoc study |
| topic | frailty systematic inflammation neutrophil to lymphocyte ratio cancer elderly |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2023.936904/full |
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