Akciğer Kanseri Nedeniyle Ameliyat Edilen Yaşlı Hastalarda Sağkalım ile İnflamatuvar ve Beslenme Belirteçleri Arasındaki İlişki
Abstract
Amaç: Günümüzde yaşlı nüfusta kanser insidansında ve kansere bağlı ölümlerde artış görülmektedir. Bu çalışmanın amacı küçük hücreli dışı akciğer kanseri (KHDAK) tanılı olan yaşlı hastalarda nötrofil lenfosit oranı (NLO) ve prognostik beslenme indeksi (prognostic nutritional index, PNI) düzeylerinin sağkalım oranı üzerindeki etkisinin değerlendirilmesidir.
Gereç ve Yöntemler: Bu çalışmaya 2012 ve 2018 yılları arasında KHDAK nedeniyle opere edilmiş olan toplam 73 hasta (≥70 yaş) dahil edildi. Hasta kayıtları geriye dönük olarak analiz edildi. NLO değeri, kan nötrofil sayısı/lenfosit sayısı formülü ile hesaplandı. NLR için kesim değeri 2,5 olarak kabul edildi. PNI değeri, 10 x serum albümini (g/dL) + 0,005 x toplam lenfosit sayısı (milimetre başına) şeklinde hesaplandı. 50'nin altındaki PNI değerleri düşük olarak kabul edildi.
Bulgular: Hastaların ortalama yaşı 74,15±3,23 yıl, 59 (%80,8) hasta erkek ve 14'ü (%19,2) hasta kadındı. PNI (p=0,354) ve NLO (p=0,483) ile postoperatif komplikasyon arasında istatistiksel olarak anlamlı bir ilişki saptanmadı. Postoperatif mortalite de PNI (p=0,188) ve NLO (p=0,465) ile anlamlı olarak ilişkili değildi. NLO <2,5 olan hastalarda 1-, 3- ve 5-yıllık sağkalım oranları sırasıyla %86,0, %86,1 ve %78,3 iken bu oranlar NLR >2,5 olan hastalar için sırasıyla %76,9, %65,2 ve %24,8 idi (p=0,028).
Sonuç: Sonuçlar KHDAK olan yaşlı hastalarda NLO ile sağkalım oranları arasında anlamlı bir ilişki olduğunu ortaya koydu. NLO, KHDAK hastalarında tedavi kararlarını yönlendirmek ve optimize etmek için rutin klinik uygulamaya dahil edilebilecek ucuz, kolay ölçülebilir ve tekrarlanabilir bir belirteç olarak kabul edilebilir.
References
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- Forde PM, Ettinger DS. Targeted therapy for non-small-cell lung cancer: past, present and future. Expert Rev Anticancer Ther. 2013;13(6):745-58.
- Yancik R, Ries LA. Cancer in older persons: an international issue in an aging world. Semin Oncol. 2004;31(2):128-36.
- Kasapoglu US, Güngör S, Arınc S, Yalçınsoy M, Mısırlıoğlu A, Ak ÖM. Lung carcinoma patients aged eighty years over and prognostic factors affecting survival. Tuberk Toraks. 2017;65(2):97-105. Turkish.
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- Ocak Duran A, İleri̇ İ, İnanç M, Bozkurt O, Özaslan E, Uçar M, et al. The relationship between neutrophil / lymphocytes ratio and platelet / lymphocytes ratio with prognosis in operated stage 1-2 of non-small cell lung cancer disease: one central experience. Anatol Clin. 2017;22(3):149-56. Turkish.
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- Tominaga T, Nonaka T, Hisanaga M, Fukuda A, Tanoue Y, Yoshimoto T, et al. Prognostic value of the preoperative prognostic nutritional index in oldest-old patients with colorectal cancer. Surg Today. 2020;50(5):449-59.
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- Candeloro M, Di Nisio M, Balducci M, Genova S, Valeriani E, Pierdomenico SD, et al. Prognostic nutritional index in elderly patients hospitalized for acute heart failure. ESC Heart Fail. 2020;7(5): 2479-84.
- Valiathan R, Ashman M, Asthana D. Effects of ageing on the immune system: infants to elderly. Scand J Immunol. 2016;83(4):255-66.
- Lin EY, Pollard JW. Role of infiltrated leucocytes in tumor growth and spread. Br J Cancer. 2004;90(11):2053-8.
- Kang M, Chang CT, Sung HH, Jeon HG, Jeong BC, Seo SI, et al. Prognostic significance of pre- to postoperative dynamics of the prognostic nutritional index for patients with renal cell carcinoma who underwent radical nephrectomy. Ann Surg Oncol. 2017;24(13):4067-75.
