Skip to main content

Advertisement

SpringerLink
Log in

The relationship between nutritional status, inflammatory markers and survival in patients with advanced cancer: a prospective cohort study

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstracts

Background

Malnutrition and elevated inflammatory markers have a negative impact on clinical outcomes in cancer patients. Few studies have investigated the associations between inflammatory makers, nutritional status and survival. This study investigates the association between nutritional status, inflammatory markers and overall survival (OS) in patients with advanced cancer.

Methods

This prospective cohort study recruited 114 adult patients from January 2007 to January 2010. It included patients diagnosed with advanced cancer, good Eastern Cooperative Oncology Group (ECOG) performance status 0–2, a prognosis of more than 3 months and had not received chemotherapy for advanced cancer prior to enrolment. Baseline data were collected prior to commencement of chemotherapy. Patients were followed up from the date of baseline nutritional assessment until the date of death or the date that data were last updated, whichever came first.

Results

Malnourished cancer patients had statistically significant higher concentrations of serum C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR) or modified Glasgow Prognostic Score (mGPS) prior to starting chemotherapy. In univariate analyses to predict survival, mGPS 1 or 2 had a hazard ratio (HR) of 1.81 (95 % confidence interval (CI) 1.13–2.89) and NLR ≥ 5 had a HR of 1.13 (95 % CI 1.08–4.60) and malnutrition (HR of 1.66 for Patient-Generated Subjective Global Assessment (PG-SGA) B (95 % CI 1.02–2.71), and HR for severely malnourished patients (PG-SGA C) was 2.73 (95 % CI 1.50–4.96).

Conclusions

Inflammatory markers were statistically associated with malnutrition. Malnutrition and mGPS were significant independent predictors of overall survival in patients with advanced cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Bozzetti F, On behalf of the Scrinio Working Group (2009) Screening the nutritional status in oncology: a preliminary report on 1,000 outpatients. Support Care Cancer 17(3):279–284

    Article  PubMed  Google Scholar 

  2. Read JA, Choy SB, Beale P, Clarke SJ (2006) An evaluation of the prevalence of malnutrition in cancer patients attending the outpatient oncology clinic. Asia-Pacific J Clin Oncol 2(2):80–86

    Article  Google Scholar 

  3. Laky B, Janda M, Cleghorn G, Obermair A (2008) Comparison of different nutritional assessments and body-composition measurements in detecting malnutrition among gynecologic cancer patients. Am J Clin Nutr 87(6):1678–1685

    CAS  PubMed  Google Scholar 

  4. Wie G-A, Cho Y-A, Kim S-Y, Kim S-M, Bae J-M, Joung H (2010) Prevalence and risk factors of malnutrition among cancer patients according to tumor location and stage in the national cancer center in Korea. Nutrition (Burbank, Los Angeles County, Calif) 26(3):263–268

    Article  Google Scholar 

  5. Gupta D, Lammersfeld CA, Vashi PG, Burrows J, Lis CG, Grutsch JF (2004) Prognostic significance of Subjective Global Assessment (SGA) in advanced colorectal cancer. Eur J Clin Nutr 59(1):35–40

    Article  Google Scholar 

  6. Gupta D, Lis CG, Vashi PG, Lammersfeld CA (2010) Impact of improved nutritional status on survival in ovarian cancer. Support Care Cancer 18:373–381

    Article  PubMed  Google Scholar 

  7. Schiesser M, Kirchhoff P, Müller MK, Schäfer M, Clavien P-A (2009) The correlation of nutrition risk index, nutrition risk score, and bioimpedance analysis with postoperative complications in patients undergoing gastrointestinal surgery. Surgery 145(5):519–526

    Article  PubMed  Google Scholar 

  8. Bozzetti F, Gianotti L, Braga M, Di Carlo V, Mariani L (2007) Postoperative complications in gastrointestinal cancer patients: the joint role of the nutritional status and the nutritional support. Clin Nutr 26(6):698–709

    Article  PubMed  Google Scholar 

  9. Garth AK, Newsome CM, Simmance N, Crowe TC (2010) Nutritional status, nutrition practices and post-operative complications in patients with gastrointestinal cancer. J Hum Nutr Diet 23(4):393–401

    Article  CAS  PubMed  Google Scholar 

  10. Laky B, Janda M, Kondalsamy-Chennakesavan S, Cleghorn G, Obermair A (2010) Pretreatment malnutrition and quality of life—association with prolonged length of hospital stay among patients with gynecological cancer: a cohort study. BMC Cancer 10:232, Epub 2010/05/26

    Article  PubMed Central  PubMed  Google Scholar 

  11. Arrieta O, Ortega RMM, Villanueva-Rodríguez G, Serna-Thomé MG, Flores-Estrada D, Diaz-Romero C et al (2010) Association of nutritional status and serum albumin levels with development of toxicity in patients with advanced non-small cell lung cancer treated with paclitaxel-cisplatin chemotherapy: a prospective study. BMC Cancer 10:50

