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Ma S, Li Z, Wang L. The advanced lung cancer inflammation index (ALI) predicted the postoperative survival rate of patients with non-small cell lung cancer and the construction of a nomogram model. World J Surg Oncol 2024; 22:158. [PMID: 38877553 PMCID: PMC11177447 DOI: 10.1186/s12957-024-03432-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 06/01/2024] [Indexed: 06/16/2024] Open
Abstract
OBJECTIVE To investigate the prognostic significance of the advanced lung cancer inflammation index (ALI) in patients with operable non-small-cell lung carcinoma (NSCLC). By constructing the nomogram model, it can provide a reference for clinical work. METHODS A total of 899 patients with non-small cell lung cancer who underwent surgery in our hospital between January 2017 and June 2021 were retrospectively included. ALI was calculated by body mass index (BMI) × serum albumin/neutrophil to lymphocyte ratio (NLR). The optimal truncation value of ALI was obtained using the receiver operating characteristic (ROC) curve and divided into two groups. Survival analysis was represented by the Kaplan-Meier curve. The predictors of Overall survival (OS) were evaluated by the Cox proportional risk model using single factor and stepwise regression multifactor analysis. Based on the results of multi-factor Cox proportional risk regression analysis, a nomogram model was established using the R survival package. The bootstrap method (repeated sampling 1 000 times) was used for internal verification of the nomogram model. The concordance index (C-index) was used to represent the prediction performance of the nomogram model, and the calibration graph method was used to visually represent its prediction conformity. The application value of the model was evaluated by decision curve analysis (DCA). RESULTS The optimal cut-off value of ALI was 70.06, and the low ALI group (ALI < 70.06) showed a poor survival prognosis. In multivariate analyses, tumor location, pathological stage, neuroaggression, and ALI were independently associated with operable NSCLC-specific survival. The C index of OS predicted by the nomogram model was 0.928 (95% CI: 0.904-0.952). The bootstrap self-sampling method (B = 1000) was used for internal validation of the prediction model, and the calibration curve showed good agreement between the prediction and observation results of 1-year, 2-year, and 3-year OS. The ROC curves for 1-year, 2-year, and 3-year survival were plotted according to independent factors, and the AUC was 0.952 (95% CI: 0.925-0.979), 0.951 (95% CI: 0.916-0.985), and 0.939 (95% CI: 0.913-0.965), respectively. DCA shows that this model has good clinical application value. CONCLUSION ALI can be used as a reliable indicator to evaluate the prognosis of patients with operable NSCLC, and through the construction of a nomogram model, it can facilitate better individualized treatment and prognosis assessment.
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Affiliation(s)
- Shixin Ma
- Graduate School, Dalian Medical University, Dalian, 116000, Liaoning, China
- Department of Thoracic Surgery, Qingdao Municipal Hospital, No.5 Donghai Middle Road, Qingdao, 266071, Shandong, China
| | - Zongqi Li
- Graduate School, Dalian Medical University, Dalian, 116000, Liaoning, China
- Department of Thoracic Surgery, Qingdao Municipal Hospital, No.5 Donghai Middle Road, Qingdao, 266071, Shandong, China
| | - Lunqing Wang
- Department of Thoracic Surgery, Qingdao Municipal Hospital, No.5 Donghai Middle Road, Qingdao, 266071, Shandong, China.
