Impact of systemic inflammatory markers in patients with ALK-positive non-small cell lung cancer treated with crizotinib

OBJECTIVES

To evaluate the prognostic utility of inflammation-based prognostic scores in patients with ALK-positive metastatic or non-resectable non-small-cell lung cancer (NSCLC) treated with crizotinib.

PATIENTS AND METHODS

A total of 82 patients with ALK-positive metastatic or non-resectable NSCLC who received ALK TKI crizotinib were included. Pre-treatment modified Glasgow prognostic score (mGPS), prognostic nutritional index (PNI), and systemic immune-inflammation index (SII) were calculated. Multivariable logistic regression and Cox proportional hazards models were used to assess the impact of pretreatment mGPS, PNI, and SII on overall survival (OS), progression-free survival (PFS), and objective response rate (ORR).

RESULTS

The ORR was 77.2%, while 1-year OS and PFS rates were 95.0% and 93.5%, respectively. The univariate analysis revealed significantly higher 1-year PFS (89.4 vs. 64.4%, p=0.043) and OS (92.0 vs. 83.3%, p=0.01) rates in patients with low (<934.7) vs. high (≥934.7) SII scores. Multivariate analysis revealed that PNI ≥0.09 was a significant determinant of poorer 1-year OS rates (hazard ratio [HR]: 2.46, 95% confidence interval [CI] 0.88-4.85, p=0.035). No significant difference was observed in survival rates according to gender, age, smoking status, prior lines of therapy, or mGPS scores, while higher mGPS scores (odds ratio [OR]: 0.1, 95%CI 0.16-1.04; p=0.009) and higher PNI scores (OR: 0.16, 95% CI 0.02-0.55; p=0.035) were associated with poorer ORR.

CONCLUSION

Our findings indicate the prognostic significance of PNI and SII in terms of survival outcome and the impact of mGPS and PNI on treatment response in patients with ALK-positive NSCLC treated with crizotinib.

Presepsin and platelet to lymphocyte ratio predict the progression of septic subclinical acute kidney injury to septic acute kidney injury: a pilot study

OBJECTIVE

This study aimed to determine whether presepsin and inflammation-based prognostic scores can predict the progression of septic subclinical acute kidney injury (AKI) to septic AKI among intensive care unit (ICU) patients.

RESULTS

Presepsin values were measured immediately after ICU admission (baseline) and on Days 2, 3, and 5 after ICU admission. Glasgow Prognostic Score, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio (PLR), Prognostic Index, and Prognostic Nutritional Index were measured at baseline. Presepsin values and these indices were compared between septic AKI and septic subclinical AKI patients. There were 38 septic AKI patients and 21 septic subclinical AKI patients. Receiver operating characteristic curve analyses revealed the following cut-off values for AKI (relative to subclinical AKI): 708.0 (pg/ml) for presepsin on Day 1 (AUC, 0.69; sensitivity, 82%; specificity, 52%), 1283.0 (pg/ml) for presepsin on Day 2 (AUC, 0.69; sensitivity, 55%; specificity, 80%), and 368.66 for PLR (AUC, 0.67; sensitivity, 71%; specificity, 62%). Multivariate logistic regression analyses revealed PLR to be a predictor of septic subclinical AKI (odds ratio, 1.0023; 95% confidence interval, 1.0000-1.0046; p = 0.046). Presepsin and PLR predicted the progression of septic subclinical AKI to septic AKI and the prognosis of subclinical septic AKI patients.

Presepsin and prognostic nutritional index are predictors of septic acute kidney injury, renal replacement therapy initiation in sepsis patients, and prognosis in septic acute kidney injury patients: a pilot study

Background

Sepsis is the most common cause of acute kidney injury (AKI) among critically ill patients. This study aimed to determine whether presepsin is a predictor of septic acute kidney injury, renal replacement therapy initiation (RRTi) in sepsis patients, and prognosis in septic AKI patients.

Methods

Presepsin values were measured immediately after ICU admission (baseline) and on Days 2, 3, and 5 after ICU admission. Glasgow Prognostic Score (GPS), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio, Prognostic Index, and Prognostic Nutritional Index (PNI) were measured at baseline, and total scores (“inflammation-presepsin scores [iPS]”) were calculated for category classification. Presepsin values, inflammation-based prognostic scores, and iPS were compared between patients with and without septic AKI or RRTi and between survivors and non-survivors.

