Effects of systemic inflammation and frailty on survival in elderly cancer patients: Results from the INSCOC study

Qi Zhang; Ziwen Wang; Mengmeng Song; Tong Liu; Jiashan Ding; Li Deng; Xi Zhang; Liang Qian; Yizhong Ge; Hailun Xie; Guotian Ruan; Chunhua Song; Qinghua Yao; Hongxia Xu; Haixing Ju; Hanping Shi

doi:10.3389/fimmu.2023.936904

Effects of systemic inflammation and frailty on survival in elderly cancer patients: Results from the INSCOC study

Front Immunol. 2023 Feb 20:14:936904. doi: 10.3389/fimmu.2023.936904. eCollection 2023.

Authors

Qi Zhang^{1

2

3

4}, Ziwen Wang^{2

3

5

6}, Mengmeng Song^{2

3

6

7}, Tong Liu^{2

3

6

7}, Jiashan Ding⁸, Li Deng^{2

3

6

7}, Xi Zhang^{2

3

6

7}, Liang Qian⁹, Yizhong Ge¹⁰, Hailun Xie^{2

3

6

7}, Guotian Ruan^{2

3

6

7}, Chunhua Song¹¹, Qinghua Yao¹², Hongxia Xu¹³, Haixing Ju¹, Hanping Shi^{2

3

6

7}

Affiliations

¹ Department of Colorectal Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital) Hangzhou, Zhejiang, China.
² Key Laboratory of Cancer Food for Special Medical Purposes (FSMP) for State Market Regulation, Beijing Shijitan Hospital, Beijing, China.
³ Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing Shijitan Hospital, Beijing, China.
⁴ Integrated Traditional Chinese and Western Medicine Oncology Laboratory, Key Laboratory of Traditional Chinese Medicine of Zhejiang Province, Hangzhou, Zhejiang, China.
⁵ Department of Cardiology, Geriatric Cardiovascular Disease Research and Treatment Center, the 82nd Group Army Hospital of PLA (252 Hospital of PLA), Baoding, Hebei, China.
⁶ Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
⁷ Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
⁸ Department of Obstetrics and Gynecology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
⁹ Department of Obstetrics and Gynecology, Hangzhou Women's Hospital, Hangzhou Maternal and Child Health Hospital, Hangzhou First People's Hospital Qianjiang, Hangzhou, China.
¹⁰ Department of Oncology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
¹¹ Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
¹² Department of Integrated Chinese and Western Medicine, Cancer Hospital of University of Chinese Academy of Science, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China.
¹³ Department of Clinical Nutrition, Daping Hospital, Army Medical University, Chongqing, China.

Abstract

Background: Frailty and systemic inflammation are parameters, which are easy to evaluate, can be used to predict disease outcomes, and are potentially modifiable. The combination of frailty and inflammation-based data may help identify elderly cancer patients predisposed to adverse clinical outcomes. The aim of this study was to examine the association of systemic inflammation and frailty at admission, and to determine whether these risk factors interact and may predict the survival of elderly cancer patients.

Methods: A prospective Investigation on Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) with 5,106 elderly cancer patients admitted from 2013 through 2020 was included in this study. The primary marker of inflammation was the neutrophil-to-lymphocyte ratio (NLR), with the reference group having NLR<3, which indicated no inflammation. Frailty was assessed using the FRAIL scale, and patients with≥3 positives out of a total of five components were assumed to be frail. The primary outcome was all-cause mortality. We classified participants according to the presence (or absence) of frailty and high inflammation and assessed their association with overall survival using the Cox proportional hazards models adjusted for demographic, tumor, and treatment factors.

Results: Among the 5,106 patients enrolled in the study, 3396 individuals (66.51%) were male and the mean( ± SD) age at diagnosis was 70.92( ± 5.34). Over a median of 33.5 months follow-up, we observed 2,315 deaths. Increasing NLR was associated with frailty (compared with NLR<3, odds ratio=1.23, 95%CI=1.08-1.41 for NLR≥3). An NLR≥3 and frailty independently predicted the overall survival [hazard ratio(HR)=1.35, 95%CI=1.24-1.47 and HR=1.38, 95%CI=1.25-1.52, respectively). Patients with both frailty and NLR≥3 had the lowest overall survival(HR=1.83, 95%CI=1.59-2.04) than patients with no risk factors. The mortality rate increased with the presence of the frailty components.

Conclusions: Systemic inflammation was positively associated with frailty. Frail elderly cancer patients with elevated systemic inflammation had low survival rate.

Keywords: cancer; elderly; frailty; neutrophil to lymphocyte ratio; systematic inflammation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Female
Frail Elderly
Frailty*
Humans
Inflammation
Male
Neoplasms*
Nutritional Status
Prospective Studies

Grants and funding

This study is supported by the National Natural Science Foundation of China (32100939); the Beijing Municipal Science and Technology Commission (SCW2018-06); Zhejiang Provincial Natural Science Foundation (Y22H167257). The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.