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Brown LR, Thomson GG, Gardner E, Chien S, McGovern J, Dolan RD, McSorley ST, Forshaw MJ, McMillan DC, Wigmore SJ, Crumley AB, Skipworth RJE. Cachexia index for prognostication in surgical patients with locally advanced oesophageal or gastric cancer: multicentre cohort study. Br J Surg 2024; 111:znae098. [PMID: 38593042 PMCID: PMC11003541 DOI: 10.1093/bjs/znae098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/08/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Features of cancer cachexia adversely influence patient outcomes, yet few currently inform clinical decision-making. This study assessed the value of the cachexia index (CXI), a novel prognostic marker, in patients for whom neoadjuvant chemotherapy and surgery for oesophagogastric cancer is planned. METHODS Consecutive patients newly diagnosed with locally advanced (T3-4 or at least N1) oesophagogastric cancer between 1 January 2010 and 31 December 2015 were identified through the West of Scotland and South-East Scotland Cancer Networks. CXI was calculated as (L3 skeletal muscle index) × (serum albumin)/(neutrophil lymphocyte ratio). Sex-stratified cut-off values were determined based on the area under the curve (AUC), and patients were divided into groups with low or normal CXI. Primary outcomes were disease progression during neoadjuvant chemotherapy and overall survival (at least 5 years of follow-up). RESULTS Overall, 385 patients (72% men, median age 66 years) were treated with neoadjuvant chemotherapy for oesophageal (274) or gastric (111) cancer across the study interval. Although patients with a low CXI (men: CXI below 52 (AUC 0.707); women: CXI below 41 (AUC 0.759)) were older with more co-morbidity, disease characteristics were comparable to those in patients with a normal CXI. Rates of disease progression during neoadjuvant chemotherapy, leading to inoperability, were higher in patients with a low CXI (28 versus 12%; adjusted OR 3.07, 95% c.i. 1.67 to 5.64; P < 0.001). Low CXI was associated with worsened postoperative mortality (P = 0.019) and decreased overall survival (median 14.9 versus 56.9 months; adjusted HR 1.85, 1.42 to 2.42; P < 0.001). CONCLUSION CXI is associated with disease progression, worse postoperative mortality, and overall survival, and could improve prognostication and decision-making in patients with locally advanced oesophagogastric cancer.
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Affiliation(s)
- Leo R Brown
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
- Department of General Surgery, Forth Valley Royal Hospital, Larbert, UK
| | - Georgina G Thomson
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ellen Gardner
- Department of General Surgery, Forth Valley Royal Hospital, Larbert, UK
| | - Siobhan Chien
- Centre for Sustainable Delivery, Golden Jubilee Hospital, Glasgow, UK
| | - Josh McGovern
- Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Ross D Dolan
- Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Stephen T McSorley
- Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Matthew J Forshaw
- Department of Upper Gastrointestinal Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - Donald C McMillan
- Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Stephen J Wigmore
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Andrew B Crumley
- Department of General Surgery, Forth Valley Royal Hospital, Larbert, UK
- Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Richard J E Skipworth
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
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Vagnildhaug OM, Balstad TR, Ottestad I, Bye A, Greil C, Arends J, Baracos V, Brown LR, Dajani OF, Dolan RD, Fallon M, Fraser E, Grzyb A, Hjermstad MJ, Jakobsen G, Kaasa S, McDonald J, Philips I, Sayers J, Simpson MR, Sousa MS, Skipworth RJ, Laird BJ, Solheim TS. Appetite and dietary intake endpoints in cancer cachexia clinical trials: Systematic Review 2 of the cachexia endpoints series. J Cachexia Sarcopenia Muscle 2024; 15:513-535. [PMID: 38343065 PMCID: PMC10995275 DOI: 10.1002/jcsm.13434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 04/06/2024] Open
Abstract
There is no consensus on the optimal endpoint(s) in cancer cachexia trials. Endpoint variation is an obstacle when comparing interventions and their clinical value. The aim of this systematic review was to summarize and evaluate endpoints used to assess appetite and dietary intake in cancer cachexia clinical trials. A search for studies published from 1 January 1990 until 2 June 2021 was conducted using MEDLINE, Embase and Cochrane Central Register of Controlled Trials. Eligible studies examined cancer cachexia treatment versus a comparator in adults with assessments of appetite and/or dietary intake as study endpoints, a sample size ≥40 and an intervention lasting ≥14 days. Reporting was in line with PRISMA guidance, and a protocol was published in PROSPERO (2022 