Abstract
e17541 Background: Nutritional status impacts on the outcomes of cancer treatment ( http://www.cancer.gov/cancertopics/pdq/supportivecare/nutrition/ HealthProfessional ). Nutrition is a concern of cancer patients. Many centres lack the resources to undertake formal nutritional assessments on cancer patients. Inflammatory markers have been shown to correlate with nutritional status and cancer treatment outcomes. The NLR is the ratio of the neutrophil and lymphocyte counts in a full blood count (FBC). Our aim was to determine if the NLR can be used to identify cancer patients needing nutritional assessment and intervention. Methods: A prospective observational study evaluated sequential new patients attending a cancer centre. All were assessed for nutritional status using the patient generated scored global assessment (PGSGA) tool and categorized as A (well nourished), or B/C (malnourished). A FBC was done in the week prior to treatment. Receiver operation characteristic (ROC) curves were used to determine optimal cut-points for NLR to predict malnutrition. Results: 234 patients were enrolled - 112 had advanced cancer. The median age was 60 years (range 25-83), 108 (46%) were male and 101 (43%) were malnourished at baseline. The mean NLR was higher in malnourished patients (4.1 vs 2.5 – p<0.001), however this was due to differences in advanced cancer patients. The optimal cut point for NLR in all patients to predict malnutrition was 5.0 (4.3 in advanced patients). In advanced patients, an NLR ≥4.3 had a sensitivity and specificity for malnutrition of 42.2% (95% CI 30.1-54.3) and 97.9% (95% CI 88.9-99.9), respectively, producing a positive predictive value of 0.96 (95% CI-0.82-1.00). Thus, NLR while strongly correlated with malnutrition is not sensitive enough alone to be used to identify malnourished cancer patients. However, as >98% of patients with a raised NLR had malnutrition, the NLR could be used to triage patients for nutritional assessment and thereby reduce the workload for clinical dieticians. Conclusions: The NLR is a useful indicator of nutritional status, which when elevated is specific for malnutrition. A low NLR should be reassuring in regard to nutritional status in advanced cancer patients.
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