nach oben

Erschienen in:

01.01.2024 | Research

A comprehensive analysis of the association between anemia and systemic inflammation in older patients with cancer

verfasst von: Xi Zhang, Jia-Xin Huang, Meng Tang, Qi Zhang, Li Deng, Chun-Hua Song, Wei Li, Min Yang, Han-Ping Shi, Ming-Hua Cong

Erschienen in: Supportive Care in Cancer | Ausgabe 1/2024

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Our study aimed to comprehensively analyze the association between anemia and systemic inflammation in older patients with cancer.

Methods

This multicenter prospective cohort study included 4955 older patients with cancer between 2013 and 2020. Logistic regression analysis was performed to investigate risk factors of anemia, reporting odds ratios (ORs), and 95% confidence intervals (CIs). Comprehensive survival analyses, including Kaplan–Meier curve, Cox proportional risk model, and subgroup analysis, were performed.

Results

The participants’ median age was 70.0 (interquartile range [IQR]=67.0–74.0) years, with 3293 (66.5%) males and 1662 (33.5%) females. There were 1717 (34.7%) older patients with cancer diagnosed with anemia. High neutrophil-to-lymphocyte ratio (NLR) was an independent risk factor associated with anemia (adjusted OR=1.97, 95%CI=1.73–2.24, P<0.001). In older patients with cancer and different anemia levels, the median overall survival was significantly shorter in those with a high NLR. In multivariate Cox analysis, high NLR served as a negative factor, independently affecting survival. The anemia-inflammation prognostic grading system showed a significant survival discriminative performance in older patients with cancer. After adjusting for confounders, high grades were independent risk factors for survival (grade 2: hazard ratio [HR] = 1.38, 95%CI = 1.26–1.52, P<0.001; grade 3: HR=1.82 95%CI = 1.59–2.09, P<0.001). This grading system was beneficial in determining survival in patients with lung, digestive tract, and urogenital cancers.

Conclusions

Increased systemic inflammation is an independent risk factor for anemia. A high inflammatory status is also associated with poor survival in older cancer patients at different anemia levels. The anemia-inflammation grading system is beneficial for determining the prognosis in older patients with cancer.

Nur mit Berechtigung zugänglich

Knight K, Wade S, Balducci L (2004) Prevalence and outcomes of anemia in cancer: a systematic review of the literature. Am J Med 5(116 Suppl 7A):11S–26S. https://doi.org/10.1016/j.amjmed.2003.12.008CrossRef

Blohmer JU, Dunst J, Harrison L, Johnston P, Khayat D, Ludwig H, O'Brien M, Van Belle S, Vaupel P (2005) Cancer-related anemia: biological findings, clinical implications and impact on quality of life. Oncology. 68(Suppl 1):12–21. https://doi.org/10.1159/000083129CrossRefPubMed

Bohlius J, Weingart O, Trelle S, Engert A (2006) Cancer-related anemia and recombinant human erythropoietin--an updated overview. Nat Clin Pract Oncol 3(3):152–164. https://doi.org/10.1038/ncponc0451CrossRefPubMed

Gillespie TW (2002) Effects of cancer-related anemia on clinical and quality-of-life outcomes. Clin J Oncol Nurs 6(4):206–211. https://doi.org/10.1188/02.CJON.206-211CrossRefPubMed

Birgegård G, Aapro MS, Bokemeyer C, Dicato M, Drings P, Hornedo J, Krzakowski M, Ludwig H, Pecorelli S, Schmoll H, Schneider M, Schrijvers D, Shasha D, Van Belle S (2005) Cancer-related anemia: pathogenesis, prevalence and treatment. Oncology. 68(Suppl 1):3–11. https://doi.org/10.1159/000083128CrossRefPubMed

Schwartz RN (2007) Anemia in patients with cancer: incidence, causes, impact, management, and use of treatment guidelines and protocols. Am J Health Syst Pharm 64(3 Suppl 2):S5–S13; quiz S28-30. https://doi.org/10.2146/ajhp060601CrossRefPubMed

Singh N, Baby D, Rajguru JP, Patil PB, Thakkannavar SS, Pujari VB (2019) Inflammation and cancer. Ann Afr Med 18(3):121–126. https://doi.org/10.4103/aam.aam_56_18CrossRefPubMedPubMedCentral

Nøst TH, Alcala K, Urbarova I, Byrne KS, Guida F, Sandanger TM, Johansson M (2021) Systemic inflammation markers and cancer incidence in the UK Biobank. Eur J Epidemiol 36(8):841–848. https://doi.org/10.1007/s10654-021-00752-6CrossRefPubMedPubMedCentral

Templeton AJ, McNamara MG, Šeruga B et al (2014) Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst 106(6):dju124. https://doi.org/10.1093/jnci/dju124CrossRefPubMed

10.

