Systemic inflammation, nutritional status and survival in patients with cancer

Abstract

2 Purpose of the ReviewThere is now good evidence in humans that a chronic systemic inflammatory response results in the cardinal features of cancer cachexia, principally the progressive loss of weight (in particular lean tissue). This review examines the role of recent simple objective systemic inflammation-based scores in predicting reduction of nutritional status and survival. Recent findingsThe most common measure of the systemic inflammatory response in cancer patients has been an elevated C-reactive protein concentration. This has now been included in recent definitions of cancer cachexia. There are also recent systemic inflammation-based scores, the Glasgow Prognostic Score, Neutrophil Lymphocyte Ratio and the Platelet Lymphocyte ratio which have been shown to have prognostic value in cancer patients. These scores, in particular the Glasgow Prognostic Score, enable identification of patients who are or likely to develop cachexia, have a poor response to treatment and who are likely to have poor survival. SummaryA chronic systemic inflammatory response is clearly implicated in the progressive nutritional and functional decline of the cancer patient and their subsequent poor outcome.Systemic inflammation-based prognostic scores not only identify patients at risk but also provide well defined therapeutic targets for future clinical trials targeting nutritional decline.3

Albumin-globulin Ratio for Prediction of Long-term Mortality in Lung Adenocarcinoma Patients

“…In several studies, high inflammatory parameters (CRP, alpha and gamma globulins, neutrophil lymphocyte ratio (NLR), complement C3-C4) were found and associated with reduced overall survival in patients with different cancers including lung cancers (Shimada et al, 2003;Canna et al, 2005;Kaya et al, 2013;Zheng et al, 2013;Dai et al, 2014;Soliman et al, 2014). Increasing synthesis of acute phase proteins and interleukins and tumor necrosis-related hypoxia may be the mechanisms underlying this increased inflammation (McMillan et al, 2009). In our study, level of white blood cell was an independent predictor of mortality in patients with lung adenocarcinoma (Table 3).…”

Preoperative globulin‐to‐albumin ratio predicts outcome after curative resection in patients with gastric cancer

“…Malnutrition and inflammation suppress albumin synthesis and affect the survival of cancer patients 31, 39. In fact, it has been reported that hypoalbuminemia in cancer patients is associated with poor outcome 31, 38, 39. In fact, patients in the high GAR group (>0.80) had decreased serum albumin level and poor outcome after curative surgery compared as low GAR group (Table 2 and Figure 2).…”

“…In addition, these cytokines induce the production of various acute‐phase proteins and these proteins which are contained in the serum globulin fraction 24, 25, 26, 27, 28. Interestingly, it has been reported that these cytokines and acute‐phase proteins are associated with the prognosis of cancer patients 29, 30, 31, 32, 33, 34, 35, 36, 37. These facts suggest that an elevated serum globulin level may reflect an enhancement of tumor progression and distant metastasis due to an alteration of tumor cell biology and suppression of antitumor immunity.…”

“…On the other hand, albumin plays an important role in suppressing the growth of cancer cell through its antioxidant effect and stabilization of DNA replication 38. Malnutrition and inflammation suppress albumin synthesis and affect the survival of cancer patients 31, 39. In fact, it has been reported that hypoalbuminemia in cancer patients is associated with poor outcome 31, 38, 39.…”

The relationship between the insulin-like growth factor-1 axis, weight loss, an inflammation-based score and survival in patients with inoperable non-small cell lung cancer

“…Therefore, patients with an elevated C-reactive protein were assigned a modified GPS score (mGPS) of 1 or 2 depending on the absence or presence of hypoalbuminaemia 20 . The rationale for the development of the GPS has been described previously 8 and the prognostic value of the combination of C-reactive protein and albumin has validated in a variety of common solid tumours 21 .…”