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Prete M, Ballarin G, Porciello G, Arianna A, Luongo A, Belli V, Scalfi L, Celentano E. Bioelectrical impedance analysis-derived phase angle (PhA) in lung cancer patients: a systematic review. BMC Cancer 2024; 24:608. [PMID: 38769506 PMCID: PMC11106952 DOI: 10.1186/s12885-024-12378-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/13/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Lung cancer is the second most diagnosed cancer in the world. Up to 84% of diagnosed patients have malnutrition, which can negatively affect quality of life and survival and may worsen with neoadjuvant treatment. Bioelectrical Impedance Analysis-Derived Phase Angle (PhA) in these patients could be a valid tool to assess the nutritional status in order to improve their condition. METHODS This review provides an update on PhA assessment in lung cancer patients over the past twenty years. We searched PubMed, Embase, Scopus, Web of Science, and Cochrane, for articles regarding the PhA obtained from Bioelectrical Impedance Analysis in lung cancer patients. The authors independently performed a literature search: sample size, patient population, study type, study dates, survival and interventions were evaluated. The final review included 11 studies from different countries. RESULTS Eight studies only considered patients with lung cancer, while three studies considered patients with different kind of cancer, including lung. Correlation data between PhA and age are conflicting. In patients undergoing clinical treatment and patients undergoing surgical treatment lower PhA was observed. A lower PhA is associated with a shorter survival. In three studies emerged a relationship between Karnofski Performance Status and Handgrip Strenght with PhA. From one study, univariate logistic regression analysis showed that higher PhA values represent a protective factor for sarcopenia. CONCLUSION Our research underlined interesting, but not conclusive, results on this topic; however more researches are needed to understand the clinical meaning of PhA.
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Affiliation(s)
- Melania Prete
- Division of Radiotherapy, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, 80131, Italy
| | - Giada Ballarin
- Department of Medical, Movement Sciences and Wellbeing, University of Naples "Parthenope", Naples, 80133, Italy
| | - Giuseppe Porciello
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, 80131, Italy.
| | - Aniello Arianna
- Department of Public Health, Federico II University Hospital, Via Pansini 5, Naples, 80131, Italy
| | - Assunta Luongo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, 80131, Italy
| | - Valentina Belli
- Scientific Direction, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, 80131, Italy
| | - Luca Scalfi
- Department of Public Health, Federico II University Hospital, Via Pansini 5, Naples, 80131, Italy
| | - Egidio Celentano
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, 80131, Italy
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MacDonald M, Poei D, Leyba A, Diep R, Chennapan K, Leon C, Xia B, Nieva JJ, Hsu R. Real world prognostic utility of platelet lymphocyte ratio and nutritional status in first-line immunotherapy response in stage IV non-small cell lung cancer. Cancer Treat Res Commun 2023; 36:100752. [PMID: 37611343 PMCID: PMC11160511 DOI: 10.1016/j.ctarc.2023.100752] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/25/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Elevated platelet lymphocyte ratio (PLR) and low body mass index (BMI) are associated with inferior survival in non-small cell lung cancer (NSCLC) patients receiving immunotherapy (IO). We evaluated real-world prognostic utility of PLR, BMI, and albumin level in stage IV NSCLC patients receiving first line (1L) IO. METHODS We identified 75 stage IV patients who received 1L IO therapy at USC Norris Comprehensive Cancer Center and Los Angeles General Medical Center from 2015 to 2022. The primary outcome was overall survival (OS) from time of IO with attention to pre-treatment BMI < 22, albumin < 3.5 g/dL, and PLR > 180. RESULTS Median age was 66.5 years with 49 (65.3%) males. 25 (33.3%) had BMI < 22. 45/75 (60%) had PLR > 180. Patients with BMI < 22 had inferior OS (13.1 months (m) vs. 37.4 m in BMI > 28, p-value = 0.042) along with patients with albumin<3.5 g/dL (OS: 2.8 m vs. 14.6 m, p-value = 0.0027), and patients with PLR>180 (OS: 8.7 m vs. 23.0 m, p = 0.028). Composite BMI < 22, PLR > 180 had the worst OS, p-value = 0.0331. Multivariate analysis controlling for age, smoking, gender, PD-L1 tumor proportion score (TPS), and histology (adenocarcinoma, squamous, adenosquamous, and large cell) showed that BMI (HR: 0.8726, 95% CI: 0.7892-0.954) and PLR > 180 (HR: 2.48, 95% CI: 1.076-6.055) were significant in OS mortality risk. CONCLUSION Patients with a composite of BMI < 22, albumin < 3.5 g/dL, and PLR > 180 had significantly worse OS. This highlights the importance of screening for poor nutritional status and high PLR to better inform stage IV NSCLC patients receiving IO therapy of their prognosis and supportive care. MICROABSTRACT We evaluated real-world prognostic utility of platelet lymphocyte ratio (PLR), body mass index (BMI), and albumin level in 75 Stage IV NSCLC patients receiving first line IO. Patients with a composite of BMI < 22, albumin < 3.5 g/dL, and PLR > 180 had significantly worse OS. This highlights the importance of screening for poor nutritional status and high PLR to better inform stage IV NSCLC patients of their prognosis and to emphasize supportive care needs.