Weiss G, Ganz T, Goodnough LT (2019) Anemia of inflammation. Blood. 133(1):40–50. https://doi.org/10.1182/blood-2018-06-856500CrossRefPubMedPubMedCentral

11.

Macciò A, Madeddu C, Gramignano G, Mulas C, Tanca L, Cherchi MC, Floris C, Omoto I, Barracca A, Ganz T (2015) The role of inflammation, iron, and nutritional status in cancer-related anemia: results of a large, prospective, observational study. Haematologica. 100(1):124–132. https://doi.org/10.3324/haematol.2014.112813CrossRefPubMedPubMedCentral

12.

Bottazzi B, Riboli E, Mantovani A (2018) Aging, inflammation and cancer. Semin Immunol 40:74–82. https://doi.org/10.1016/j.smim.2018.10.011CrossRefPubMed

13.

Stauder R, Valent P, Theurl I (2018) Anemia at older age: etiologies, clinical implications, and management. Blood. 131(5):505–514. https://doi.org/10.1182/blood-2017-07-746446CrossRefPubMed

14.

Xu HX, Song CH, Yin LY, Wang C, Fu ZM, Guo ZQ et al (2022) Extension protocol for the Investigation on Nutrition Status and Clinical Outcome of Patients with Common Cancers in China (INSCOC) study: 2021 update. Precision Nutrition 1(2):e00014. https://doi.org/10.1097/PN9.0000000000000014

15.

Ma J, Wang J et al (2022) China anti-cancer association working group on clinical practice guidelines for tumor-related anemia. People’s medical publishing house, 2022. Retrieved from http://www.csco.org.cn/english/news/show.php?itemid=4097

16.

Lorente D, Mateo J, Templeton AJ et al (2015) Baseline neutrophil-lymphocyte ratio (NLR) is associated with survival and response to treatment with second-line chemotherapy for advanced prostate cancer independent of baseline steroid use. Ann Oncol 26(4):750–755. https://doi.org/10.1093/annonc/mdu587CrossRefPubMed

17.

Weimann A, Braga M, Carli F, Higashiguchi T, Hubner M, Klek S et al (2017) ESPEN guideline: clinical nutrition in surgery. Clin Nutr 36(3):623–650. https://doi.org/10.1016/j.clnu.2017.02.013CrossRefPubMed

18.

Zhang Z, Wan Z, Zhu Y, Zhang L, Zhang L, Wan H (2021) Prevalence of malnutrition comparing NRS2002, MUST, and PG-SGA with the GLIM criteria in adults with cancer: A multi-center study. Nutrition. 83:111072. https://doi.org/10.1016/j.nut.2020.111072CrossRefPubMed

19.

Ma C, Bandukwala S, Burman D, Bryson J, Seccareccia D, Banerjee S et al (2010) Inter-conversion of three measures of performance status: An empirical analysis. Eur J Cancer 46:3175–3183. https://doi.org/10.1016/j.ejca.2010.06.126CrossRefPubMed

20.

Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, Jatoi A, Loprinzi C, MacDonald N, Mantovani G, Davis M, Muscaritoli M, Ottery F, Radbruch L, Ravasco P, Walsh D, Wilcock A, Kaasa S, Baracos VE (2011) Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 12(5):489–495. https://doi.org/10.1016/S1470-2045(10)70218-7CrossRefPubMed

21.

Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376. https://doi.org/10.1093/jnci/85.5.365CrossRefPubMed

22.

Nordin K, Steel J, Hoffman K, Glimelius B (2001) Alternative methods of interpreting quality of life data in advanced gastrointestinal cancer patients. Br J Cancer 85:1265–1272. https://doi.org/10.1054/bjoc.2001.2046CrossRefPubMedPubMedCentral

23.

Penninx BW, Cohen HJ, Woodman RC (2007) Anemia and cancer in older persons. J Support Oncol 5(3):107–113PubMed

24.

