Frontiers in Immunology (Feb 2023)
Effects of systemic inflammation and frailty on survival in elderly cancer patients: Results from the INSCOC study
- 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
Affiliations
- Qi Zhang
- Department of Colorectal Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital) Hangzhou, Zhejiang, China
- Qi Zhang
- Key Laboratory of Cancer Food for Special Medical Purposes (FSMP) for State Market Regulation, Beijing Shijitan Hospital, Beijing, China
- Qi Zhang
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing Shijitan Hospital, Beijing, China
- Qi Zhang
- Integrated Traditional Chinese and Western Medicine Oncology Laboratory, Key Laboratory of Traditional Chinese Medicine of Zhejiang Province, Hangzhou, Zhejiang, China
- Ziwen Wang
- Key Laboratory of Cancer Food for Special Medical Purposes (FSMP) for State Market Regulation, Beijing Shijitan Hospital, Beijing, China
- Ziwen Wang
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing Shijitan Hospital, Beijing, China
- Ziwen Wang
- Department of Cardiology, Geriatric Cardiovascular Disease Research and Treatment Center, the 82nd Group Army Hospital of PLA (252 Hospital of PLA), Baoding, Hebei, China
- Ziwen Wang
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Mengmeng Song
- Key Laboratory of Cancer Food for Special Medical Purposes (FSMP) for State Market Regulation, Beijing Shijitan Hospital, Beijing, China
- Mengmeng Song
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing Shijitan Hospital, Beijing, China
- Mengmeng Song
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Mengmeng Song
- Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Tong Liu
- Key Laboratory of Cancer Food for Special Medical Purposes (FSMP) for State Market Regulation, Beijing Shijitan Hospital, Beijing, China
- Tong Liu
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing Shijitan Hospital, Beijing, China
- Tong Liu
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Tong Liu
- Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Jiashan Ding
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Li Deng
- Key Laboratory of Cancer Food for Special Medical Purposes (FSMP) for State Market Regulation, Beijing Shijitan Hospital, Beijing, China
- Li Deng
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing Shijitan Hospital, Beijing, China
- Li Deng
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Li Deng
- Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Xi Zhang
- Key Laboratory of Cancer Food for Special Medical Purposes (FSMP) for State Market Regulation, Beijing Shijitan Hospital, Beijing, China
- Xi Zhang
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing Shijitan Hospital, Beijing, China
- Xi Zhang
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Xi Zhang
- Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Liang Qian
- Department of Obstetrics and Gynecology, Hangzhou Women’s Hospital, Hangzhou Maternal and Child Health Hospital, Hangzhou First People’s Hospital Qianjiang, Hangzhou, China
- Yizhong Ge
- 0Department of Oncology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Hailun Xie
- Key Laboratory of Cancer Food for Special Medical Purposes (FSMP) for State Market Regulation, Beijing Shijitan Hospital, Beijing, China
- Hailun Xie
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing Shijitan Hospital, Beijing, China
- Hailun Xie
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Hailun Xie
- Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Guotian Ruan
- Key Laboratory of Cancer Food for Special Medical Purposes (FSMP) for State Market Regulation, Beijing Shijitan Hospital, Beijing, China
- Guotian Ruan
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing Shijitan Hospital, Beijing, China
- Guotian Ruan
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Guotian Ruan
- Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Chunhua Song
- 1Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
- Qinghua Yao
- 2Department 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, China
- Hongxia Xu
- 3Department of Clinical Nutrition, Daping Hospital, Army Medical University, Chongqing, China
- Haixing Ju
- Department of Colorectal Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital) Hangzhou, Zhejiang, China
- Hanping Shi
- Key Laboratory of Cancer Food for Special Medical Purposes (FSMP) for State Market Regulation, Beijing Shijitan Hospital, Beijing, China
- Hanping Shi
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing Shijitan Hospital, Beijing, China
- Hanping Shi
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Hanping Shi
- Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- DOI
- https://doi.org/10.3389/fimmu.2023.936904
- Journal volume & issue
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Vol. 14
Abstract
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.
Keywords