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- Kaneko M, Nozawa H, Sasaki K, Hongo K, Hiyoshi M, Tada N, et al. Elevated neutrophil to lymphocyte ratio predicts poor prognosis in advanced colorectal cancer patients receiving oxaliplatin-based chemotherapy. Oncology. 2012;82(5):261-8.
- Teramukai S, Kitano T, Kishida Y, Kawahara M, Kubota K, Komuta K, et al. Pretreatment neutrophil count as an independent prognostic factor in advanced non-small-cell lung cancer: an analysis of Japan Multinational Trial Organisation LC00-03. Eur J Cancer. 2009;45(11):1950-8.
- Fest J, Ruiter TR, Groot Koerkamp B, Rizopoulos D, Ikram MA, van Eijck CHJ, et al. The neutrophil-to-lymphocyte ratio is associated with mortality in the general population: The Rotterdam Study. Eur J Epidemiol. 2019;34(5):463-70.
- Yıldız Gülhan P, Ataoğlu Ö, Güleç Balbay E, Annakkaya AN. General features of patients followed up in hospital with diagnosis of lung cancer. J DU Health Sci Inst. 2019;9(3):150-4.
- Cedrés S, Torrejon D, Martínez A, Martinez P, Navarro A, Zamora E, et al. Neutrophil to lymphocyte ratio (NLR) as an indicator of poor prognosis in stage IV non-small cell lung cancer. Clin Transl Oncol. 2012;14(11):864-9.
The Association between Inflammatory and Nutritional Markers and Survival in Elderly Patients Operated for Lung Cancer
Abstract
Aim: Today, there is an increase in cancer incidence and cancer-related deaths in the elderly population. This study aimed to evaluate the impact of neutrophil-to-lymphocyte ratio (NLR) and prognostic nutritional index (PNI) levels on the survival rate in elderly patients diagnosed with non-small cell lung cancer (NSCLC).
Material and Methods: A total of 73 patients (aged ≥70 years) who operated for NSCLC between 2012 and 2018 were included in this study. Patient records were analyzed retrospectively. The NLR value was calculated with the blood neutrophil count/lymphocyte count formula. The cut-off value for NLR was considered as 2.5. The PNI value was calculated as 10 x serum albumin (g/dL) + 0.005 × total lymphocyte count (per millimeter). PNI values lower than 50 were considered as low.
Results: The mean age of the patients was 74.15±3.23 years, 59 (80.8%) patients were male and 14 (19.2%) were female. No statistically significant relation of postoperative complication was noted with PNI (p=0.354) and NLR (p=0.483). Postoperative mortality was not significantly associated with PNI (p=0.188) and NLR (p=0.465). For patients with NLR <2.5, 1-, 3-, and 5-year survival rates were at 86.0%, 86.1%, and 78.3%, respectively, while these rates were at 76.9%, 65.2%, and 24.8%, respectively, for patients with NLR >2.5 (p=0.028).
Conclusion: Results revealed a significant association of NLR with survival rates in elderly patients with NSCLC. NLR can be considered inexpensive, easily measurable, and reproducible marker that can be incorporated into routine clinical practice for guiding and optimizing treatment decisions in patients with NSCLC.
References
- Bray F, Ferlay J, Soerjomataram I, Siegel R, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424.
- Forde PM, Ettinger DS. Targeted therapy for non-small-cell lung cancer: past, present and future. Expert Rev Anticancer Ther. 2013;13(6):745-58.
- Yancik R, Ries LA. Cancer in older persons: an international issue in an aging world. Semin Oncol. 2004;31(2):128-36.
- Kasapoglu US, Güngör S, Arınc S, Yalçınsoy M, Mısırlıoğlu A, Ak ÖM. Lung carcinoma patients aged eighty years over and prognostic factors affecting survival. Tuberk Toraks. 2017;65(2):97-105. Turkish.
- Parkin DM. Global cancer statistics in the year 2000. Lancet Oncol. 2001;2(9):533-43.
- Wang J, Kalhor N, Hu J, Wang B, Chu H, Zhang B, et al. Pretreatment neutrophil to lymphocyte ratio is associated with poor survival in patients with stage I-III non-small cell lung cancer. PLoS One. 2016;11(10):e0163397.
- Ocak Duran A, İleri̇ İ, İnanç M, Bozkurt O, Özaslan E, Uçar M, et al. The relationship between neutrophil / lymphocytes ratio and platelet / lymphocytes ratio with prognosis in operated stage 1-2 of non-small cell lung cancer disease: one central experience. Anatol Clin. 2017;22(3):149-56. Turkish.
- Dirican N, Anar C, Atalay Ş, Öztürk Ö, Bircan HA, Çakır M, et al. Effects on the prognosis of hematologic parameters in patients with small cell lung cancer. Cukurova Med J. 2016;41(2):333-41. Turkish.
