The systemic inflammatory response, weight loss, performance status and survival in patients with inoperable non-small cell lung cancer

Abstract

The relationship between the magnitude of systemic inflammatory response and the nutritional/functional parameters in patients with inoperable non-small cell lung cancer were studied. The extent of weight loss, albumin, C-reactive protein, performance status and quality of life was measured in 106 patients with inoperable non-small cell lung cancer (stages III and IV). Survival analysis was performed using the Cox proportional hazard model. The majority of patients were male and almost 80% had elevated circulating C-reactive protein concentrations (410 mg l 71 ). On multivariate analysis, age (P=0.012), tumour type (0.002), weight loss (P=0.056), C-reactive protein (P=0.047), Karnofsky performance status (P=0.002) and fatigue (P=0.046) were independent predictors of survival. The patients were grouped according to the magnitude of the C-reactive protein concentrations (410, 11 -100 and 4100 mg l 71 ). An increase in the magnitude of the systemic inflammatory response was associated with increased weight loss (P=0.004), reduced albumin concentrations (P=0.001), reduced performance status (P=0.060), increased fatigue (P=0.011) and reduced survival (HR 1.936 95%CI 1.414 -2.650, P50.001). These results indicate that the majority of patients with inoperable non-small cell lung cancer have evidence of a systemic inflammatory response. Furthermore, an increase in the magnitude of the systemic inflammatory response resulted in greater weight loss, poorer performance status, more fatigue and poorer survival.

Evaluation of cumulative prognostic scores based on the systemic inflammatory response in patients with inoperable non-small-cell lung cancer

“…These results are consistent with the evidence that chronic activation of the systemic inflammatory response is detrimental to the outcome of patients with NSCLC, being associated with an increase in weight loss (Staal van den Brekel et al, 1995;Scott et al, 1996) and fatigue (Scott et al, 2003), loss of lean tissue (McMillan et al, 1998;Simons et al, 1999), decreased performance status and survival (Martin et al, 1999;Scott et al, 2002).…”

“…Systemic inflammation in lung cancer LM Forrest et al and C-reactive protein concentrations (Scott et al, 2002), have prognostic value, independent of stage, in patients with inoperable NSCLC. When C-reactive protein concentrations were combined with stage, performance status and albumin to form new prognostic scores, these combined scores improved the prediction of survival based on stage, performance status or albumin alone.…”

“…Recent studies have shown that the presence and the magnitude of a systemic inflammatory response, as evidenced by increased circulating concentrations of C-reactive protein, is a prognostic factor independent of age, stage, performance status, weight-loss and hypoalbuminaemia in patients with advanced cancer including non-small-cell lung cancer (NSCLC) (Martin et al, 1999;O'Gorman et al, 2000;Mahmoud and Rivera, 2002;Scott et al, 2002).…”

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

“…It is increasingly recognised that systemic inflammation is an important factor in the progressive loss of lean tissue in cancer patients 4,6,30 . In light of the above studies on the IGF-1 axis 15,17 it is possible that the increased systemic inflammation-driven demand for amino acids for increased hepatic synthesis of acute phase proteins 31 , maintenance of albumin synthesis 32 and increased glucose production 33 is the main factor in the progressive loss of lean tissue in cancer patients.…”

“…This systemic inflammatory involvement, as evidenced by elevated circulating concentrations of C-reactive protein and hypoalbuminaemia (Glasgow Prognostic score, GPS), is a normal response to an insult which, when prolonged in cancer, becomes detrimental to the patient, being associated with cachexia, poor performance status and reduced survival in patients with a variety of common solid tumours [6][7][8] . These deleterious consequences have been attributed, in part, to the production of inflammatory cytokines, in particular interleukin 1-beta and interleukin-6 [9][10][11] , which exert a directly catabolic effect on skeletal muscle and other host tissues [12][13] .…”