CRD42022276710). This review is part of a series of systematic reviews examining cachexia endpoints. Of the 5975 articles identified, 116 were eligible for the wider review series and 80 specifically examined endpoints of appetite (65 studies) and/or dietary intake (21 studies). Six trials assessed both appetite and dietary intake. Appetite was the primary outcome in 15 trials and dietary intake in 7 trials. Median sample size was 101 patients (range 40-628). Forty-nine studies included multiple primary tumour sites, while 31 studies involved single primary tumour sites (15 gastrointestinal, 7 lung, 7 head and neck and 2 female reproductive organs). The most frequently reported appetite endpoints were visual analogue scale (VAS) and numerical rating scale (NRS) (40%). The appetite item from the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) C30/C15 PAL (38%) and the appetite question from North Central Cancer Treatment Group anorexia questionnaire (17%) were also frequently applied. Of the studies that assessed dietary intake, 13 (62%) used food records (prospective registrations) and 10 (48%) used retrospective methods (24-h recall or dietary history). For VAS/NRS, a mean change of 1.3 corresponded to Hedge's g of 0.5 and can be considered a moderate change. For food records, a mean change of 231 kcal/day or 11 g of protein/day corresponded to a moderate change. Choice of endpoint in cachexia trials will depend on factors pertinent to the trial to be conducted. Nevertheless, from trials assessed and available literature, NRS or EORTC QLQ C30/C15 PAL seems suitable for appetite assessments. Appetite and dietary intake endpoints are rarely used as primary outcomes in cancer cachexia. Dietary intake assessments were used mainly to monitor compliance and are not validated in cachexia populations. Given the importance to cachexia studies, dietary intake endpoints must be validated before they are used as endpoints in clinical trials.
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Affiliation(s)
- Ola Magne Vagnildhaug
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Cancer Clinic, St. Olavs HospitalTrondheim University HospitalTrondheimNorway
| | - Trude R. Balstad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Department of Clinical Medicine, Clinical Nutrition Research GroupUiT The Arctic University of NorwayTromsøNorway
| | - Inger Ottestad
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of MedicineUniversity of OsloOsloNorway
- The Clinical Nutrition Outpatient Clinic, Section of Clinical Nutrition, Department of Clinical Service, Division of Cancer MedicineOslo University HospitalOsloNorway
| | - Asta Bye
- Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University HospitalUniversity of OsloOsloNorway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical MedicineUniversity of OsloOsloNorway
- Department of Nursing and Health Promotion, Faculty of Health SciencesOsloMet—Oslo Metropolitan UniversityOsloNorway
| | - Christine Greil
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburg im BreisgauGermany
| | - Jann Arends
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburg im BreisgauGermany
| | - Vickie Baracos
- Department of OncologyUniversity of AlbertaEdmontonAlbertaCanada
| | - Leo R. Brown
- Clinical SurgeryUniversity of Edinburgh, Royal Infirmary of EdinburghEdinburghUK
| | - Olav F. Dajani
- Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University HospitalUniversity of OsloOsloNorway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Ross D. Dolan
- Academic Unit of SurgeryUniversity of Glasgow, Glasgow Royal InfirmaryGlasgowUK
| | - Marie Fallon
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | - Eilidh Fraser
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | - Aleksandra Grzyb
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | - Marianne J. Hjermstad
- Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University HospitalUniversity of OsloOsloNorway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Gunnhild Jakobsen
- Cancer Clinic, St. Olavs HospitalTrondheim University HospitalTrondheimNorway
- Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Stein Kaasa
- Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University HospitalUniversity of OsloOsloNorway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - James McDonald
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
- Institute of Genetics and CancerUniversity of EdinburghEdinburghUK
| | - Iain Philips
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | - Judith Sayers
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
- Institute of Genetics and CancerUniversity of EdinburghEdinburghUK
- St Columba's HospiceEdinburghUK
| | - Melanie R. Simpson
- Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Mariana S. Sousa
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT)University of Technology SydneySydneyNew South WalesAustralia
| | | | - Barry J.A. Laird
