scholarly journals Novel Nutrition-Based Nomograms to Assess the Outcomes of Lung Cancer Patients Treated With Anlotinib or Apatinib

2021 ◽  
Vol 11 ◽  
Author(s):  
Hui Zheng ◽  
Qin Pan ◽  
Wenchao Zhu ◽  
Hongsen Li ◽  
Zhongfeng Niu ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Body Composition ◽  
Adipose Tissue ◽  
Clinical Response ◽  
Cox Regression ◽  
Group Performance ◽  
Therapeutic Regimen ◽  
Advanced Lung Cancer ◽  
Antiangiogenic Treatment ◽  
Ecog Ps

BackgroundPrevious studies have indicated that the changes in body composition during treatment are prognostic in lung cancer. The question which follows is it may be too late to identify vulnerable patients after treatment and to improve outcomes for these patients. In our study, we sought to explore the alterations of body composition and weight before the outset of the antiangiogenic treatment and its role in predicting clinical response and outcomes.MethodsIn this retrospective study, 122 patients with advanced lung cancer treated with anlotinib or apatinib were analyzed. The changes in weight and body composition including skeletal muscle index (SMI), subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT) for 3 months before the outset of antiangiogenic treatment and other clinical characteristics were evaluated with LASSO Cox regression and multivariate Cox regression analysis, which were applied to construct nomograms. The performance of the nomograms was validated internally by using bootstrap method with 1,000 resamples models and was assessed by the concordance index (C-index), calibration plots, decision curve analysis (DCA).ResultsThe median progression-free survival (PFS) and overall survival (OS) were 128 (95% CI 103.2–152.8) days and 292 (95% CI 270.9–313.1) days. Eastern Cooperative Oncology Group performance status (ECOG PS), brain metastases, the Glasgow Prognostic Score (GPS), clinical response, therapeutic regimen, and ΔL1SMI per 90 days were significantly associated with PFS, while ECOG PS, GPS, clinical response, therapeutic regimen, ΔL1SMI per 90 days were identified for OS. The C-index for the nomograms of PFS and OS were 0.763 and 0.748, respectively. The calibration curves indicated excellent agreement between the predicted and actual survival outcomes of 3- and 4-month PFS and 7- and 8-month OS. DCA showed the considerable value of the model.ConclusionNomograms were developed from clinical features and nutritional indicators to predict the probability of achieving 3-month and 4-month PFS and 7-month and 8-month OS with antiangiogenic therapy for advanced lung cancer. Dynamic changes in body composition before the initiation of treatment contributed to early detection of poor outcome.

scholarly journals Comparison of the prognostic value of MUST, ECOG-PS, mGPS and CT derived body composition analysis in patients with advanced lung cancer

2020 ◽  
Vol 40 ◽  
pp. 349-356
Author(s):  
Tanvir Abbass ◽  
Ross D. Dolan ◽  
Nicholas MacLeod ◽  
Paul G. Horgan ◽  
Barry J. Laird ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Body Composition ◽  
Prognostic Value ◽  
Advanced Lung Cancer ◽  
Composition Analysis ◽  
Body Composition Analysis ◽  
Ecog Ps

Beneficial Effects of Adenosine Triphosphate on Nutritional Status in Advanced Lung Cancer Patients: A Randomized Clinical Trial

2002 ◽  
Vol 20 (2) ◽  
pp. 371-378 ◽  
Author(s):  
Hendrik J. Agteresch ◽  
Trinet Rietveld ◽  
Leon G.M. Kerkhofs ◽  
J. Willem O. van den Berg ◽  
J. H. Paul Wilson ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Clinical Trial ◽  
Body Composition ◽  
Body Weight ◽  
Energy Expenditure ◽  
Randomized Clinical Trial ◽  
Energy Intake ◽  
Advanced Lung Cancer ◽  
Control Group ◽  
Muscle Area

