Highly elevated systemic inflammation is a strong independent predictor of early mortality in advanced non-small cell lung cancer. (2022)

• Record Type: Journal Article
• Authors: Isaksson, Johan; Wennström, Leo; Branden, Eva; Koyi, Hirsh; Berglund, Anders; Micke, Patrick; Mattsson, Johanna Sofia Margareta; Willén, Linda; Botling, Johan
• Is Part Of: Cancer treatment and research communications. Number 31(2022)
• Publication Date: 2022
• Subjects: Lung cancer -- Inflammation -- NSCLC -- Survival -- C-reactive protein
• DOI: 10.1016/j.ctarc.2022.100556
• Languages: English
• ISSNs: 2468-2942

Abstract

Highlights: High systemic inflammation is common in advanced stage lung cancer and is an independent strong predictor of poor outcomes. A high inflammation score has an independent survival impact equal to deterioration of performance status from ECOG 0 to 2. Routine laboratory blood tests can be used to define the NSCLC group with the highest degree of systemic inflammation. Abstract: Background: Ample evidence support inflammation as a marker of outcome in non-small cell lung cancer (NSCLC). Here we explore the outcome for a subgroup of patients with advanced disease and substantially elevated systemic inflammatory activity. Methods: The source cohort included consecutive patients diagnosed with NSCLC between January 2016 – May 2017 ( n = 155). Patients with active infection were excluded. Blood parameters were examined individually, and cut-offs (ESR > 60 mm, CRP > 20 mg/L, WBC > 10 × 10 9, PLT > 400 × 10 9 ) were set to define the group of hyperinflamed patients. A score was developed by assigning one point for each parameter above cut-off (0–4 points). Results: High systemic inflammation was associated with advanced stage and was seldom present in limited NSCLC. However, the one year survival of patients in stage IIIB-IV ( n = 93) with an inflammation score of ≥2 was 0% compared to 33% and 50% among patients with a score of 1 and 0 respectively. The effect of a high inflammation score on overall survival remained significant in multi-variate analysis adjusted for confounding factors. The independent hazard ratio of an inflammation score ≥ 2 in multi-variate analysis (HR 3.43, CI 1.76–6.71) was comparable to a change in ECOG PS from 0 to 2 (HR 2.42, CI 1.13–5.18). Conclusion: Our results show that high level systemic inflammation is a strong independent predictor of poor survival in advanced stage NSCLC. This observation may indicate a need to use hyperinflammation as an additional clinical parameter for stratification of patients in clinical studies and warrants further research on underlying mechanisms linked to tumor progression.