title: The relationship between nutritional status, inflammatory markers and survival in patients with advanced cancer: a prospective cohort study.
abstract: BACKGROUND
  Malnutrition and elevated inflammatory markers have a negative impact on clinical outcomes in cancer patients. Few studies have investigated the associations between inflammatory makers, nutritional status and survival. This study investigates the association between nutritional status, inflammatory markers and overall survival (OS) in patients with advanced cancer.
  
  
  METHODS
  This prospective cohort study recruited 114 adult patients from January 2007 to January 2010. It included patients diagnosed with advanced cancer, good Eastern Cooperative Oncology Group (ECOG) performance status 0-2, a prognosis of more than 3 months and had not received chemotherapy for advanced cancer prior to enrollment. Baseline data were collected prior to commencement of chemotherapy. Patients were followed up from the date of baseline nutritional assessment until the date of death or the date that data were last updated, whichever came first.
  
  
  RESULTS
  Malnourished cancer patients had statistically significant higher concentrations of serum C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR) or modified Glasgow Prognostic Score (mGPS) prior to starting chemotherapy. In univariate analyses to predict survival, mGPS 1 or 2 had a hazard ratio (HR) of 1.81 (95 % confidence interval (CI) 1.13-2.89) and NLR ≥ 5 had a HR of 1.13 (95 % CI 1.08-4.60) and malnutrition (HR of 1.66 for Patient-Generated Subjective Global Assessment (PG-SGA) B (95 % CI 1.02-2.71), and HR for severely malnourished patients (PG-SGA C) was 2.73 (95 % CI 1.50-4.96).
  
  
  CONCLUSIONS
  Inflammatory markers were statistically associated with malnutrition. Malnutrition and mGPS were significant independent predictors of overall survival in patients with advanced cancer.
authors.affiliation: Nutrition and Dietetics Department, Concord Hospital, Sydney, Australia, cindy.tan@sswahs.nsw.gov.au.
authors.forename: Cindy S Y
authors.initials: CS
authors.lastname: Tan
authors.forename: Jane A
authors.initials: JA
authors.lastname: Read
authors.forename: Viet H
authors.initials: VH
authors.lastname: Phan
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Beale
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Peat
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Clarke
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D015331:Cohort Studies; D004358:Drug Therapy / Q000379:methods; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology; D007958:Leukocyte Count; D008214:Lymphocytes; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000209:etiology; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000097:blood / Q000150:complications / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D009504:Neutrophils; D009752:Nutritional Status; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
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