Ludwig H, Van Belle S, Barrett-Lee P, Birgegård G, Bokemeyer C, Gascón P, Kosmidis P, Krzakowski M, Nortier J, Olmi P, Schneider M, Schrijvers D (2004) The European Cancer Anaemia Survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients. Eur J Cancer 40(15):2293–2306. https://doi.org/10.1016/j.ejca.2004.06.019CrossRefPubMed

25.

Macciò A, Madeddu C, Massa D, Mudu MC, Lusso MR, Gramignano G, Serpe R, Melis GB, Mantovani G (2005) Hemoglobin levels correlate with interleukin-6 levels in patients with advanced untreated epithelial ovarian cancer: role of inflammation in cancer-related anemia. Blood. 106(1):362–367. https://doi.org/10.1182/blood-2005-01-0160CrossRefPubMed

26.

Xu H, Zheng X, Ai J, Yang L (2023) Hemoglobin, albumin, lymphocyte, and platelet (HALP) score and cancer prognosis: A systematic review and meta-analysis of 13,110 patients. Int Immunopharmacol 114:109496. https://doi.org/10.1016/j.intimp.2022.109496CrossRefPubMed

27.

Liguori C, Copparoni C, Felicetti C, Pecci F, Lupi A, Pinterpe G, Berardi R, Giampieri R (2023) Hemoglobin and Neutrophil Count as Prognostic Factors in Cholangiocarcinoma Patients in 2nd Line Treatment Setting: Results from a Small Monocentric Retrospective Study. Curr Oncol 30(1):1032–1045. https://doi.org/10.3390/curroncol30010079CrossRefPubMedPubMedCentral

28.

Alexandre J, Gross-Goupil M, Falissard B, Nguyen ML, Gornet JM, Misset JL, Goldwasser F (2003) Evaluation of the nutritional and inflammatory status in cancer patients for the risk assessment of severe haematological toxicity following chemotherapy. Ann Oncol 14(1):36–41. https://doi.org/10.1093/annonc/mdg013CrossRefPubMed

29.

Zhang XW, Zhang Q, Song MM, Zhang KP, Zhang X, Ruan GT, Yang M, Ge YZ, Tang M, Li XR, Wang KH, Shi HP (2022) The prognostic effect of hemoglobin on patients with cancer cachexia: a multicenter retrospective cohort study. Support Care Cancer 30(1):875–885. https://doi.org/10.1007/s00520-021-06486-1CrossRefPubMed

30.

Siqueira JM, Soares JDP, Borges TC, Gomes TLN, Pimentel GD (2021) High neutrophil to lymphocytes ratio is associated with nutritional risk in hospitalised, unselected cancer patients: a cross-sectional study. Sci Rep 11(1):17120. https://doi.org/10.1038/s41598-021-96586-zCrossRefPubMedPubMedCentral

31.

Gonda K, Shibata M, Sato Y, Washio M, Takeshita H, Shigeta H, Ogura M, Oka S, Sakuramoto S (2017) Elevated neutrophil-to-lymphocyte ratio is associated with nutritional impairment, immune suppression, resistance to S-1 plus cisplatin, and poor prognosis in patients with stage IV gastric cancer. Mol Clin Oncol 7(6):1073–1078. https://doi.org/10.3892/mco.2017.1438CrossRefPubMedPubMedCentral

32.

Cella D (2002) The effects of anemia and anemia treatment on the quality of life of people with cancer. Oncology (Williston Park) 16(9 Suppl 10):125–132PubMed

33.

GURNEY CW. (1960) Erythropoietin, erythropoiesis, and the kidney. JAMA. 20(173):1828–1829CrossRef

Titel: A comprehensive analysis of the association between anemia and systemic inflammation in older patients with cancer
verfasst von: Xi Zhang
Jia-Xin Huang
Meng Tang
Qi Zhang
Li Deng
Chun-Hua Song
Wei Li
Min Yang
Han-Ping Shi
Ming-Hua Cong
Publikationsdatum: 01.01.2024
Verlag: Springer Berlin Heidelberg
Erschienen in: Supportive Care in Cancer / Ausgabe 1/2024
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-023-08247-8

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

A comprehensive analysis of the association between anemia and systemic inflammation in older patients with cancer