Results

Receiver operating characteristic curve analyses identified the following variables as predictors of septic AKI and RRTi in sepsis patients: presepsin on Day 1 (AUC: 0.73) and Day 2 (AUC: 0.71) for septic AKI, and presepsin on Day 1 (AUC: 0.71), Day 2 (AUC: 0.9), and Day 5 (AUC: 0.96), Δpresepsin (Day 2 – Day 1) (AUC: 0.84), Δpresepsin (Day 5 – Day 1) (AUC: 0.93), and PNI (AUC: 0.72) for RRTi. Multivariate logistic regression analyses identified presepsin on Day 2 as a predictor of prognosis in septic AKI patients.

Conclusions

Presepsin and PNI were found to be predictors of septic AKI, RRTi in sepsis patients, and prognosis in septic AKI patients.

Urinary neutrophil gelatinase-associated lipocalin was a predictor from the day after intensive care unit entry, but not on the day of intensive care unit entry

BACKGROUND AND AIMS

Sepsis is the main cause of death from infection. This study aimed to determine whether neutrophil gelatinase-associated lipocalin (NGAL) values better predict mortality in septic patients when combined with inflammation-based prognostic scores.

MATERIAL AND METHODS

Forty-four adult patients diagnosed according to the Sepsis-3 definition and who were admitted to the ICU were prospectively examined from June 2018 to November 2018. Urine samples were collected from each patient with a urethral balloon bag to measure NGAL after ICU entry at the following time points: immediately after and 2, 3, and 4 days after ICU entry. The Glasgow Prognostic Score, the neutrophil to lymphocyte ratio (NLR), the platelet to lymphocyte ratio, the Prognostic Nutritional Index, the Prognostic Index (PI), the Sequential Organ Failure Assessment (SOFA), and quick SOFA were examined immediately after ICU entry. Predictors of mortality were assessed by receiver operating characteristics curve (ROC) analysis, log-rank test, and multivariate logistic regression analysis.

RESULTS

NGAL on day 4 (AUC: 0.94) and ΔNGAL from day 4 to day 1 (AUC: 0.9) for 28-day mortality; NGAL on day 4 (AUC: 0.94) and inflammation-NGAL score (iNS) NGAL-PI (AUC: 0.69) for 60-day mortality; ΔNGAL from day 3 to day 1 (AUC: 0.82) for 90-day mortality; and iNS NGAL-NLR (AUC: 0.71) and iNS NGAL-PI (AUC: 0.68) for in-hospital mortality were found to be predictors of mortality by ROC curve analysis. NLR (p = 0.02) for 28-day mortality; NGAL on day 2 (p = 0.031), ΔNGAL from day 2 to day 1 (p = 0.013), and NLR (p < 0.0001) for 60-day mortality; NGAL on day 2 (p = 0.017), ΔNGAL from day 2 to day 1 (p = 0.014), and NLR (p = 0.033) for 90-day mortality; and NGAL on day 2 (p = 0.007) for in-hospital mortality were found to be predictors of mortality by log-rank test. iNS NGAL-NLR (OR, 0.024; p = 0.019) for 60-day mortality and NGAL from day 3 to day 1 (OR, 1.005; p = 0.013) for 90-day mortality were found to be predictors of mortality by multivariate logistic regression analysis.

CONCLUSIONS

NGAL and ΔNGAL were predictors of mortality in sepsis patients on day 2 after ICU entry and thereafter, but not on day 1.

Prognostic value of pre-treatment risk stratification and post-treatment neutrophil/lymphocyte ratio change for pembrolizumab in patients with advanced urothelial carcinoma

BACKGROUND

Pembrolizumab is effective in a limited number of patients with advanced urothelial carcinoma (UC). Therefore, we evaluated the prognostic value of clinical biomarkers following pembrolizumab treatment in patients with advanced UC.

METHODS

We retrospectively reviewed the medical records of 121 patients with platinum-refractory advanced UC who received pembrolizumab. Inflammation-based prognostic scores before and 6 weeks after the treatment were recorded. The categorical variables influencing overall survival (OS) and objective response rate (ORR) were analyzed.

RESULTS

Multivariate analyses showed that pretreatment Eastern Cooperative Oncology Group (ECOG) performance score (PS), presence of only lymph node metastasis (only LN mets), C-reactive protein (CRP), and neutrophil/lymphocyte ratio (NLR) were independent prognostic factors for OS (P = 0.0077; RR = 2.42, P = 0.0049; RR = 0.36, P = 0.0047; RR = 2.53, and P = 0.0079; RR = 2.33, respectively). The pretreatment risk stratification using ECOG PS, only LN mets, CRP, and NLR was used for estimating the OS (P < 0.0001) and ORR (P < 0.0001). Furthermore, changes in NLR in response to pembrolizumab were significantly associated with the OS (P = 0.0002) and ORR (P = 0.0023). This change was also significantly correlated with OS even in the high-risk group stratified by this pretreatment risk stratification (P = 0.0069).