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
- Institute of Genetics and CancerUniversity of EdinburghEdinburghUK
- St Columba's HospiceEdinburghUK
| | - Tora S. Solheim
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Cancer Clinic, St. Olavs HospitalTrondheim University HospitalTrondheimNorway
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Bradley NA, McGovern J, Dolan RD, Golder AM, Roxburgh CSD, Guthrie GJK, McMillan DC. CT-derived body composition: Differential association with disease, age and inflammation in a retrospective cohort study. PLoS One 2024; 19:e0300038. [PMID: 38512880 PMCID: PMC10956827 DOI: 10.1371/journal.pone.0300038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/20/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Low skeletal muscle mass and density, as assessed by CT-body composition (CT-BC), are recognised to have prognostic value in non-cancer and cancer patients. The aim of the present study was to compare CT-BC parameters between non-cancer (abdominal aortic aneurysm, AAA) and cancer (colorectal cancer, CRC) patients. METHODS Two retrospective multicentre cohorts were compared. Thresholds of visceral fat area (VFA, Doyle), skeletal fat index (SFI, Ebadi), skeletal muscle index (SMI, Martin), and skeletal muscle density (SMD, Martin) were applied to these cohorts and compared. The systemic inflammatory response (SIR) was measured by the systemic inflammatory grade (SIG). RESULTS 1695 patients were included; 759 patients with AAA and 936 patients with CRC. Low SMD (33% vs. 66%, p <0.001) was more prevalent in the CRC cohort. Low SMI prevalence was similar in both cohorts (51% vs. 51%, p = 0.80). Compared with the AAA cohort, the CRC cohort had a higher prevalence of raised SIG (p <0.001). Increasing age (OR 1.54, 95% CI 1.38-1.72, p < 0.001) and elevated SIG (OR 1.23, 95% CI 1.09-1.40, p = 0.001) were independently associated with increased odds of low SMI. Increasing age (OR 1.90, 95% CI 1.66-2.17, p < 0.001) CRC diagnosis (OR 5.89, 95% CI 4.55-7.62, p < 0.001), ASA > 2 (OR 1.37, 95% CI 1.08-1.73, p = 0.01), and elevated SIG (OR 1.19, 95% CI 1.03-1.37, p = 0.02) were independently associated with increased odds of low SMD. CONCLUSIONS Increasing age and systemic inflammation appear to be important determinants of loss of skeletal muscle mass and quality irrespective of disease.
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Affiliation(s)
| | - Josh McGovern
- Academic Unit of Surgery, University of Glasgow, Glasgow, United Kingdom
| | - Ross D. Dolan
- Academic Unit of Surgery, University of Glasgow, Glasgow, United Kingdom
| | - Allan M. Golder
- Academic Unit of Surgery, University of Glasgow, Glasgow, United Kingdom
| | | | | | - Donald C. McMillan
- Academic Unit of Surgery, University of Glasgow, Glasgow, United Kingdom
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Saeed R, McGovern J, Bench H, Dolan RD, McMillan DC, Cascales A. The relationship between clinicopathological variables, systemic inflammation, and CT-derived body composition with survival in patients with advanced non-small cell lung cancer receiving nivolumab as a second-line treatment. Cancer Med 2023; 12:22062-22070. [PMID: 38088761 PMCID: PMC10757089 DOI: 10.1002/cam4.6805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND Second-line immunotherapy is currently recognized to help only a subset of patients with advanced forms of non-small cell lung cancer (NSCLC). The current study analyzes the connection between prior treatment host/tumor characteristics and survival in advanced NSCLC patients receiving nivolumab as a second-line therapy. METHODS A retrospective cohort analysis was carried out on individuals with advanced NSCLC receiving second-line Nivolumab with palliative intent between February 2016 and May 2019 across three health boards in NHS Greater Glasgow and Clyde, Lanarkshire, Ayrshire, and Arran in Scotland to examine the association between systemic inflammation, body composition, and survival were determined using computed tomography (CT). RESULTS The current study investigates the connection between prior treatment host/tumor characteristics and survival in advanced NSCLC patients receiving nivolumab as a second-line therapy. The majority were 65 years of age or older (51%), female (53%), had adenocarcinoma (53%), and had good performance status (ECOG 0/1) (86%). Most patients had high SFI (70%) or VFA (54%). The median overall survival after starting Nivolumab was 15 months. ECOG-PS and hypoalbuminemia were significant predictors of 12-month survival in patients with advanced NSCLC following Nivolumab treatment, according to Cox regression (p-value = 0.047 and 0.014, respectively). CONCLUSION In patients with advanced NSCLC receiving Nivolumab as a second-line therapy, ECOG-PS and hypoalbuminemia were strongly associated with survival. Systemic inflammation and hypoalbuminemia measurements may enhance the ECOG-PS stratification of expected outcomes.
