Prognostic value of baseline inflammatory markers in inoperable non-small cell lung cancer (NSCLC)

Abstract

17035 Background: Markers of chronic inflammation are not commonly included in standard NSCLC staging, which remains anatomically based. Several studies have reported that an increased C-reactive protein (CRP), a marker of chronic inflammation, presages short survival for NSCLC patients (pts). A cohort of 68 pts with advanced NSCLC (stages 3A, 3B and 4) was studied in order to evaluate the prognostic value for survival of various pretreatment inflammatory parameters. Methods: The following factors were collected at the time of diagnosis prior to treatment: sex, age, stage, performance status, CRP, LDH, hemoglobin, platelets, albumin, and white blood cells (WBC). Statistical evaluation employed univariate and multivariate analyses. Survival was calculated using the Kaplan-Meier method and compared using the log-rank test. Results: Median survival for the entire cohort was ten months (mo) (95% CI 7, 15). Those with stages 3A, 3B (18 pts) had a survival of 11 mo (95% CI 6,15), whereas those with 3B (effusion)/4 (50 pts) had a survival of 8 mo (95% CI 3,13). Univariate analysis identified CRP and WBC as the only significant prognostic factors for survival (p < 0.01). Multivariate analysis also demonstrated that CRP (p = 0.005), and WBC (p=0.009) displayed independent correlation with prognosis. CRP and WBC were then combined into a prognostic index (PI) ranging from 0–2. The total score demonstrated a better stratification value for survival. Both parameters were normal [WBC ≤ 11, CRP ≤ 10] (PI 0) in 26 (38%) pts; one parameter was elevated (PI 1) in 27 (40%) pts; and both parameters were elevated (PI 2) in 15 (22%) others. Pts with PI 0 had a median survival of 14 mo (95% CI 12, 21); those with PI 1 had a median survival of 7 mo (95% CI 5, 10); and pts with PI 2 had a median survival of 5 mo (95% CI 3, 7). Conclusions: Systemic inflammatory markers predicted survival in our cohort with NSCLC. These data need to be confirmed in a larger validation study. Studies on staging systems that include inflammatory markers are indicated. Clinical trials linking anti-inflammatory therapies with chemotherapy should be prioritized. No significant financial relationships to disclose.