CONCLUSIONS

This pretreatment risk stratification may be used for estimating the OS and ORR of patients with advanced UC treated with pembrolizumab. If changes in NLR in response to pembrolizumab treatment improve, pembrolizumab should be continued.

Prognostic value of inflammation-based prognostic scores on outcome in patients undergoing continuous ambulatory peritoneal dialysis

BACKGROUND

Inflammation-based prognostic scores have been used as outcome predictors in patients with cancer or on hemodialysis. However, their role in patients on continuous ambulatory peritoneal dialysis (CAPD) remains unclear. This study aimed to examine the prognostic value of inflammation-based composite scores for mortality in CAPD patients.

METHODS

This study was conducted in CAPD patients enrolled from January 1, 2006 to December 31, 2014 and followed until December 31, 2016. Three inflammation-based prognostic scores, including Glasgow prognostic score (GPS), prognostic nutritional index (PNI), and prognostic index (PI), were conducted in this study. The associations between these scores and all-cause or cardiovascular mortality were evaluated by Kaplan-Meier method and Cox proportional hazards models. The areas under the curve (AUC) of receiver-operating characteristic (ROC) analysis were used to determine the predictive values of mortality.

RESULTS

A total of 1501 patients were included. During a median follow-up of 38.7 (range, 21.6-62.3) months, 346 (23.1%) patients died, of which 168 (48.6%) were due to cardiovascular diseases (CVD). After adjustment for confounders, the results showed that elevated GPS, PNI, and PI scores were all independently associated with all-cause [GPS: Score 1: hazard ratio(HR) 3.94, 95% confidence interval(CI) 2.90-5.35; Score 2: HR 7.56, 95% CI 5.35-10.67; PNI: HR 1.82, 95% CI 1.36-2.43; PI: Score 1: HR 2.08, 95% CI 1.63-2.65; Score 2: HR 3.03, 95% CI 2.00-4.60)] and CVD mortality(GPS: Score 1: HR 4.41, 95% CI 2.76-7.03; Score 2: HR 9.64, 95% CI 5.72-16.26; PNI: HR 1.63, 95% CI 1.06-2.51; PI: Score 1: HR 2.57, 95% CI 1.81-3.66, Score 2: HR 3.85, 95% CI 1.99-7.46).The AUC values of GPS score were 0.798 (95% CI0.770-0.826) for all-cause mortality and 0.781 (95% CI 0.744-0.817) for CVD mortality, both of which significantly higher than those of PNI and PI scores (P < 0.001, respectively).

CONCLUSIONS

All elevated GPS, PNI, and PI scores were independently associated with all-cause and CVD mortality. The GPS score showed better predictive value than PNI and PI scores in CAPD patients.

Comparison of Inflammation-Based Prognostic Scores in Patients undergoing Curative Resection for Non-small Cell Lung Cancer

BACKGROUND

Inflammation-based prognostic scores, including Glasgow prognostic score (GPS), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), prognostic nutritional index (PNI), systemic immune-inflammation index (SII) and advance lung cancer inflammation index (ALI) are reported to be associated with survival in patients with non-small cell lung cancer (NSCLC). However, at present, there are no studies that compared these scoring systems for resectable NSCLC.

METHODS

Three hundred forty-one NSCLC patients who underwent surgery at our institution were included. The optimal cut-off values of SII and ALI were calculated by the Cutoff Finder. The area under the receiver operating characteristics curve (AUC) was calculated to compare the predictive ability of each of the scoring systems. Univariate and multivariate analyses were performed to identify the clinicopathological variables associated with overall survival.

RESULTS

The optimal cut-off value of SII and ALI were 471.2 × 109/L and 37.66, respectively. All scores were significantly related to the 5-year cancer-specific survival. The ALI consistently had a higher AUC value in comparison with other inflammation-based prognostic scores. A multivariate analysis showed that GPS and ALI were independently associated with overall cancer-specific survival.

CONCLUSION

To the best of our knowledge, this is the first study to demonstrate that GPS and ALI appear to be superior to other inflammation-based prognostic scores in patients undergoing potentially curative resection for NSCLC.