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Affiliation(s)
- Randa Saeed
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK
| | - Josh McGovern
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK
| | | | - Ross D Dolan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK
| | - Almudena Cascales
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
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5
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Brown LR, Sayers J, Yule MS, Drake TM, Dolan RD, McMillan DC, Laird BJA, Wigmore SJ, Skipworth RJE. The prognostic impact of pre-treatment cachexia in resectional surgery for oesophagogastric cancer: a meta-analysis and meta-regression. Br J Surg 2023; 110:1703-1711. [PMID: 37527401 PMCID: PMC10638534 DOI: 10.1093/bjs/znad239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/21/2023] [Accepted: 07/09/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Cancer cachexia is not purely an end-stage phenomenon and can influence the outcomes of patients with potentially curable disease. This review examines the effect of pre-treatment cachexia on overall survival, in patients undergoing surgical resection of oesophagogastric cancer. METHODS A systematic literature search of MEDLINE, EMBASE and Cochrane Library databases was conducted, from January 2000 to May 2022, to identify studies reporting the influence of cachexia on patients undergoing an oesophagogastric resection for cancer with curative intent. Meta-analyses of the primary (overall survival) and secondary (disease-free survival and postoperative mortality) outcomes were performed using random-effects modelling. Meta-regression was used to examine disease stage as a potential confounder. RESULTS Ten non-randomized studies, comprising 7186 patients, were eligible for inclusion. The prevalence of pre-treatment cachexia was 35 per cent (95 per cent c.i.: 24-47 per cent). Pooled adjusted hazard ratios showed that cachexia was adversely associated with overall survival (HR 1.46, 95 per cent c.i.: 1.31-1.60, P < 0.001). Meta-analysis of proportions identified decreased overall survival at 1-, 3- and 5-years in cachectic cohorts. Pre-treatment cachexia was not a predictor of disease-free survival and further data are required to establish its influence on postoperative mortality. The proportion of patients with stage III/IV disease was a significant moderator of between-study heterogeneity. Cachexia may have a greater influence on overall survival in studies where more patients have a locally advanced malignancy. CONCLUSION Pre-treatment cachexia adversely influences overall survival following resection of an oesophagogastric malignancy.
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Affiliation(s)
- Leo R Brown
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Judith Sayers
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Michael S Yule
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Thomas M Drake
- Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
- Cancer Research UK Beatson Institute, Glasgow, UK
| | - Ross D Dolan
- Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Donald C McMillan
- Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Barry J A Laird
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Stephen J Wigmore
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Richard J E Skipworth
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
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McGovern J, Dolan RD, McMillan DC. Assessment and Prognostic Value of Inflammatory Biomarkers in Patients With Colon Cancer. JAMA Oncol 2023; 9:1152-1153. [PMID: 37318817 DOI: 10.1001/jamaoncol.2023.1529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Josh McGovern
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Ross D Dolan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, United Kingdom
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McGovern J, Dolan RD, Simmons C, Daly LE, Ryan AM, Power DG, Fallon MT, Laird BJ, McMillan DC. Are CT-Derived Muscle Measurements Prognostic, Independent of Systemic Inflammation, in Good Performance Status Patients with Advanced Cancer? Cancers (Basel) 2023; 15:3497. [PMID: 37444607 DOI: 10.3390/cancers15133497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
The present study examined the relationships between CT-derived muscle measurements, systemic inflammation, and survival in advanced cancer patients with good performance status (ECOG-PS 0/1). Data was collected prospectively from patients with advanced cancer undergoing anti-cancer therapy with palliative intent. The CT Sarcopenia score (CT-SS) was calculated by combining the CT-derived skeletal muscle index (SMI) and density (SMD). The systemic inflammatory status was determined using the modified Glasgow Prognostic Score (mGPS). The primary outcome of interest was overall survival (OS). Univariate and multivariate Cox regressions were used for survival analysis. Three hundred and seven patients met the inclusion criteria, out of which 62% (n = 109) were male and 47% (n = 144) were ≥65 years of age, while 38% (n = 118) were CT-SS ≥ 1 and 47% (n = 112) of patients with pre-study blood were inflamed (mGPS ≥ 1). The median survival from entry to the study was 11.1 months (1-68.1). On univariate analysis, cancer type (p < 0.05) and mGPS (p < 0.001) were significantly associated with OS. On multivariate analysis, only mGPS (p < 0.001) remained significantly associated with OS. In patients who were ECOG-PS 0, mGPS was significantly associated with CT-SS (p < 0.05). mGPS may dominate the prognostic value of CT-derived sarcopenia in good-performance-status patients with advanced cancer.
