Inflamasyon ilişkili indeksler, palyatif bakım hastalarında kötü prognozu tanımlayabilir mi?

Abstract

Amaç: Palyatif tıp, hastaların yaşam kalitesini artırmak için bütünsel bakım sağlar. Kişiselleştirilmiş bir tedavi planı için prognozu tahmin etmek çok önemlidir. Bu nedenle, biyobelirteç bazlı indekslere (mGPS, PI ve PNI) ek olarak rutin biyokimya testleri, tam kan sayımı (CBC) ve nötrofil/lenfosit oranlarının sağkalım tahmin özelliklerini araştırmayı amaçladık. Yöntem: 139 palyatif bakım hastasının yaşamlarının son 5 haftasındaki laboratuvar parametre değerleri, prognostik faktör skorları, tanıları ve sağkalım süreleri geriye dönük olarak değerlendirildi. Bulgular: Doksan bir (%65.5) hasta erkekti ve yaş ortalaması 65.9 (28-91 yıl) idi. Bu çalışmada incelenen her üç prognostik indeksin (mGPS, PI ve PNI) sonuçlarının hastalarımızın sağkalım süreleri ile istatistiksel olarak anlamlı bir ilişkisi olduğu bulundu. Ayrıca NLO, nötrofil yüzdesi, hemoglobin, serum albümin ve CRP değerlerinin her üç prognostik indeksin skorları ile istatistiksel olarak anlamlı bir ilişkisi olduğu görüldü. Ayrıca WBC, NLR, albümin ve CRP değerlerinin genel sağ kalım ile ilişkili olduğu saptandı. Sonuç: Bu indekslerin palyatif bakım hastalarında prognostik belirteçlere sahip olduğunu gösteren çalışmamızın sonuçları klinik sürecin yönetimine rehberlik edecektir. Hayatta kalma tahmini için prognostik araçları kullanan hastalar için kişiselleştirilmiş tedavi planları geliştirmede palyatif bakım klinisyenlerinin önemini vurgulamak istiyoruz.

Keywords

• Palyatif bakım
• modifiye Glasgow prognostik ölçeği
• prognostic nutrisyonel index
• prognostic index

Can inflammation-based indices describe the poor prognosis in palliative care patients?

Abstract

Aim: Palliative medicine provides holistic care to increase the quality of life of patients. Predicting prognosis is critical for a personalized treatment plan. Therefore, we aimed to investigate the survival prediction properties of routine biochemistry tests, complete blood count (CBC) and neutrophil/lymphocyte ratios, in addition to biomarker-based indices (the mGPS, PI, and PNI). Materials and methods: The laboratory parameter values, prognostic factor scores, diagnoses and survival time of 139 palliative care patients in the last 5 weeks of their life were evaluated retrospectively. Results: Ninety-one (65.5%) patients were male and the average age was 65.9 years (28–91 years). Results of all three prognostic indices (the mGPS, PI, and PNI) investigated in this study were found to have a statistically significant relationship with the survival time of our patients. In addition, NLR, neutrophil percent, hemoglobin, serum albumin and CRP values were seen to have a statistically significant relationship with the scores of all three prognostic indices. Moreover, hand it is detected that WBC, NLR, albumin, and CRP values were associated with overall survival. Conclusion: The results of our study, which showed that these indices have prognostic markers in palliative care patients, will guide the management of the clinical process. We would like to emphasize the importance of palliative care clinicians in developing personalized treatment plans for patients using prognostic tools for survival prediction.

Keywords

• Palliative Care
• Modified Glasgow Prognostic Score
• Prognostic Nutritional Index
• Prognostic Index

References

1. Hui D. Prognostication of Survival in Patients With Advanced Cancer: Predicting the Unpredictable?. Cancer Control.2015;22(4):489-497. DOI: 10.1177/107327481502200415
2. Minami S, Ogata Y, Ihara S, Yamamoto S, Komuta K. Pretreatment Glasgow prognostic score and prognostic nutritional index predict overall survival of patients with advanced small cell lung cancer. Lung Cancer (Auckl). 2017;8:249-257. DOI: 10.2147/LCTT.S142880
3. Zhang J, Zhang C, Li Q, et al. C-Reactive Protein/Albumin Ratio Is an Independent Prognostic Predictor of Survival in Advanced Cancer Patients Receiving Palliative Care. J Palliat Med. 2019;22(12):1536-1545. DOI: 10.1089/jpm.2019.0102
4. Simmons CPL, McMillan DC, McWilliams K, et al. Prognostic Tools in Patients with Advanced Cancer: A Systematic Review. J Pain Symptom Manage. 2017;53(5):962-970.e10. DOI: 10.1016/j.jpainsymman.2016.12.330
5. Zhang CL, Fan K, Gao MQ, Pang B. Prognostic Value of Glasgow Prognostic Score in Non-small Cell Lung Cancer: A Systematic Review and Meta-Analysis. Pathol Oncol Res. 2022;28:1610109. DOI: 10.3389/pore.2022.1610109
6. Demirelli B, Babacan NA, Ercelep Ö, et al. Modified Glasgow Prognostic Score, Prognostic Nutritional Index and ECOG Performance Score Predicts Survival Better than Sarcopenia, Cachexia and Some Inflammatory Indices in Metastatic Gastric Cancer. Nutr Cancer. 2021;73(2):230-238. DOI: 10.1080/01635581.2020.1749290
7. Kasymjanova G, MacDonald N, Agulnik JS, et al. The predictive value of pre-treatment inflammatory markers in advanced non-small-cell lung cancer. Curr Oncol. 2010;17(4):52-58. DOI: 10.3747/co.v17i4.567
8. Onodera T, Goseki N, Kosaki G. Nihon Geka Gakkai Zasshi. 1984;85(9):1001-1005. (PMID: 6438478)