PURPOSE: In a randomized clinical trial in patients with advanced non–small-cell lung cancer (NSCLC), infusion with adenosine 5′-triphosphate (ATP) inhibited loss of body weight and quality of life. In the present article, the effects of ATP on body composition, energy intake, and energy expenditure as secondary outcome measures in the same patients are reported. PATIENTS AND METHODS: Patients with NSCLC, stage IIIB or IV, were randomized to receive either 10 intravenous, 30-hour ATP infusions every 2 to 4 weeks or no ATP. Fat mass (FM), fat-free mass (FFM), and arm muscle area were assessed at 4-week intervals for 28 weeks. Food intake, body cell mass (BCM), and resting energy expenditure (REE) were assessed at 8-week intervals for 16 weeks. Between-group differences were tested for statistical significance by repeated-measures analysis of covariance. RESULTS: Fifty-eight patients were randomized (28 ATP, 30 control). No change in body composition over the 28-week follow-up period was found in the ATP group, whereas, per 4 weeks, the control group lost 0.6 kg of FM (P = .004), 0.5 kg of FFM (P = .02), 1.8% of arm muscle area (P = .02), and 0.6% of BCM/kg body weight (P = .054) and decreased 568 KJ/d in energy intake (P = .0001). Appetite also remained stable in the ATP group but decreased significantly in the control group (P = .0004). No significant differences in REE between the ATP and control groups were observed. CONCLUSION: The inhibition of weight loss by ATP infusions in patients with advanced NSCLC is attributed to counteracting the loss of both metabolically active and inactive tissues. These effects are partly ascribed to maintenance of energy intake.

scholarly journals Analysis of systemic inflammatory biomarkers in neuroendocrine carcinomas of the lung: prognostic and predictive significance of NLR, LDH, ALI, and LIPI score

2020 ◽  
Vol 12 ◽  
pp. 175883592094237
Author(s):  
Antonio Galvano ◽  
Marta Peri ◽  
Aurelia Ada Guarini ◽  
Marta Castiglia ◽  
Antonino Grassadonia ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Neuroendocrine Carcinoma ◽  
Group Performance ◽  
Univariate Analysis ◽  
Eastern Cooperative Oncology Group ◽  
Prognostic Index ◽  
Inflammatory Biomarkers ◽  
Advanced Lung Cancer ◽  
First Line ◽  
Line Chemotherapy

Background: Lung neuroendocrine carcinoma (NEC) is characterized by aggressive clinical behavior and lack of treatment advances. We evaluate the prognostic and the predictive roles of systemic inflammatory biomarkers in patient circulating blood: neutrophil–lymphocyte ratio (NLR), lactate dehydrogenase (LDH), advanced lung cancer inflammation index (ALI), and the Lung Immune Prognostic Index (LIPI) score. Methods: A total of 120 patients with small-cell lung cancer (SCLC) ( n = 110) and large cell neuroendocrine carcinoma (LCNEC) ( n = 10) were enrolled. Overall survival (OS) was evaluated by Kaplan–Meier estimator and univariate and multivariate Cox proportional hazard analyses were performed to determine prognostic factors associated with OS while χ2 test was used for categorical data. Results: NLR cutoff value was 1.93. NLR was measured before and after first-line chemotherapy; 25 (21%) patients had higher NLR (delta NLR >1), whereas NLR was lower in 37 (31%). At the univariate analysis, median OS was 12 months: OS for SCLC and LCNEC were 11 months and 14 months, respectively. OS had a prognostic positive value in patients with pre-treatment NLR <1.93 ( p = 0.0002), LDH <600 U/L ( p = 0,03) and ALI ⩾34 ( p = 0,0065). At the multivariate analysis, Eastern Cooperative Oncology Group performance status, LDH levels and response after first-line chemotherapy were independently associated with OS. Median OS for good, intermediate, and poor LIPI was 15 months, 11 months, and 9 months, respectively( p = 0.091). Patients with higher NLR (>1.93) had an increased probability of tumor progression ( p = 0.045, χ2 test). Conclusion: This study demonstrated that systemic inflammatory biomarkers could facilitate the understanding of survival differences in the clinical management of lung NEC patients, underlying the need for prospective biomarker-driven studies in the immune checkpoint inhibitors setting.

scholarly journals Neutrophil-Lymphocyte Ratio as a Prognostic Marker for Chemotherapy in Advanced Lung Cancer