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Affiliation(s)
- Josh McGovern
- Academic Unit of Surgery, New Lister Building, Royal Infirmary, Glasgow G31 2ER, UK
| | - Ross D Dolan
- Academic Unit of Surgery, New Lister Building, Royal Infirmary, Glasgow G31 2ER, UK
| | - Claribel Simmons
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Louise E Daly
- Cork Cancer Research Centre, University College Cork, T12 YN60 Cork, Ireland
| | - Aoife M Ryan
- Cork Cancer Research Centre, University College Cork, T12 YN60 Cork, Ireland
| | - Derek G Power
- Department of Medical Oncology, Mercy and Cork University Hospital, T12 DC4A Cork, Ireland
| | - Marie T Fallon
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Barry J Laird
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Donald C McMillan
- Academic Unit of Surgery, New Lister Building, Royal Infirmary, Glasgow G31 2ER, UK
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McGovern J, Leadbitter S, Miller G, Hounat A, Kamande I, Dolan RD, Horgan PG, Chang DK, Jamieson NB, McMillan DC. The relationship between heart rate variability and TNM stage, co-morbidity, systemic inflammation and survival in patients with primary operable colorectal cancer. Sci Rep 2023; 13:8157. [PMID: 37208421 PMCID: PMC10198985 DOI: 10.1038/s41598-023-35396-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 05/17/2023] [Indexed: 05/21/2023] Open
Abstract
High vagal nerve activity, reliability measured by HRV, is considered protective in cancer, reducing oxidative stress, inflammation and opposing sympathetic nerve activity. The present monocentric study examines the relationship between HRV, TNM stage, co-morbidity, systemic inflammation and survival in patients who underwent potentially curative resections for colorectal cancer (CRC). Time-domain HRV measures, Standard Deviation of NN-intervals (SDNN) and Root Mean Square of Successive Differences (RMSSD), were examined as categorical (median) and continuous variables. Systemic inflammation was determined using systemic inflammatory grade (SIG) and co-morbidity using ASA. The primary end point was overall survival (OS) and was analysed using Cox regression. There were 439 patients included in the study and the median follow-up was 78 months. Forty-nine percent (n = 217) and 48% (n = 213) of patients were categorised as having low SDNN (< 24 ms) and RMSSD (< 29.8 ms), respectively. On univariate analysis, SDNN was not significantly associated with TNM stage (p = 0.830), ASA (p = 0.598) or SIG (p = 0.898). RMSSD was not significantly associated with TNM stage (p = 0.267), ASA (p = 0.294) or SIG (p = 0.951). Neither SDNN or RMSSD, categorical or continuous, were significantly associated with OS. In conclusion, neither SDNN or RMSSD were associated with TNM stage, ASA, SIG or survival in patients undergoing potentially curative surgery for CRC.
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Affiliation(s)
- Josh McGovern
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Level 2, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK.
| | - Stephen Leadbitter
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Level 2, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Gillian Miller
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Level 2, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Adam Hounat
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Level 2, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Irvine Kamande
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Level 2, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Ross D Dolan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Level 2, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Paul G Horgan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Level 2, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
| | - David K Chang
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Level 2, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Nigel B Jamieson
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Level 2, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Level 2, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
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Brown LR, Ramage MI, Dolan RD, Sayers J, Bruce N, Dick L, Sami S, McMillan DC, Laird BJA, Wigmore SJ, Skipworth RJE. The Impact of Acute Systemic Inflammation Secondary to Oesophagectomy and Anastomotic Leak on Computed Tomography Body Composition Analyses. Cancers (Basel) 2023; 15:cancers15092577. [PMID: 37174044 PMCID: PMC10177546 DOI: 10.3390/cancers15092577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
This study aimed to longitudinally assess CT body composition analyses in patients who experienced anastomotic leak post-oesophagectomy. Consecutive patients, between 1 January 2012 and 1 January 2022 were identified from a prospectively maintained database. Changes in computed tomography (CT) body composition at the third lumbar vertebral level (remote from the site of complication) were assessed across four time points where available: staging, pre-operative/post-neoadjuvant treatment, post-leak, and late follow-up. A total of 20 patients (median 65 years, 90% male) were included, with a total of 66 computed tomography (CT) scans analysed. Of these, 16 underwent neoadjuvant chemo(radio)therapy prior to oesophagectomy. Skeletal muscle index (SMI) was significantly reduced following neoadjuvant treatment (p < 0.001). Following the inflammatory response associated with surgery and anastomotic leak, a decrease in SMI (mean difference: -4.23 cm2/m2, p < 0.001) was noted. Estimates of intramuscular and subcutaneous adipose tissue quantity conversely increased (both p < 0.001). Skeletal muscle density fell (mean difference: -5.42 HU, p = 0.049) while visceral and subcutaneous fat density were higher following anastomotic leak. Thus, all tissues trended towards the radiodensity of water. Although tissue radiodensity and subcutaneous fat area normalised on late follow-up scans, skeletal muscle index remained below pre-treatment levels.
