Abstract
Purpose. To determine the values of prognostic nutritional and inflammatory markers in chemotherapy outcomes and survival in the patients with advanced nonsmall cell lung cancer (NSCLC) and also in the secondary malnutrition and cachexia. Methods. Twenty-five patients with diagnosis of aNSCLC were registered for the prospective study. Malnutrition was determined by the Subjective Global Assessment (SGA) and performance status by criteria of the Eastern Cooperative Oncology Group (ECOG). Before treatment, serum levels of albumin, prealbumin, vitamin D, zinc (Zn), C-reactive protein (CRP), IL-6, IL-1 β, TNF-α, lipoprotein lipase (LPL), and the Glasgow Prognostic Score (GPS) were recorded. Patients were followed prospectively for treatment outcomes and survival. Results. Due to the deaths of 18 patients during the 4-month follow-up period, no adequate measurements of inflammatory and nutritional markers could be performed. However, seven patients completed the treatment period and evaluations of these markers could be performed during the three periods. Eighty-four percent of patients were male with a mean age of 63.3 ± 8.7 years. Evaluation of the malnutrition by SGA showed that 5 (20%) patients were well nourished (A), 12(48%) were moderately malnourished (B), and 8(32%) were severely malnourished (C). Low levels of serum albumin (<3.5g/dl), prealbumin (<20 mg/ml), 25-hydroxycholecalciferol (<30 ng/ml), and Zn (<70mg/ml) were detected in 15(60%), 17(68%), 24 (96%), and 22 (88%) patients, respectively. Elevated levels of CRP (≥10 mg/L), IL6 (≥18pg/ml), TNF-α (≥24pg/ml), IL-1β (≥10pg/ml), and LPL (<12pg/ml) were found in 24 (96%), 11(44%), 9(36), 13(52%), and 11(44%) patients, respectively. Moderate and severe malnutrition, acute phase response, and reduced survival were determined in patients with NCSLC. In 7 patients that completed the treatment period, there was an association between elevated serum levels of IL-6, IL-1β, TNF-α, CRP, and LPL and also the reduced serum levels of albumin, prealbumin, Zn, vitamin D, and GPS, respectively. Similarly, Friedman analysis indicated that prealbumin significantly increased (p=0.007) in the follow-up period. But the serum levels of CRP (mean 37.3±22.3; Wilcoxon test P=0.368) in the seven patients were lower than those of the 18 patients that expired (mean 75.82±56.2). Conclusion. Malnutrition and cachexia negatively influence oncological outcomes in patients with NSCLC. These nutritional/inflammatory markers may be useful for selection of high risk and reduced survival in patients with aNSCLC undergoing adjuvant chemotherapy.
Highlights
Malnutrition is a complex and major problem encountered in patients with each stage of the cancer
With a different approach, we considered that evaluating Glasgow Prognostic Score (GPS) with serum levels of zinc and vitamin D together with all nutritional and inflammatory biomarkers utilized in the previous studies reported in the literature might be useful and meaningful for estimating prognostic, nutritional, and inflammatory markers in patient with aNSCLC
We examined serum levels of IL-1β, IL-6, TNF-α, and lipoprotein lipase (LPL) to determine the association with inflammation and clinical outcomes of patients with nonsmall cell lung cancer (NSCLC)
Summary
Malnutrition is a complex and major problem encountered in patients with each stage of the cancer. Zinc decreases oxidative stress markers (i.e., CRP) and generation of inflammatory cytokines It is known as antioxidant by increasing the body immunity [4,5,6]. Vitamin D is the precursor of the potent steroid hormone calcitriol that regulates numerous cellular pathways and plays a role in determining cancer risk and prognosis shows beneficial anti-inflammatory process in several cancers. It is involved in some key mechanisms including inhibition of proinflammatory cytokine production and NF κB signaling [5, 6, 8]. In a systematic review, including 10 studies on lung cancer, the majority of studies identified that higher albumin is associated with increased survival [9, 10]
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