2016 ◽  
Vol 31 (4) ◽  
pp. 395-401 ◽  
Author(s):  
Zhu-Lin Liu ◽  
Ting-Ting Zeng ◽  
Xiao-Juan Zhou ◽  
Ya-Nv Ren ◽  
Lei Zhang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cox Regression ◽  
Demographic Data ◽  
Biological Marker ◽  
Progression Free Survival ◽  
Advanced Lung Cancer ◽  
Characteristic Analysis ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Treatment Naïve

Background Lung cancer ranks first both in morbidity and mortality in malignancies, but prognostic biological markers are lacking. The neutrophil-lymphocyte ratio (NLR) was proposed as a convenient biological marker. This study aimed to explore the prognostic value of NLR in advanced non-small cell lung cancer (NSCLC). Methods This retrospective study screened patients admitted from October 2007 to October 2014. Patients had histopathologically confirmed, treatment-naïve, metastatic NSCLC, and were prescribed platinum doublet chemotherapy. NLR and demographic data were collected, together with the outcome of chemotherapy. Progression-free survival (PFS) and overall survival (OS) were analyzed using the Kaplan-Meier method and Cox regression model. Results A total of 325 patients were enrolled. The cutoff value for NLR (3.19) was determined by receiver operator characteristic analysis. Patients were dichotomized into high (≥3.19) and low (<3.19) NLR groups. Both groups had similar demographic features. However, the low-NLR group had longer PFS (6.1 months) and OS (22.3 months) than the high-NLR group (5.1 months, p = 0.002; 13.1 months, p<0.001, respectively). Multivariate analysis confirmed that NLR was inversely related to the prognosis of these patients (HR = 1.684, 95%: 1.297-2.185, p<0.001). Conclusions This study argues that NLR is a convenient prognostic biological marker for advanced NSCLC patients treated with first-line chemotherapy and warrants further validation.

scholarly journals Association of Diabetes Status With Survival After Immune Checkpoint Inhibitor Treatment for Advanced Lung Cancer: a Retrospective Study in Japan

2020 ◽  
Author(s):  
Kaori Hisanaga ◽  
hiroshi uchino ◽  
Naoko Kakisu ◽  
Masahiko Miyagi ◽  
Fukumi Yoshikawa ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Propensity Score ◽  
Immune Checkpoint ◽  
Cox Regression ◽  
Tnm Staging ◽  
Wilcoxon Test ◽  
Advanced Lung Cancer ◽  
Kaplan Meier ◽  
Diabetes Status ◽  
Organ Systems

Abstract Introduction: Although immune checkpoint inhibitors (ICIs) are promising in the treatment of advanced cancer, they may lead to immune-related adverse events (irAEs), which can affect endocrine organ systems. However, development of the irAEs was associated with improved cancer-specific survival, the risk for years have not been elucidated. We investigated the association of pre-ICI comorbidities—including diabetes—with years and overall survival (OS) and progression-free survival (PFS) in advanced lung cancer. Research design and methods: Patients with lung cancer who were treated with ICIs at the period from September 1, 2015 through July 31, 2018 were retrospectively enrolled. All data were collected from the university patient NEPTUNE database. Hazard ratios were estimated by using Cox regression weighted for propensity scores. Odds ratios were calculated by logistic regression and adjusted for unbalanced variables. The Kaplan–Meier method was used to compare OS, and the generalized Wilcoxon test was used to compare median survival. The results: Among the 88 patients identified, 22 (25.0%) had diabetes (DM) before ICI treatment and 57 (75.0%) did not (non-DM). Iris developed in 12.2% of patients with DM and in 9.1% of patients in non-DM (p=0.87). Diabetes status was not associated with auras risk in relation to baseline characteristics (age, sex, TNM staging, thyroid and renal function) or after propensity score matching analysis (age, TNM staging). During a mean follow-up of 30 months, OS and cancer-specific PFS were significantly higher in patients who developed iris (Kaplan–Meier estimates, p=0·04 and 0·03, respectively). In propensity score–matched analysis, diabetes was significantly associated with lower OS (multivariate hazard ratio, 0·36; 95% CI, 0·13–0·98). Irrespective of eras, PFS was lower among patients with DM than among non-DM (Kaplan–Meier estimate, p=0·04). Conclusions: Pre-existing diabetes was associated with higher mortality in advanced lung cancer, regardless of irAEs development after treatment with ICIs.

scholarly journals Patients’ confidence in treatment decisions for early stage non-small cell lung cancer (NSCLC)

