Screening for frailty among older patients with cancer using blood biomarkers of inflammation

Harneshaug, Magnus; Kirkhus, Lene; Benth, Jūratė Šaltytė; Grønberg, Bjørn Henning; Bergh, Sverre; Whist, Jon Elling; Rostoft, Siri; Jordhøy, Marit S.

doi:10.1016/j.jgo.2018.07.003

Cited by 12 publications

(20 citation statements)

References 41 publications

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“…With respect to survival in cancer patients, few studies have directly compared frailty and inflammation ( 33 ). Our findings suggest that the co-occurrence of inflammation and frailty is associated with a high mortality risk, which is consistent with results reported in existing literature ( 34 ). Additionally, in our study, the hazard ratios of frailty with inflammation were higher for tumors with relatively long-life expectancies than tumors with higher lethality [HR (95%CI): 2.02 (1.52-2.69) vs. 1.69 (1.36-2.10)].…”

Section: Discussionsupporting

confidence: 93%

Effects of systemic inflammation and frailty on survival in elderly cancer patients: Results from the INSCOC study

et al. 2023

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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.

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Section: Discussionsupporting

confidence: 93%

Effects of systemic inflammation and frailty on survival in elderly cancer patients: Results from the INSCOC study

et al. 2023

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“…Eight studies measured frailty as a deficit accumulation index or geriatric vulnerability scores using the Leuven Oncogeriatric Frailty Score ( 27 , 32 , 34 ), Balducci criteria ( 27 , 30 , 32 , 34 ), Flemish Triage Risk Screening Tool (fTRST) ( 27 ), G8 ( 27 ), geriatric assessment domains ( 30 , 31 ), the geriatric vulnerability score ( 23 ), the Edmonton frailty scale ( 35 ), and the Carolina frailty index ( 37 ). One study ( 23 ) used geriatric assessment domains that also included hypoalbuminemia and lymphopenia as two additional vulnerabilities calculated into the total geriatric vulnerability score.…”

Section: Results Of Synthesismentioning

confidence: 99%

Blood-based biomarkers of frailty in solid tumors: a systematic review

Sass

Streck

Guedes

et al. 2023

Front. Public Health

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This review examines the current literature to identify biomarkers of frailty across patients with solid tumors. We conducted the systematic review using preferred reporting items for systematic reviews and meta-analysis guidelines (PRISMA). PubMed, Web of Science, and Embase databases were searched from their inception to December 08, 2021, for reports of biomarkers and frailty. Two reviewers independently screened titles, abstracts, and full-text articles. A quality assessment was conducted using NHLBI Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, and Quality Assessment of Case-Control Studies. In total, 915 reports were screened, and 14 full-text articles were included in the review. Most studies included breast tumors, were cross-sectional in design, and measured biomarkers at baseline or pre-treatment. Frailty tools varied with Fried Frailty Phenotype and the geriatric assessment most frequently used. Increased inflammatory parameters (i.e., Interleukin-6, Neutrophil Lymphocyte Ratio, Glasgow Prognostic Score-2) were associated with frailty severity. Only six studies were rated as good quality using assessment ratings. Together, the small number of studies and heterogeneity in frailty assessment limited our ability to draw conclusions from the extant literature. Future research is needed to identify potential target biomarkers of frailty in cancer survivors that may aid in early detection and referral.

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“…In patients with mCRC, high baseline CRP is associated with shorter survival [ 21 ]. Moreover, CRP is known as a biomarker of frailty, is linked to sarcopenia, functional decline, increased risk of toxicity, decreased QoL, and higher mortality in older adults with different types of malignancies [ 15 , 22 , 23 , 24 , 25 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

The Prognostic Value of Pre-Treatment Circulating Biomarkers of Systemic Inflammation (CRP, dNLR, YKL-40, and IL-6) in Vulnerable Older Patients with Metastatic Colorectal Cancer Receiving Palliative Chemotherapy—The Randomized NORDIC9-Study

Liposits

Skuladottir

Ryg

et al. 2022

JCM

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Appropriate patient selection for palliative chemotherapy is crucial in patients with metastatic colorectal cancer (mCRC). We investigated the prognostic value of C-reactive protein (CRP), derived neutrophil-to-lymphocyte ratio (dNLR), Interleukin (IL)-6, and YKL-40 on progression-free survival (PFS) and overall survival (OS) in the NORDIC9 cohort. The randomized NORDIC9-study included patients ≥70 years with mCRC not candidates for standard full-dose combination chemotherapy. Participants received either full-dose S1 (Teysuno) or a dose-reduced S1 plus oxaliplatin. Blood samples were collected at baseline and biomarkers were dichotomized according to standard cut-offs. Multivariable analyses adjusted for age, sex, ECOG performance status, and treatment allocation; furthermore, C-statistics were estimated. In total, 160 patients with a median age of 78 years (IQR: 76–81) were included between 2015 and 2017. All investigated biomarkers were significantly elevated in patients with either weight loss, ≥3 metastatic sites, or primary tumor in situ. In multivariable analyses, all markers showed significant association with OS; the highest HR was observed for CRP (HR = 3.40, 95%CI: 2.20–5.26, p < 0.001). Regarding PFS, statistically significant differences were found for CRP and IL-6, but not for dNLR and YKL-40. Applying C-statistics, CRP indicated a good prognostic model for OS (AUC = 0.72, 95%CI: 0.67–0.76). CRP is an easily available biomarker, which may support therapeutic decision-making in vulnerable older patients with mCRC.

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Screening for frailty among older patients with cancer using blood biomarkers of inflammation

Abstract: Frailty and GPS two are strongly associated, and GPS two is a significant prognostic factor in frail, older patients with cancer. The inflammatory biomarkers investigated are not suitable screening tools for frailty.

Cited by 12 publications

References 41 publications

Effects of systemic inflammation and frailty on survival in elderly cancer patients: Results from the INSCOC study

Effects of systemic inflammation and frailty on survival in elderly cancer patients: Results from the INSCOC study

Blood-based biomarkers of frailty in solid tumors: a systematic review

The Prognostic Value of Pre-Treatment Circulating Biomarkers of Systemic Inflammation (CRP, dNLR, YKL-40, and IL-6) in Vulnerable Older Patients with Metastatic Colorectal Cancer Receiving Palliative Chemotherapy—The Randomized NORDIC9-Study

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