Association of Nutrition Parameters Including Bioelectrical Impedance and Systemic Inflammatory Response With Quality of Life and Prognosis in Patients With Advanced Non-Small-Cell Lung Cancer: A Prospective Study

Abstract

Early identification and treatment of nutritional deficiencies can lead to improved outcomes in the quality of life (QoL) and survival of patients with nonsmall cell lung cancer (NSCLC). Noninvasive techniques are needed to evaluate changes in body composition as part of determining nutritional status. The aim of the study was to evaluate the association of nutritional parameters in health-related quality of life (HRQL) and survival in patients with advanced NSCLC. Chemotherapy-naïve patients with advanced NSCLC with good performance status Eastern Cooperative Oncology Group (ECOG) 0-2 were included prospectively in the study. We evaluated inflammatory parameters such as C-reactive protein, platelet/lymphocyte index, neutrophil/lymphocyte index, serum interleukin (IL)-6, and tumor necrosis factor-α, and nutritional variables such as body mass index (BMI) and serum albumin levels. Bioelectrical impedance analysis including phase angle was obtained before cisplatin-based chemotherapy was started. HRQL was assessed by application of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ)-C30 and QLQ-LC13 instruments at baseline. Overall survival (OS) was calculated with the Kaplan-Meier method and analyzed with log-rank and Cox proportional hazard models. One hundred nineteen patients were included. Mean BMI was 24.8 ± 4.5 kg/m(2), average weight loss of patients was 8.4%, and median phase angle was 5.8°. Malnutrition measured by subjective global assessment (SGA), weight loss >10%, BMI >20 was associated with lower HRQL scales. Patients with ECOG 2, high content serum IL-6, lower phase angle, and malnutrition parameters showed lower OS; however, after multivariate analysis, only ECOG 2 [Hazard ratio (HR), 2.7; 95% confidence interval (95% CI), 1.5-4.7; P = 0.001], phase angle ≤5.8° (HR = 3.02; 95% CI: 1.2-7.11; P = 0.011), and SGA (HR = 2.7; 95% CI, 1.31-5.5; P = 0.005) were associated with poor survival. Patients were divided into low-, intermediate-, and high-risk groups according to regression coefficients; OS at 1 yr was 78.4, 53, and 13.8%, respectively. Malnutrition is associated with low HRQL and is an independent prognostic factor in advanced NSCLC. The results warrant prospective trials to evaluate the impact of different nutritional interventions on HRQL and survival.

Prognostic Significance of Basic Laboratory Methods in Non-Small-Cell-Lung Cancer

“…In a study where albumin NLR and PLR were evaluated, NLR was found to be statistically insignificant as a prognostic factor unlike our study, whereas PLR and serum albumin level was found to have a prognostic significance (Sánchez-Lara et al, 2012).…”

Prognostic role of pretreatment platelet/lymphocyte ratio in patients with non-small cell lung cancer

“…PLR was accepted as an inflammatory marker among other inflammatory parameters, which were used to evaluate the relationship among nutritional and inflammatory parameters with health-related quality of life in advanced stage NSCLC [20]. Mean PLR was estimated as 231.2 ± 162.3 in this study, including 119 NSCLC patients.…”

Clinical significance of preoperative neutrophil–lymphocyte vs platelet–lymphocyte ratio in primary operable patients with non–small cell lung cancer

“…The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are other markers, and some studies have shown elevated NLR or PLR to be a significant prognostic factor in various cancers [4][5][6][7][8][9], including NSCLC [10][11][12][13][14][15][16][17][18][19][20].…”