2020 ◽  
Author(s):  
Cecilia Pompili ◽  
Patricia Holch ◽  
Zoe Rogers ◽  
Kate Absolom ◽  
Beverly Clayton ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Psychometric Properties ◽  
Cell Lung Cancer ◽  
Group Performance ◽  
Early Stage ◽  
Treatment Decisions ◽  
Small Cell ◽  
Small Cell Lung ◽  
Ecog Ps

Abstract Background In early-stage Non-Small Cell Lung Cancer (NSCLC) patients, little is known about how to measure patient participation in Shared-Decision Making (SDM). We examined the psychometric properties and clinical acceptability of the Decision Self-Efficacy scale (DSE) in a cohort of patients undergoing to Stereotactic Ablative Radiotherapy (SABR) or Video-assisted Thoracoscopic Surgery (VATS) to capture patient involvement in treatment decisions. Methods In the context of a prospective longitudinal study (Life after Lung Cancer-LiLAC) involving 244 patients with early-stage NSCLC, 158 (64.7%) patients completed the DSE either on paper or electronically online prior to treatment with SABR or VATS pulmonary resection. DSE psychometric properties were examined using: principal components analysis of item properties and internal structure, and internal construct validity; we also performed a sensitivity analysis according to Eastern Cooperative Oncology Group Performance Status (ECOG PS), gender, age and treatment received (VATS or SABR) difference. Results Exploratory factor analysis using polychoric correlations substantiated that the 11 item DSE is one scale accounting for 81% of the variance. We calculated a value of 0.96 for Cronbach’s alpha for the total DSE score. DSE scores did not differ by gender ( p =0.37), between the two treatment groups (p=0.09) and between younger and older patients ( p =0.4). However, patients with an ECOG PS >1 have a DSE mean of 73.8 (SD 26) compared to patients with a PS 0-1 who have a DSE mean of 85.8 (SD 20.3 p =0.002). Conclusion Findings provide preliminary evidence for the reliability and validity of the DSE questionnaire in this population. However, future studies are warranted to identify the most appropriate SDM tool for clinical practice in the lung cancer treatment field.

Maintenance Therapy for Advanced Lung Cancer: Who, What, and When?

2013 ◽  
Vol 31 (24) ◽  
pp. 2983-2990 ◽  
Author(s):  
David E. Gerber
Keyword(s):  
Lung Cancer ◽  
Transient Ischemic Attack ◽  
Group Performance ◽  
Small Cell ◽  
Smoking History ◽  
Advanced Lung Cancer ◽  
Lung Mass ◽  
Splenic Lesion ◽  
Ct Guided ◽  
Ischemic Attack

A 60-year-old woman with hypertension, dyslipidemia, and 35–pack-year smoking history is referred for treatment of advanced non–small-cell lung cancer (NSCLC). She initially presented after a transient ischemic attack, when a chest radiograph demonstrated a right lung mass. Computed tomography (CT) of the chest revealed a 5-cm right upper lobe mass, without mediastinal adenopathy, and a 6-cm cystic mass in the spleen. Additional imaging showed no brain metastasis. Endobronchial ulstrasound-guided core biopsies of the lung mass and ipsilateral mediastinal nodes confirmed a poorly differentiated non–small-cell carcinoma. Immunohistochemical stains were positive for napsin A and thyroid transcription factor 1, suggestive of adenocarcinoma ( Fig 1 ). Molecular analysis identified a KRAS G12C mutation. A positron emission tomography (PET) –CT scan demonstrated [18F]fluorodeoxyglucose uptake in the right upper lobe mass and splenic lesion ( Fig 2 A). CT-guided fine-needle aspiration of the splenic lesion was performed and revealed metastatic carcinoma, consistent with the lung primary. Treatment with carboplatin plus pemetrexed was initiated, without bevacizumab because of the recent transient ischemic attack; carboplatin was selected over cisplatin because of similar concerns. The patient received two cycles of chemotherapy without complications, and repeat imaging showed decrease in size of the lung mass and splenic lesion ( Figs 2 B and 2 C). After four cycles of chemotherapy, a chest CT showed ongoing response ( Fig 2 D). Her Eastern Cooperative Oncology Group performance status remained 0.