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Affiliation(s)
- Leo R Brown
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Michael I Ramage
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Ross D Dolan
- Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary, Glasgow G31 2ER, UK
| | - Judith Sayers
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
- St Columba's Hospice, Edinburgh EH5 3RW, UK
| | - Nikki Bruce
- Department of General Surgery, Borders General Hospital, Melrose TD6 9BS, UK
| | - Lachlan Dick
- Department of General Surgery, Victoria Hospital, Kirkcaldy KY2 5AH, UK
| | - Sharukh Sami
- Department of General Surgery, Dumfries and Galloway Royal Infirmary, Dumfries DG2 8RX, UK
| | - Donald C McMillan
- Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary, Glasgow G31 2ER, UK
| | - Barry J A Laird
- St Columba's Hospice, Edinburgh EH5 3RW, UK
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XR, UK
| | - Stephen J Wigmore
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Richard J E Skipworth
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
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Rocha BMM, Dolan RD, Paiva CE, McGovern J, Paiva BSR, Preto DD, McMillan DC, Maia YCP, Laird BJ. Inflammation and Performance Status: The Cornerstones of Prognosis in Advanced Cancer. J Pain Symptom Manage 2023; 65:348-357. [PMID: 36493981 DOI: 10.1016/j.jpainsymman.2022.11.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
CONTEXT In advanced cancer, although performance status (PS), systemic inflammatory response and nutritional status are known to have prognostic value, geographical variations and sociodemographic indexes may also impact survival. OBJECTIVES This study compares validated prognostic factors in two international cohorts and establishes a prognostic framework for treatment. METHODS Two international biobanks of patients (n=1.518) with advanced cancer were analyzed. Prognostic factors (Eastern Cooperative Oncology Group Performance Status [ECOG-PS], body mass index [BMI] and modified Glasgow Prognostic Score [mGPS]) were assessed. The relationship between these and survival was examined using Kaplan-Meier and Cox regression methods. RESULTS According to multivariate analysis, in the European cohort the most highly predictive factors were BMI <20 kg/m2 (hazard ratio [HR] 1.644), BMI 20-21.9 kg/m2 (HR 1.347), ECOG-PS (HR 1.597-11.992) and mGPS (HR 1.843-2.365). In the Brazilian cohort, the most highly predictive factors were ECOG-PS (HR 1.678-8.938) and mGPS (HR 2.103-2.837). Considering gastrointestinal cancers in particular (n=551), the survival rate at 3 months in both cohorts together ranged from 93% (mGPS 0, PS 0-1) to 0% (mGPS 2, PS 4), and from 81% (mGPS 0, BMI >28 kg/m2) to 44% (mGPS 2, BMI <20 kg/m2). CONCLUSION The established prognostic factors that were compared had similar prognostic capacity in both cohorts. A high ECOG-PS and a high mGPS as outlined in the ECOG-PS/mGPS framework were consistently associated with poorer survival of patients with advanced cancer in the prospective European and Brazilian cohorts.