- Buzby GP, Mullen JL, Matthews DC, Hobbs CL, Rosato EF. Prognostic nutritional index in gastrointestinal surgery. Am J Surg. 1980;139(1):160-7.
- Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi. 1984;85(9):1001-5. Japanese.
- Li D, Yuan X, Liu J, Li C, Li W. Prognostic value of the prognostic nutritional index in lung cancer: a meta-analysis. J Thorac Dis. 2018;10(9):5298-307.
- Ren F, Zhao T, Liu B, Pan L. Neutrophil-lymphocyte ratio (NLR) predicted prognosis for advanced non-small-cell lung cancer (NSCLC) patients who received immune checkpoint blockade (ICB). Onco Targets Ther. 2019;12:4235-44.
- Cabrerizo S, Cuadras D, Gomez-Busto F, Artaza-Artabe I, Marín-Ciancas F, Malafarina V. Serum albumin and health in older people: review and meta analysis. Maturitas. 2015;81(1):17-27.
- Sahyoun NR, Jacques PF, Dallal G, Russell RM. Use of albumin as a predictor of mortality in community dwelling and institutionalized elderly populations. J Clin Epidemiol. 1996;49(9):981-8.
- Tominaga T, Nonaka T, Hisanaga M, Fukuda A, Tanoue Y, Yoshimoto T, et al. Prognostic value of the preoperative prognostic nutritional index in oldest-old patients with colorectal cancer. Surg Today. 2020;50(5):449-59.
- Maeda K, Shibutani M, Otani H, Nagahara H, Sugano K, Ikeya T, et al. Low nutritional prognostic index correlates with poor survival in patients with stage IV colorectal cancer following palliative resection of the primary tumor. World J Surg. 2014;38(5):1217-22.
- Candeloro M, Di Nisio M, Balducci M, Genova S, Valeriani E, Pierdomenico SD, et al. Prognostic nutritional index in elderly patients hospitalized for acute heart failure. ESC Heart Fail. 2020;7(5): 2479-84.
- Valiathan R, Ashman M, Asthana D. Effects of ageing on the immune system: infants to elderly. Scand J Immunol. 2016;83(4):255-66.
- Lin EY, Pollard JW. Role of infiltrated leucocytes in tumor growth and spread. Br J Cancer. 2004;90(11):2053-8.
- Kang M, Chang CT, Sung HH, Jeon HG, Jeong BC, Seo SI, et al. Prognostic significance of pre- to postoperative dynamics of the prognostic nutritional index for patients with renal cell carcinoma who underwent radical nephrectomy. Ann Surg Oncol. 2017;24(13):4067-75.
- Yang Y, Gao P, Song Y, Sun J, Chen X, Zhao J, et al. The prognostic nutritional index is a predictive indicator of prognosis and postoperative complications in gastric cancer: A meta-analysis. Eur J Surg Oncol. 2016;42(8):1176-82.
- Chen XL, Xue L, Wang W, Chen HN, Zhang WH, Liu K, et al. Prognostic significance of the combination of preoperative hemoglobin, albumin, lymphocyte and platelet in patients with gastric carcinoma: a retrospective cohort study. Oncotarget. 2015;6(38):41370-82.
- Kaneko M, Nozawa H, Sasaki K, Hongo K, Hiyoshi M, Tada N, et al. Elevated neutrophil to lymphocyte ratio predicts poor prognosis in advanced colorectal cancer patients receiving oxaliplatin-based chemotherapy. Oncology. 2012;82(5):261-8.
- Teramukai S, Kitano T, Kishida Y, Kawahara M, Kubota K, Komuta K, et al. Pretreatment neutrophil count as an independent prognostic factor in advanced non-small-cell lung cancer: an analysis of Japan Multinational Trial Organisation LC00-03. Eur J Cancer. 2009;45(11):1950-8.
- Fest J, Ruiter TR, Groot Koerkamp B, Rizopoulos D, Ikram MA, van Eijck CHJ, et al. The neutrophil-to-lymphocyte ratio is associated with mortality in the general population: The Rotterdam Study. Eur J Epidemiol. 2019;34(5):463-70.
- Yıldız Gülhan P, Ataoğlu Ö, Güleç Balbay E, Annakkaya AN. General features of patients followed up in hospital with diagnosis of lung cancer. J DU Health Sci Inst. 2019;9(3):150-4.
- Cedrés S, Torrejon D, Martínez A, Martinez P, Navarro A, Zamora E, et al. Neutrophil to lymphocyte ratio (NLR) as an indicator of poor prognosis in stage IV non-small cell lung cancer. Clin Transl Oncol. 2012;14(11):864-9.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Research Article |
| Authors | |
| Early Pub Date | August 20, 2023 |
| Publication Date | August 30, 2023 |
| Submission Date | April 23, 2023 |
| Published in Issue | Year 2023 Volume: 25 Issue: 2 |
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