9. Rossi S, Basso M, Strippoli A, et al. Are Markers of Systemic Inflammation Good Prognostic Indicators in Colorectal Cancer?. Clin Colorectal Cancer. 2017;16(4):264-274. DOI: 10.1016/j.clcc.2017.03.015
10. Slaviero KA, Clarke SJ, Rivory LP. Inflammatory response: an unrecognised source of variability in the pharmacokinetics and pharmacodynamics of cancer chemotherapy. Lancet Oncol. 2003;4(4):224-232. DOI: 10.1016/s1470-2045(03)01034-9
11. Amano K, Maeda I, Morita T, et al. Clinical Implications of C-Reactive Protein as a Prognostic Marker in Advanced Cancer Patients in Palliative Care Settings. J Pain Symptom Manage. 2016;51(5):860-867. DOI: 10.1016/j.jpainsymman.2015.11.025
12. Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002;420(6917):860-867. DOI: 10.1038/nature01322
13. Wilcox RA. Cancer-associated myeloproliferation: old association, new therapeutic target. Mayo Clin Proc. 2010;85(7):656-663. DOI: 10.4065/mcp.2010.0077
14. Schernberg A, Escande A, Rivin Del Campo E, et al. Leukocytosis and neutrophilia predicts outcome in anal cancer. Radiother Oncol. 2017;122(1):137-145. DOI: 10.1016/j.radonc.2016.12.009
15. Templeton AJ, McNamara MG, Šeruga B, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014;106(6):dju124. DOI: 10.1093/jnci/dju124
16. Ahn HK, Hwang IC, Lee JS, Sym SJ, Cho EK, Shin DB. Neutrophil-Lymphocyte Ratio Predicts Survival in Terminal Cancer Patients. J Palliat Med. 2016;19(4):437-441. DOI: 10.1089/jpm.2015.0277
17. Gruber ES, Jomrich G, Kaider A, Gnant M, Sahora K, Schindl M. The Prognostic Index Independently Predicts Survival in Patients with Pancreatic Ductal Adenocarcinoma Undergoing Resection [published correction appears in Ann Surg Oncol. 2020 Dec;27(Suppl 3):985]. Ann Surg Oncol. 2020;27(6):2017-2024. DOI: 10.1245/s10434-019-08161-6
18. Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation [published correction appears in N Engl J Med 1999 Apr 29;340(17):1376]. N Engl J Med. 1999;340(6):448-454. DOI: 10.1056/NEJM199902113400607
19. Li QQ, Lu ZH, Yang L, et al. Neutrophil count and the inflammation-based glasgow prognostic score predict survival in patients with advanced gastric cancer receiving first-line chemotherapy. Asian Pac J Cancer Prev. 2014;15(2):945-950. DOI: 10.7314/apjcp.2014.15.2.945
20. Danan D, Shonka DC Jr, Selman Y, Chow Z, Smolkin ME, Jameson MJ. Prognostic value of albumin in patients with head and neck cancer. Laryngoscope. 2016;126(7):1567-1571. DOI: 10.1002/lary.25877
21. Fujiwara R, Takemura K, Fujiwara M, et al. Modified Glasgow Prognostic Score as a Predictor of Prognosis in Metastatic Renal Cell Carcinoma Treated With Nivolumab [published online ahead of print, 2020 Nov 10]. Clin Genitourin Cancer. 2020;S1558-7673(20)30249-4. DOI: 10.1016/j.clgc.2020.10.007
22. Ikuta S, Sonoda T, Aihara T, Nakajima T, Yamanaka N. The preoperative modified Glasgow prognostic score for the prediction of survival after pancreatic cancer resection following non-surgical treatment of an initially unresectable disease. Contemp Oncol (Pozn). 2018;22(4):229-235. DOI: 10.5114/wo.2018.81344
23. Tsujino T, Komura K, Matsunaga T, et al. Preoperative Measurement of the Modified Glasgow Prognostic Score Predicts Patient Survival in Non-Metastatic Renal Cell Carcinoma Prior to Nephrectomy. Ann Surg Oncol. 2017;24(9):2787-2793. DOI: 10.1245/s10434-017-5948-6
24. Tokunaga R, Sakamoto Y, Nakagawa S, et al. Prognostic Nutritional Index Predicts Severe Complications, Recurrence, and Poor Prognosis in Patients With Colorectal Cancer Undergoing Primary Tumor Resection. Dis Colon Rectum. 2015;58(11):1048-1057. DOI: 10.1097/DCR.0000000000000458
25. Jeon HG, Choi DK, Sung HH, et al. Preoperative Prognostic Nutritional Index is a Significant Predictor of Survival in Renal Cell Carcinoma Patients Undergoing Nephrectomy. Ann Surg Oncol. 2016;23(1):321-327. DOI: 10.1245/s10434-015-4614-0
26. Okadome K, Baba Y, Yagi T, et al. Prognostic Nutritional Index, Tumor-infiltrating Lymphocytes, and Prognosis in Patients with Esophageal Cancer. Ann Surg. 2020;271(4):693-700. DOI: 10.1097/SLA.0000000000002985