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Affiliation(s)
- Madeline MacDonald
- Department of Internal Medicine, University of Southern California, Los Angeles, CA, United States
| | - Darin Poei
- Department of Internal Medicine, University of Southern California, Los Angeles, CA, United States
| | - Alexis Leyba
- Department of Internal Medicine, University of Southern California, Los Angeles, CA, United States
| | - Raymond Diep
- California University of Science and Medicine SOM, Colton, CA, United States
| | - Krithika Chennapan
- Department of Internal Medicine, University of Southern California, Los Angeles, CA, United States
| | - Christopher Leon
- Department of Surgery, University of Southern California, Los Angeles, CA, United States
| | - Bing Xia
- Department of Internal Medicine, Division of Medical Oncology, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA, United States
| | - Jorge J Nieva
- Department of Internal Medicine, Division of Medical Oncology, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA, United States
| | - Robert Hsu
- Department of Internal Medicine, Division of Medical Oncology, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA, United States.
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Hartmann P, Trufa DI, Hohenberger K, Tausche P, Trump S, Mittler S, Geppert CI, Rieker RJ, Schieweck O, Sirbu H, Hartmann A, Finotto S. Contribution of serum lipids and cholesterol cellular metabolism in lung cancer development and progression. Sci Rep 2023; 13:5662. [PMID: 37024569 PMCID: PMC10079859 DOI: 10.1038/s41598-023-31575-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/14/2023] [Indexed: 04/08/2023] Open
Abstract
Neoplasms of the lungs are the leading cause of cancer incidence and mortality worldwide. Although immunotherapy has increased the overall survival of patients with lung cancer, there is the need to improve this treatment. At this regard, blood lipid levels are thought to be linked to cancer risk and thus a preventive intervention through regulation of the nutrition of patients with lung cancer is gaining much attention. In this study, we therefore asked about the contribution of serum lipids and cholesterol cellular metabolism in lung cancer development and progression. We measured different serum lipids and analyzed cholesterol synthesis enzymes 3-hydroxy-3-methyl-glutaryl-CoA reductase (HMGCR) and acetyl-coenzyme A cholesterol acetyltransferase 1 (ACAT1) as well as the cholesterol cellular export protein ATP-binding cassette (ABC) A-1 mRNA by quantitative PCR (qPCR) in the control and tumoral regions of post-surgery lung tissues to analyze the accumulation of cholesterol in cancer cells in a cohort of patients with lung adenocarcinoma (LUAD). We found that triglycerides in serum directly correlated with the body mass index (BMI) in patients with LUAD. By contrast, we found that high-density lipoprotein (HDL) cholesterol inversely correlated with the BMI, C-reactive protein (CRP) and overall survival and total cholesterol inversely correlated with the tumor diameter, serum CRP and overall survival in these LUAD patients. Functionally, the role of cholesterol is indispensable for the growth and development of normal animal cells where it is tightly regulated. Excess of cellular cholesterol regulated by HMGCR is converted to cholesteryl esters by the enzyme ACAT1 and exported extracellularly by the cholesterol transporter ABCA1. Here we found HMGCR and ACAT1 upregulated and ABCA1 downregulated in the lung's tumoral region of our LUAD cohort, indicating cholesterol dysregulated cellular export in lung tumor cells.
