Highly elevated systemic inflammation is a strong independent predictor of early mortality in advanced non-small cell lung cancer
Background: Ample evidence support inflammation as a marker of outcome in non-small cell lung cancer (NSCLC). Here we explore the outcome for a subgroup of patients with advanced disease and substantially elevated systemic inflammatory activity. Methods: The source cohort included consecutive patien...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-01-01
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| Series: | Cancer Treatment and Research Communications |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468294222000466 |
| _version_ | 1828332432438329344 |
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| author | Johan Isaksson Leo Wennström Eva Branden Hirsh Koyi Anders Berglund Patrick Micke Johanna Sofia Margareta Mattsson Linda Willén Johan Botling |
| author_facet | Johan Isaksson Leo Wennström Eva Branden Hirsh Koyi Anders Berglund Patrick Micke Johanna Sofia Margareta Mattsson Linda Willén Johan Botling |
| author_sort | Johan Isaksson |
| collection | DOAJ |
| description | Background: Ample evidence support inflammation as a marker of outcome in non-small cell lung cancer (NSCLC). Here we explore the outcome for a subgroup of patients with advanced disease and substantially elevated systemic inflammatory activity. Methods: The source cohort included consecutive patients diagnosed with NSCLC between January 2016 – May 2017 (n = 155). Patients with active infection were excluded. Blood parameters were examined individually, and cut-offs (ESR > 60 mm, CRP > 20 mg/L, WBC > 10 × 109, PLT > 400 × 109) were set to define the group of hyperinflamed patients. A score was developed by assigning one point for each parameter above cut-off (0–4 points). Results: High systemic inflammation was associated with advanced stage and was seldom present in limited NSCLC. However, the one year survival of patients in stage IIIB-IV (n = 93) with an inflammation score of ≥2 was 0% compared to 33% and 50% among patients with a score of 1 and 0 respectively. The effect of a high inflammation score on overall survival remained significant in multi-variate analysis adjusted for confounding factors. The independent hazard ratio of an inflammation score ≥ 2 in multi-variate analysis (HR 3.43, CI 1.76–6.71) was comparable to a change in ECOG PS from 0 to 2 (HR 2.42, CI 1.13–5.18). Conclusion: Our results show that high level systemic inflammation is a strong independent predictor of poor survival in advanced stage NSCLC. This observation may indicate a need to use hyperinflammation as an additional clinical parameter for stratification of patients in clinical studies and warrants further research on underlying mechanisms linked to tumor progression. |
| first_indexed | 2024-04-13T21:05:55Z |
| format | Article |
| id | doaj.art-d083ff73ea5e401f92b22046c87edee2 |
| institution | Directory Open Access Journal |
| issn | 2468-2942 |
| language | English |
| last_indexed | 2024-04-13T21:05:55Z |
| publishDate | 2022-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Cancer Treatment and Research Communications |
| spelling | doaj.art-d083ff73ea5e401f92b22046c87edee22022-12-22T02:29:59ZengElsevierCancer Treatment and Research Communications2468-29422022-01-0131100556Highly elevated systemic inflammation is a strong independent predictor of early mortality in advanced non-small cell lung cancerJohan Isaksson0Leo Wennström1Eva Branden2Hirsh Koyi3Anders Berglund4Patrick Micke5Johanna Sofia Margareta Mattsson6Linda Willén7Johan Botling8Center for Research and Development, Uppsala University/Region Gävleborg, Sweden; Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden; Department of Respiratory Medicine, Gävle Hospital, Gävle, SwedenCenter for Research and Development, Uppsala University/Region Gävleborg, Sweden; Department of Respiratory Medicine, Gävle Hospital, Gävle, SwedenCenter for Research and Development, Uppsala University/Region Gävleborg, Sweden; Department of Respiratory Medicine, Gävle Hospital, Gävle, SwedenCenter for Research and Development, Uppsala University/Region Gävleborg, Sweden; Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden; Department of Oncology–Pathology, Karolinska Biomics Center, Karolinska Institutet, Stockholm, SwedenEpiStat, Uppsala, SwedenDepartment of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, SwedenDepartment of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, SwedenCenter for Research and Development, Uppsala University/Region Gävleborg, Sweden; Department of Radiation Sciences and Oncology, Umeå University Hospital, Umeå, Sweden; Department of Oncology, Gävle Hospital, Gävle, SwedenDepartment of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden; Corresponding author at: Department of Immunology, Genetics and Pathology Uppsala University, Rudbeck Laboratory 75185 Uppsala Sweden.Background: Ample evidence support inflammation as a marker of outcome in non-small cell lung cancer (NSCLC). Here we explore the outcome for a subgroup of patients with advanced disease and substantially elevated systemic inflammatory activity. Methods: The source cohort included consecutive patients diagnosed with NSCLC between January 2016 – May 2017 (n = 155). Patients with active infection were excluded. Blood parameters were examined individually, and cut-offs (ESR > 60 mm, CRP > 20 mg/L, WBC > 10 × 109, PLT > 400 × 109) were set to define the group of hyperinflamed patients. A score was developed by assigning one point for each parameter above cut-off (0–4 points). Results: High systemic inflammation was associated with advanced stage and was seldom present in limited NSCLC. However, the one year survival of patients in stage IIIB-IV (n = 93) with an inflammation score of ≥2 was 0% compared to 33% and 50% among patients with a score of 1 and 0 respectively. The effect of a high inflammation score on overall survival remained significant in multi-variate analysis adjusted for confounding factors. The independent hazard ratio of an inflammation score ≥ 2 in multi-variate analysis (HR 3.43, CI 1.76–6.71) was comparable to a change in ECOG PS from 0 to 2 (HR 2.42, CI 1.13–5.18). Conclusion: Our results show that high level systemic inflammation is a strong independent predictor of poor survival in advanced stage NSCLC. This observation may indicate a need to use hyperinflammation as an additional clinical parameter for stratification of patients in clinical studies and warrants further research on underlying mechanisms linked to tumor progression.http://www.sciencedirect.com/science/article/pii/S2468294222000466Lung cancerInflammationNSCLCSurvivalC-reactive protein |
| spellingShingle | Johan Isaksson Leo Wennström Eva Branden Hirsh Koyi Anders Berglund Patrick Micke Johanna Sofia Margareta Mattsson Linda Willén Johan Botling Highly elevated systemic inflammation is a strong independent predictor of early mortality in advanced non-small cell lung cancer Cancer Treatment and Research Communications Lung cancer Inflammation NSCLC Survival C-reactive protein |
| title | Highly elevated systemic inflammation is a strong independent predictor of early mortality in advanced non-small cell lung cancer |
| title_full | Highly elevated systemic inflammation is a strong independent predictor of early mortality in advanced non-small cell lung cancer |
| title_fullStr | Highly elevated systemic inflammation is a strong independent predictor of early mortality in advanced non-small cell lung cancer |
| title_full_unstemmed | Highly elevated systemic inflammation is a strong independent predictor of early mortality in advanced non-small cell lung cancer |
| title_short | Highly elevated systemic inflammation is a strong independent predictor of early mortality in advanced non-small cell lung cancer |
| title_sort | highly elevated systemic inflammation is a strong independent predictor of early mortality in advanced non small cell lung cancer |
| topic | Lung cancer Inflammation NSCLC Survival C-reactive protein |
| url | http://www.sciencedirect.com/science/article/pii/S2468294222000466 |
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