scholarly journals Best supportive care and prognosis: advanced gastroesophageal adenocarcinoma

2021 ◽  
pp. bmjspcare-2020-002637
Author(s):  
Kirsty E Cavanagh ◽  
Mark A Baxter ◽  
Russell D Petty
Keyword(s):  
Regression Analysis ◽  
Supportive Care ◽  
Real World ◽  
Palliative Chemotherapy ◽  
Cox Regression ◽  
Group Performance ◽  
Best Supportive Care ◽  
Cox Regression Analysis ◽  
Gastroesophageal Adenocarcinoma ◽  
Ecog Ps

ObjectivesReal-world data are lacking on survival in patients with advanced gastroesophageal adenocarcinoma (GOA) treated with best supportive care (BSC) alone. This knowledge is vital to personalise cancer treatment and obtain informed consent. This study aimed to define and compare survival in patients with advanced GOA treated with and without palliative chemotherapy (CTx), and to explore the factors that impact prognosis.MethodsPatients in NHS Tayside, Scotland, diagnosed with advanced GOA (defined as non-resectable) over a 2-year period were identified retrospectively. Clinical data were obtained from electronic records. Kaplan-Meier and Cox regression analysis were performed to determine median overall survival (mOS) and investigate contributing factors.Results127 eligible patients were identified. There was a significant difference in mOS between patients in the BSC and CTx groups (3.1 months vs 8.9 months, p=0.00089). This was maintained when those deemed not fit for CTx were removed. One-year survival was 16% versus 33%. Cox regression analysis in the BSC group identified stage (p<0.001) and Eastern Cooperative Oncology Group performance status (ECOG PS) (p=0.013) as having independent predictive value for survival. Age was not related to outcome. Palliative stents were inserted in 48 patients (37.8%).ConclusionsTo our knowledge, this is the largest reported study in Europe of outcomes in patients with advanced GOA treated with BSC only. The mOS with BSC is approximately 3 months. Cancer stage and ECOG PS have a role in prognostication at diagnosis. Our findings support the benefit of palliative chemotherapy in this population, and real-world survival corresponds to published trial data.

scholarly journals A Low Advanced Lung Cancer Inflammation Index Predicts a Poor Prognosis in Patients With Metastatic Non–Small Cell Lung Cancer

2022 ◽  
Vol 8 ◽  
Author(s):  
Ping Lu ◽  
Yifei Ma ◽  
Jindan Kai ◽  
Jun Wang ◽  
Zhucheng Yin ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Cox Regression ◽  
Small Cell ◽  
Advanced Lung Cancer ◽  
Categorical Variables ◽  
Small Cell Lung ◽  
Neutrophil Lymphocyte Ratio ◽  
Cancer Inflammation

Introduction: Inflammation plays a crucial role in cancers, and the advanced lung cancer inflammation index (ALI) is considered to be a potential factor reflecting systemic inflammation.Objectives: This work aimed to explore the prognostic value of the ALI in metastatic non–small cell lung cancer (NSCLC) and classify patients according to risk and prognosis.Methods: We screened 318 patients who were diagnosed with stage IV NSCLC in Hubei Cancer Hospital from July 2012 to December 2013. The formula for ALI is body mass index (BMI, kg/m2) × serum albumin (Alb, g/dl)/neutrophil–lymphocyte ratio (NLR). Categorical variables were analyzed by the chi-square test or Fisher’s exact test. The overall survival (OS) rates were analyzed by the Kaplan–Meier method and plotted with the R language. A multivariate Cox proportional hazard model was used to analyze the relationship between ALI and OS.Results: According to the optimal cut-off value determined by X-tile software, patients were divided into two groups (the ALI &lt;32.6 and ALI ≥32.6 groups), and the median OS times were 19.23 and 39.97 months, respectively (p &lt; 0.01). A multivariable Cox regression model confirmed that ALI and chemotherapy were independent prognostic factors for OS in patients with NSCLC. OS in the high ALI group was better than that in the low ALI group (HR: 1.39; 95% CI: 1.03–1.89; p = 0.03).Conclusions: Patients with a low ALI tend to have lower OS among those with metastatic NSCLC, and the ALI can serve as an effective prognostic factor for NSCLC patients.

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