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Affiliation(s)
- Philipp Hartmann
- Department of Molecular Pneumology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Universitätsklinikum Erlangen, 91052, Erlangen, Germany
| | - Denis I Trufa
- Department of Thoracic Surgery, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Universitätsklinikum Erlangen, 91052, Erlangen, Germany
| | - Katja Hohenberger
- Department of Molecular Pneumology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Universitätsklinikum Erlangen, 91052, Erlangen, Germany
| | - Patrick Tausche
- Department of Molecular Pneumology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Universitätsklinikum Erlangen, 91052, Erlangen, Germany
| | - Sonja Trump
- Department of Molecular Pneumology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Universitätsklinikum Erlangen, 91052, Erlangen, Germany
| | - Susanne Mittler
- Department of Molecular Pneumology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Universitätsklinikum Erlangen, 91052, Erlangen, Germany
| | - Carol I Geppert
- Institute of Pathology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Universitätsklinikum Erlangen, 91052, Erlangen, Germany
| | - Ralf J Rieker
- Institute of Pathology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Universitätsklinikum Erlangen, 91052, Erlangen, Germany
| | - Oliver Schieweck
- Laboratory of Clinic Medicine, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Universitätsklinikum Erlangen, 91052, Erlangen, Germany
| | - Horia Sirbu
- Department of Thoracic Surgery, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Universitätsklinikum Erlangen, 91052, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Universitätsklinikum Erlangen, 91052, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Susetta Finotto
- Department of Molecular Pneumology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Universitätsklinikum Erlangen, 91052, Erlangen, Germany.
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany.
- Laboratories of Cellular and Molecular Lung Immunology, Department of Molecular Pneumology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Hartmannstraße 14, 91052, Erlangen, Germany.
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Changes in Body Weight, Body Composition, Phase Angle, and Resting Metabolic Rate in Male Patients with Stage IV Non-Small-Cell Lung Cancer Undergoing Therapy. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121779. [PMID: 36556981 PMCID: PMC9784033 DOI: 10.3390/medicina58121779] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
Background and Objectives: Cancer treatments can adversely influence body weight status, body composition, phase angle (PhA), and resting metabolic rate (RMR), which could possibly affect disease course. Τhe aim was to assess differences in body composition, PhA, RMR, and related parameters in non-small-cell lung cancer (NSCLC) patients after treatment. Methods: The sample consisted of 82 NSCLC (stage IV) male patients (chemotherapy (C) 15.7%; immunotherapy (I) 13.3%; C + I 25.3%; (C) + radiotherapy (R) 22.9 %; and other 15.5%). Body weight and body composition, PhA, RMR, oxygen consumption (VO2), ventilation rate, and diet were assessed at baseline and at 3 months after initiation of therapy. Results: Reductions in PhA, RMR, VO2, ventilation rate, and intracellular water were observed at follow up. Weight loss was evident for 45% of patients who also had a reduction in lean body mass. In the group under C, lean mass was reduced at follow up (55.3 ± 11.53 vs. 52.4 ± 12.6, p = 0.04) without significant weight changes. In subjects with a low adherence to the Mediterranean diet (MedDietScore < 30), RMR (1940 ± 485 vs. 1730 ± 338 Kcal, p = 0.001), VO2 (277.1 ± 70.2 vs. 247 ± 49.1 mL/min, p = 0.001), and ventilation rate (10.1 ± 2.28 vs. 9. ± 2 2.2 L/min, p = 0.03) were significantly reduced. The changes in body weight were positively related to % of change in fat mass (rho = 0.322, p = 0.003) and absolute lean mass change (rho = 0.534, p < 0.001) and negatively associated with % of change in total body water (rho = −0.314, p = 0.004) (Spearman correlation coefficients). Conclusions: In conclusion, cancer therapy related to reductions in PhA and RMR, while lean mass reduction may be related to the type of treatment. Our results emphasize the importance of a more holistic nutritional and body composition assessment beyond body weight, to better address patients’ needs in clinical practice.