    Article  PubMed Central  PubMed  Google Scholar 

  12. Andreyev H, Norman A, Oates J, Cunningham D (1998) Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer 34(4):503–509

    Article  CAS  PubMed  Google Scholar 

  13. Hill A, Kiss N, Hodgson B, Crowe TC, Walsh AD (2011) Associations between nutritional status, weight loss, radiotherapy treatment toxicity and treatment outcomes in gastrointestinal cancer patients. Clin Nutr 30(1):92–98

    Article  PubMed  Google Scholar 

  14. Isenring E, Bauer J, Capra S (2003) The scored Patient-generated Subjective Global Assessment (PG-SGA) and its association with quality of life in ambulatory patients receiving radiotherapy. Eur J Clin Nutr 57(2):305–309

    Article  CAS  PubMed  Google Scholar 

  15. Gupta D, Lis CG, Granick J, Grutsch JF, Vashi PG, Lammersfeld CA (2006) Malnutrition was associated with poor quality of life in colorectal cancer: a retrospective analysis. J Clin Epidemiol 59:704–709

    Article  PubMed  Google Scholar 

  16. Capuano G, Gentile PC, Bianciardi F, Tosti M, Palladino A, Di Palma M (2010) Prevalence and influence of malnutrition on quality of life and performance status in patients with locally advanced head and neck cancer before treatment. Support Care Cancer 18(4):433–437, Epub 2009/06/30

    Article  PubMed  Google Scholar 

  17. Gupta D, Lammersfeld C, Vashi P, Dahlk S, Lis C (2008) Can subjective global assessment of nutritional status predict survival in ovarian cancer? J Ovarian Res 1(1):5

    Article  PubMed Central  PubMed  Google Scholar 

  18. Dewys WD, Begg C, Lavin PT, Band PR, Bennett JM, Bertino JR et al (1980) Prognostic effect of weight loss prior to chemotherapy in cancer patients. Am J Med 69(4):491–497

    Article  CAS  PubMed  Google Scholar 

  19. Read JA, Choy STB, Beale PJ, Clarke SJ (2006) Evaluation of nutritional and inflammatory status of advanced colorectal cancer patients and its correlation with survival. Nutr Cancer 55(1):78–85

    Article  CAS  PubMed  Google Scholar 

  20. Bauer J, Capra S, Ferguson M (2002) Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr 56:779–785

    Article  CAS  PubMed  Google Scholar 

  21. McMillan DC (2009) Systemic inflammation, nutritional status and survival in patients with cancer. Curr Opin Clin Nutr Metab Care 12(3):223–226

    Article  PubMed  Google Scholar 

  22. Deans C, Wigmore S (2005) Systemic inflammation, cachexia and prognosis in patients with cancer. Curr Opin Clin Nutr Metab Care 8:265–269

    Article  CAS  PubMed  Google Scholar 

  23. McMillan D, Crozier J, Canna K, Angerson W, McArdle C (2007) Evaluation of an inflammation-based prognostic score (GPS) in patients undergoing resection for colon and rectal cancer. Int J Color Dis 22(8):881–886

    Article  Google Scholar 

  24. Sharma R, Hook J, Kumar M, Gabra H (2008) Evaluation of an inflammation-based prognostic score in patients with advanced ovarian cancer. Eur J Cancer 44(2):251–256

    Article  PubMed  Google Scholar 

  25. Walsh SR, Cook EJ, Goulder F, Justin TA, Keeling NJ (2005) Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol 91(3):181–184

    Article  CAS  PubMed  Google Scholar 

  26. Murri AMA, Bartlett JMS, Canney PA, Doughty JC, Wilson C, McMillan DC (2006) Evaluation of an inflammation-based prognostic score (GPS) in patients with metastatic breast cancer. Br J Cancer 94(2):227–230

    Article  PubMed Central  PubMed  Google Scholar 

  27. Glen P, Jamieson NB, McMillan DC, Carter R, Imrie CW, McKay CJ (2006) Evaluation of an inflammation-based prognostic score in patients with inoperable pancreatic cancer. Pancreatology 6(5):450–453

    Article  PubMed  Google Scholar 

  28. Chua W, Charles KA, Baracos VE, Clarke SJ (2011) Neutrophil/lymphocyte ratio predicts chemotherapy outcomes in patients with advanced colorectal cancer. Br J Cancer 104(8):1288–1295, Epub 2011 Mar 29

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Kao SCH, Pavlakis N, Harvie R, Vardy JL, Boyer MJ, van Zandwijk N et al (2010) High blood neutrophil-to-lymphocyte ratio is an indicator of poor prognosis in malignant mesothelioma patients undergoing systemic therapy. Clin Cancer Res 16(23):5805–5813

    Article  CAS  PubMed  Google Scholar 

  30. McMillan DC (2008) An inflammation-based prognostic score and its role in the nutrition-based management of patients with cancer. Proc Nutr Soc 67(3):257–262, Epub 2008/05/03

