A Novel Systemic Inflammation Prognostic Score to Stratify Survival in Elderly Patients With Cancer

Guo-Tian Ruan; Hai-Lun Xie; Li Deng; Yi-Zhong Ge; Qi Zhang; Zi-Wen Wang; Xi Zhang; He-Yang Zhang; Meng Tang; Meng-Meng Song; Xiao-Wei Zhang; Ming Yang; Lei Pan; Kun-Hua Wang; Ming-Hua Cong; Yi-Zhen Gong; Meng-Yan Wang; Han-Ping Shi

doi:10.3389/fnut.2022.893753

A Novel Systemic Inflammation Prognostic Score to Stratify Survival in Elderly Patients With Cancer

Front Nutr. 2022 Jul 5:9:893753. doi: 10.3389/fnut.2022.893753. eCollection 2022.

Authors

Guo-Tian Ruan^{1

2

3}, Hai-Lun Xie^{1

2

3}, Li Deng^{1

2

3}, Yi-Zhong Ge^{1

2

3}, Qi Zhang^{1

2

3}, Zi-Wen Wang^{1

2

3}, Xi Zhang^{1

2

3}, He-Yang Zhang^{1

2

3}, Meng Tang^{1

2

3}, Meng-Meng Song^{1

2

3}, Xiao-Wei Zhang^{1

2

3}, Ming Yang^{1

2

3}, Lei Pan⁴, Kun-Hua Wang^{5

6}, Ming-Hua Cong⁷, Yi-Zhen Gong^{8

9}, Meng-Yan Wang¹⁰, Han-Ping Shi^{1

2

3}

Affiliations

¹ Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
² Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
³ Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China.
⁴ Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
⁵ Yunnan University, Kunming, China.
⁶ General Surgery Clinical Medical Center of Yunnan Province, Kunming, China.
⁷ Comprehensive Oncology Department, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁸ Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, China.
⁹ Guangxi Clinical Research Center for Colorectal Cancer, Nanning, China.
¹⁰ Department of General Surgery, The 906th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Ningbo, China.

Abstract

Background: Elderly patients with cancer face the challenge of systemic inflammation, which can lead to a poor prognosis. Existing inflammatory indices cannot fully reflect the immune-inflammatory status of patients. This study aimed to develop a new scoring system to predict the survival of elderly patients with cancer using inflammatory indices, namely, the systemic inflammation prognostic score (SIPS).

Materials and methods: This prospective multicenter study included a total of 1,767 patients with cancer, with a mean age of 70.97 ± 5.49 years, of whom 1,170 (66.2%) were men. We performed the least absolute shrinkage and selection operator (LASSO) regression to screen inflammatory indicators to include in constructing SIPS. Prognostic analysis of SIPS was performed using univariate and multivariate survival analyzes. The prognostic value of SIPS and its components were compared using the prognostic receiver operating characteristic curve and concordance index. The population was divided into the training cohort and the validation cohort in a 7:3 ratio and a SIPS prognostic analysis was performed.

Results: The LASSO regression selected C-reactive protein (CRP) (≤ 9.81, "0"; > 9.81, "1"), geriatric nutritional risk index (GNRI) (≤ 93.85, "1"; 93.85, "0"), advanced lung cancer inflammation index (ALI) (≤ 23.49, "1"; > 23.49, "0"), and lymphocyte to C-reactive protein ratio (LCR) (≤ 2523.81, "1"; > 2523.81, "0") to develop SIPS. Patients were divided into the three groups based on the total SIPS: low-risk (0), moderate-risk (1-2), and high-risk (3-4). On the multivariate survival analysis, patients in the moderate-risk [P < 0.001, hazard ratio (HR) = 1.79, 95% CI: 1.47-2.17] and high-risk groups (P < 0.001, HR = 2.40, 95% CI: 1.98-2.92) showed a worse prognosis than those in the low-risk group. The total cohort, training cohort, and validation cohort all showed that SIPS had better survival prediction than CRP, GNRI, ALI, and LCR. The HRs were 2.81 times higher in patients in the high-risk group with malnutrition than in patients in the low-risk group without malnutrition.

Conclusion: SIPS was an independent prognostic indicator in elderly patients with cancer. Malnutrition in the high-risk group increased the mortality risk.

Keywords: SIPS; elderly patients with cancer; malnutrition; overall survival; systemic inflammation.