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Detopoulou P, Tsiouda T, Pilikidou M, Palyvou F, Mantzorou M, Perzirkianidou P, Kyrka K, Methenitis S, Kondyli FS, Voulgaridou G, Zarogoulidis P, Matthaios D, Oikonomidou R, Romanidou M, Giannakidis D, Papadopoulou SK. Dietary Habits Are Related to Phase Angle in Male Patients with Non-Small-Cell Lung Cancer. Curr Oncol 2022; 29:8074-8083. [PMID: 36354697 PMCID: PMC9689548 DOI: 10.3390/curroncol29110637] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/18/2022] [Accepted: 10/22/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction: Lung cancer constitutes the most common cause of cancer death. Phase angle (PhA) has been related to lung cancer prognosis, which implies that the identification of dietary or other factors that could predict or modify PhA may have beneficial effects. Νutritional interventions have been linked with positive changes in PhA in certain types of cancer. Aim: The present study aimed to investigate the relationships between dietary habits/nutrition and PhA in NSCLC patients. Methods: The sample consisted of 82 male patients with non-small-cell lung cancer (NSCLC; stage IV) from the 'Theageneio' Cancer Hospital (Thessaloniki, Greece). Several parameters were assessed, such as body mass index (BMI), lean mass, PhA, Mediterranean diet score (MedDietScore), dietary patterns, smoking, resting metabolic rate, resting oxygen consumption (VO2), ventilation rate, and physical activity. Results: According to our results, a dietary pattern rich in potatoes and animal proteins (meat and poultry) was a significant determinant of PhA (B ± SE, p: 0.165 ± 0.08, p = 0.05) in multiple linear regression models after adjusting for age, smoking, lean tissue, and MedDietScore. Conclusion: In conclusion, dietary patterns may affect PhA, suggesting the crucial role of protein in cancer management and the prevention of sarcopenia.
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Affiliation(s)
- Paraskevi Detopoulou
- Department of Clinical Nutrition, General Hospital Korgialenio Benakio, 11526 Athens, Greece
- Department of Nutritional Sciences and Dietetics, University of the Peloponnese, 24100 Kalamata, Greece
| | - Theodora Tsiouda
- Pulmonary-Oncology Department, ‘Theageneio’ Cancer Hospital, 54007 Thessaloniki, Greece
| | - Maria Pilikidou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
| | - Foteini Palyvou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
| | - Maria Mantzorou
- Department of Food Science and Nutrition, University of Aegean, 81400 Lemnos, Greece
| | | | - Krystallia Kyrka
- Pulmonary-Oncology Department, ‘Theageneio’ Cancer Hospital, 54007 Thessaloniki, Greece
| | - Spyridon Methenitis
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
- Sports Performance Laboratory, School of Physical Education and Sports Science, National and Kapodistrian University of Athens, 15772 Athens, Greece
- Theseus, Physical Medicine and Rehabilitation Center, 17671 Athens, Greece
| | - Foivi S. Kondyli
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
| | - Gavriela Voulgaridou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
| | - Paul Zarogoulidis
- Pulmonary Department, General Clinic Euromedica Private Hospital, 54645 Thessaloniki, Greece
- 3rd Surgery Department, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | | | | | - Maria Romanidou
- Dietitian, Adult Eating Disorders Service, Essex Partnership University NHS Foundation Trust, Wickford SS11 7XX, UK
| | - Dimitrios Giannakidis
- 1st Department of Surgery, Attica General Hospital “Sismanogleio—Amalia Fleming”, 15126 Athens, Greece
| | - Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
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