    Article  PubMed  Google Scholar 

  31. Slaviero KA, Read JA, Clarke SJ, Rivory LP (2003) Baseline nutritional assessment in advanced cancer patients receiving palliative chemotherapy. Nutr Cancer 46(2):148–157

    Article  PubMed  Google Scholar 

  32. Read JA, Crockett N, Volker DH, MacLennan P, Choy ST, Beale P et al (2005) Nutritional assessment in cancer: comparing the Mini-Nutritional Assessment (MNA) with the scored Patient-Generated Subjective Global Assessment (PGSGA). Nutr Cancer 53(1):51–56

    Article  PubMed  Google Scholar 

  33. Roxburgh CSDMM, Salmond JMMM, Horgan PGP, Oien KAP, McMillan DCP (2009) Comparison of the prognostic value of inflammation-based pathologic and biochemical criteria in patients undergoing potentially curative resection for colorectal cancer. Ann Surg 249(5):788–793

    Article  PubMed  Google Scholar 

  34. Forrest LM, McMillan DC, McArdle CS, Angerson WJ, Dagg K, Scott HR (2005) A prospective longitudinal study of performance status, an inflammation-based score (GPS) and survival in patients with inoperable non-small-cell lung cancer. Br J Cancer 92(10):1834–1836

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  35. Arrieta O, Michel Ortega R, Villanueva-Rodriguez G, Serna-Thome MG, Flores-Estrada D, Diaz-Romero C et al (2010) Association of nutritional status and serum albumin levels with development of toxicity in patients with advanced non-small cell lung cancer treated with paclitaxel-cisplatin chemotherapy: a prospective study. BMC Cancer 10:50, Epub 2010/02/23

    Article  PubMed Central  PubMed  Google Scholar 

  36. Deans DAC, Tan BH, Wigmore SJ, Ross JA, de Beaux AC, Paterson-Brown S et al (2009) The influence of systemic inflammation, dietary intake and stage of disease on rate of weight loss in patients with gastro-oesophageal cancer. Br J Cancer 100(1):63–69

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  37. Maurício SF, da Silva JB, Bering T, Correia MITD (2013) Relationship between nutritional status and the Glasgow Prognostic Score in patients with colorectal cancer. Nutrition 29(4):625–629

    Article  PubMed  Google Scholar 

  38. Silva JBD, Maurício SF, Bering T, Correia MITD (2013) The relationship between nutritional status and the Glasgow Prognostic score in patients with cancer of the esophagus and stomach. Nutr Cancer 65(1):25–33

    Article  PubMed  Google Scholar 

  39. Sanchez-Lara K, Turcott JG, Juarez E, Guevara P, Nunez-Valencia C, Onate-Ocana LF et al (2012) Association of nutrition parameters including bioelectrical impedance and systemic inflammatory response with quality of life and prognosis in patients with advanced non-small-cell lung cancer: a prospective study. Nutr Cancer 64(4):526–534, Epub 2012/04/12

    Article  CAS  PubMed  Google Scholar 

  40. Martin L, Watanabe S, Fainsinger R, Lau F, Ghosh S, Quan H et al (2010) Prognostic factors in patients with advanced cancer: use of the patient-generated subjective global assessment in survival prediction. J Clin Oncol 28(28):4376–4383, Epub 2010/09/02

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors gratefully acknowledge Dr. Edmund Fitzgerald for reviewing this manuscript. The authors also like to acknowledge the support received from colleagues from Medical Oncology and Nutrition & Dietetics Department, Concord Hospital.

Conflict of interest

None of the authors have a conflict of interest to declare. Access to data in the study is available if requested.

Author information

Authors and Affiliations

  1. Nutrition and Dietetics Department, Concord Hospital, Sydney, Australia

    Cindy S. Y. Tan

  2. Prince of Wales Hospital, Sydney, Australia

    Jane A. Read

  3. Gosford Hospital, Sydney, Australia

    Viet H. Phan

  4. Medical Oncology Department, Sydney Cancer Center Concord Hospital, Sydney, Australia

    Cindy S. Y. Tan & Philip J. Beale

  5. Biostatistician, Concord Repatriation General Hospital, Sydney, Australia

    Jennifer K. Peat

  6. Medical Oncology Department, Royal North Shore Hospital, Sydney, Australia

    Stephen J. Clarke

Authors
  1. Cindy S. Y. Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jane A. Read
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Viet H. Phan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Philip J. Beale
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jennifer K. Peat
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Stephen J. Clarke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cindy S. Y. Tan.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tan, C.S.Y., Read, J.A., Phan, V.H. et al. The relationship between nutritional status, inflammatory markers and survival in patients with advanced cancer: a prospective cohort study. Support Care Cancer 23, 385–391 (2015). https://doi.org/10.1007/s00520-014-2385-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-014-2385-y

Keywords

Search

Navigation