Abstract
ObjectiveSystemic inflammation and malnutrition are correlated with cancer sarcopenia and have deleterious effects on oncological outcomes. However, the combined effect of inflammation and malnutrition in patients with cancer sarcopenia remains unclear.MethodsWe prospectively collected information on 1,204 patients diagnosed with cancer sarcopenia. the mean (SD) age was 64.5 (11.4%) years, and 705 (58.60%) of the patients were male. The patients were categorized into the high advanced lung cancer inflammation index (ALI) group (≥18.39) and the low ALI group (<18.39) according to the optimal survival cut-off curve. We selected the optimal inflammation marker using the C-index, decision curve analysis (DCA), and a prognostic receiver operating characteristic curve. Univariate and multivariate survival analyses were performed to determine the prognostic value of the optimal inflammation indicator. We also analyzed the association between inflammation and malnutrition in patients with cancer.ResultsThe C-index, DCA, and prognostic area under the curve of ALI in patients with cancer sarcopenia were higher or better than those of neutrophil-lymphocyte ratio (NLR), prognostic nutritional index (PNI), systemic immune-inflammation index (SII), and platelet-lymphocyte ratio (PLR). The prognosis for patients in the low ALI group was worse than that of patients in the high ALI group [HR (95%CI) = 1.584 (1.280–1.959), P < 0.001]. When the ALI was divided into quartiles, we observed that decreased ALI scores strongly correlated with decreased overall survival (OS). Patients with both a low ALI and severe malnutrition (vs. patients with high ALI and well-nourished) had a 2.262-fold death risk (P < 0.001). Subgroup analysis showed a significant interactive association between the ALI and death risk in terms of TNM stage (P for interaction = 0.030).ConclusionsThe inflammation indicator of the ALI was better than those of the NLR, PNI, SII, and PLR in patients with cancer sarcopenia. Inflammation combined with severe malnutrition has a nearly 3-fold death risk in patients with cancer sarcopenia, suggesting that reducing systemic inflammation, strengthening nutritional intervention, and improving skeletal muscle mass are necessary.
Highlights
The European Working Group on Sarcopenia in Older People (EWGSOP) [1] and the Asian Working Group for Sarcopenia (AWGS) [2] have recommended that in the definition of skeletal sarcopenia, the loss of muscle strength and functional impairment should be increased on the basis of the loss of muscle mass
A total of 9,727 patients with cancer were included in the cohort study, of whom 1,204 patients were diagnosed with sarcopenia (Supplementary Figure S2)
1,000 patients were diagnosed with malnutrition, including 398 (33.10%) cases of moderate malnutrition and 602 (50.00%) of severe malnutrition
Summary
The European Working Group on Sarcopenia in Older People (EWGSOP) [1] and the Asian Working Group for Sarcopenia (AWGS) [2] have recommended that in the definition of skeletal sarcopenia, the loss of muscle strength and functional impairment should be increased on the basis of the loss of muscle mass. Cancer-related sarcopenia is considered part of cancer cachexia syndrome and is caused by a negative balance of protein and energy due to metabolic abnormalities and reduced food intake [3]. Low muscularity may lead to local muscle inflammation, and further to damage driving systemic inflammation [6]. This inflammatory cycle, in turn, can enhance tumor aggressiveness or reduce response to treatment, impairing the transition to survival [7]. Systemic inflammation is related to anorexia and insufficient nutrient intake, which in turn leads to accelerated loss of skeletal muscle and adipose tissue [4]. The Patient-Generated Subjective Global Assessment (PG-SGA) nutrition evaluation tool is based on the SGA and is developed for patients with cancer. The scored PG-SGA further develops the PG-SGA concept, which includes a numerical score and provides a global rating for good, moderate, or suspected malnutrition or severe malnutrition [10]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
