Demographic stratification of inflammatory signature in lung cancer patients in North Carolina: A prospective cohort study.

Abstract

e14200 Background: Lung Cancer remains the major cause of cancer related mortality in the state of North Carolina. There is a growing body of evidence that implicates inflammation as a mechanism of disease progression and reduced survival in patients with advanced cancer (Laird et al, Oncologist 2013). Smoldering inflammation in the tumor microenvironment regulates and escalates cancer invasion, angiogenesis and immune surveillance escape (Balkwill and Mantovani, Lancet 2001). We investigated the predictive value of inflammatory signature according to social stratification of cancer patients using Modified Glasgow Prognostic Score (mGPS). mGPS is a composite inflammatory score based on CRP and serum albumin with proven prognostic and predictive value in various tumor types. Methods: A prospective observational single institutional study was conducted whereby serum albumin and CRP were drawn at baseline for 333 patients with diagnosis of cancer regardless of stage from 30 counties in Eastern North Carolina. The mGPS score was compared according to rural urban divide and occupational regional exposure of various counties stratified per US Census Data. Results: Lung cancer was the predominant cancer type in 93% of patients. The mGPS of zero in Urban vs Rural counties was noted in 36% and 24% patients respectively. The mGPS score of two in Urban vs Rural counties was noted in 26% and 41% respectively. The mGPS of two in areas of hog farming, cattle farming and wet waste lands was seen in 41%, 38% and 43% respectively (p = 0.0019). The mGPS of zero was seen in 24%, 20% and 27% respectively (p = 0.0008). Conclusions: This study suggests a strikingly unfavorable inflammatory signature in rural population as well as areas of hog farm, cattle farm and wet waste lands. The hog and poultry operations heighten the harmful effect on waterways and can adversely affect the inflammatory signature, hence the tumor biology. This underscores additional interventions in these high risk populations that can have significant implications for quality of life and survival, especially in the era of immunotherapy.