Prognostic importance of the baseline nutritional status and the systemic inflammatory response in small-cell lung cancer patients. Importancia pronóstica del estado nutricional basal y de la respuesta inflamatoria sistémica en pacientes con cáncer de pulmón de célula no pequeña.

Abstract

Background: Accurate prediction of outcome in advanced non-small-cell lung cancer (NSCLC) remains challenging. Even within the same stage and treatment group, survival and response to treatment vary. We set out to determine the predictive value of inflammatory markers C-reactive protein (CRP), D-dimer (DD), ceruloplasmin (Cp) and serum albumin (SA) in patients with advanced NSCLC. Methods: Retrospective, single-institutional study, comprising a cohort of patients with NSCLC stage IIIB/IV and World Health Organization performance status (PS) 0-2 who started first-line chemotherapy between January 1, 2011, and January 31, 2013. Patient records were reviewed to obtain level of pre-treatment inflammatory markers and at the time of response assessment or clinical progression. Basal levels of CRP, DD, Cp and SA and their variation were correlated with treatment response, progression-free survival (PFS) and overall survival (OS). The value of a combined index (CRP + SA) and a multivariate analysis using Cox’s proportional hazards model was to assess prognosis. Results: The study included 98 patients with a mean age of 65 years (SD ± 11), 70% were females, 83% had adenocarcinoma, 47% had more than two organs involved by metastases, and 89% had a KI > 70%. At onset of chemotherapy, 52%, 43%, 53%, 34% had abnormal levels of Cp, DD, SA and CRP respectively. Patients with low SA (p = 0.004), high DD (p = 0.012) and abnormal CRP (p = 0.040) had a worse overall response rate to first line chemotherapy. On bivariate analysis, patients with elevated CRP (HR 1.67, 95%CI: 1.28-2.69, p = 0.008) and DD (HR 2.56, 95%CI: 1.5-3.4, p = 0.006) had inferior PFS and patients with high PCR (HR 1.9, 95%CI: 1.4-2.1, p = 0.04) and low albumin (HR 2.9, 95%CI: 2.1-4.6, p = 0.03) levels had worse OS. On multivariate analysis, both albumin and PCR were independent negative prognostic factors for survival. Conclusions: CRP and albumin levels are independent prognostic factors for survival in patients with advanced NSCLC receiving first-line chemotherapy and provide additional information to established main outcomes.