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Affiliation(s)
- Bruna M M Rocha
- Nutrition and Molecular Biology Research Group (B.M.M.R., Y.C.P.M.), School of Medicine, Federal University of Uberlandia, Minas Gerais, Uberlandia, Brazil
| | - Ross D Dolan
- Academic Unit of Surgery (R.D.D., J.M.G., D.C.M.M.), School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, Scotland, United Kingdom
| | - Carlos E Paiva
- Palliative Care and Quality of Life Research Group (GPQual) (C.E.P., B.S.R.P., D.D.P.), Pio XII Foundation, Barretos Cancer Hospital, São Paulo, Barretos, Brazil
| | - Josh McGovern
- Academic Unit of Surgery (R.D.D., J.M.G., D.C.M.M.), School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, Scotland, United Kingdom
| | - Bianca S R Paiva
- Palliative Care and Quality of Life Research Group (GPQual) (C.E.P., B.S.R.P., D.D.P.), Pio XII Foundation, Barretos Cancer Hospital, São Paulo, Barretos, Brazil
| | - Daniel D Preto
- Palliative Care and Quality of Life Research Group (GPQual) (C.E.P., B.S.R.P., D.D.P.), Pio XII Foundation, Barretos Cancer Hospital, São Paulo, Barretos, Brazil
| | - Donald C McMillan
- Academic Unit of Surgery (R.D.D., J.M.G., D.C.M.M.), School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, Scotland, United Kingdom
| | - Yara C P Maia
- Nutrition and Molecular Biology Research Group (B.M.M.R., Y.C.P.M.), School of Medicine, Federal University of Uberlandia, Minas Gerais, Uberlandia, Brazil.
| | - Barry J Laird
- Institute of Genetics and Molecular Medicine, University of Edinburgh (B.J.L.), Edinburgh, Scotland, United Kingdom
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McGovern J, Dolan RD, Simmons C, Laird B, Fallon MT, Power DG, Daly L, Ryan AM, Horgan PG, McMillan DC. The relationship between CT-derived sarcopenia, systemic inflammation, physical function and survival in patients with advanced cancer. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
804 Background: The CT-derived sarcopenia score (CT-SS) is thought to capture the nutritional and functional reserve of the cancer patient. However, it is unknown whether the CT-SS is associated with measures of physical function in patients with advanced cancer. Furthermore, has complimentary prognostic value when utilised as a phenotypic criterion in the GLIM cachexia framework. Methods: Prospectively collected data from patients with advanced cancer, undergoing anti-cancer therapy with palliative intent, across nine sites in the UK and Ireland between 2011–2016, was retrospectively analysed. Relationships between the CT-SS, ECOG-PS, measures of physical function and aetiological GLIM criterion (mGPS and metastatic disease) were examined using χ2 test for linear-by-linear association. Results: 518 patients met the inclusion criteria. 55 % (n=286) were male and 51% (n=266) were 65 years of age. The majority of patients had either GI (47%, n=242) or lung (25%, n=129) tumours. 46% (n=241) were CT-SS ≥1. 53% (n=274) of patients were inflamed (mGPS≥1). 63% (n=325) had an ECOG-PS>0/1. Of the 192 patients who underwent timed up-and-go testing and two-minute walk testing, 72% (n=138) and 96% (n=185) were categorised as a failure, respectively. Median survival from entry to the study was 8.7 months (4.2-18.3). 84% (n=433), 64% (n=339) and 38% (n=194) of patients were alive at 3-, 6- and 12-months, respectively. The CT-SS was significantly associated with ECOG-PS (p<0.001), timed up-and-go test failure (p<0.05), two-minute walk test failure (p<0.05), 3-month survival (p<0.05), 6-month survival (p<0.05) and 12-month survival (p<0.05). Furthermore, was significantly associated with 3-, 6- and 12-month survival in patients who were mGPS 0 and did not have metastatic disease (p<0.05 and p<0.05, respectively). Conclusions: The CT-SS is associated with physical function and survival in patients with advanced cancer. Furthermore, has complementary prognostic value to the aetiological criterion of the GLIM framework.
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Affiliation(s)
| | | | | | - Barry Laird
- University of Edinburgh, Edinburgh, United Kingdom
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12
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McGovern J, Grayston A, Coates D, Leadbitter S, Hounat A, Horgan PG, Dolan RD, McMillan DC. The relationship between the modified frailty index score (mFI-5), malnutrition, body composition, systemic inflammation and short-term clinical outcomes in patients undergoing surgery for colorectal cancer. BMC Geriatr 2023; 23:9. [PMID: 36609242 PMCID: PMC9817261 DOI: 10.1186/s12877-022-03703-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/14/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND While the current literature suggests an association with frailty and clinical outcomes in patients undergoing surgery for colorectal cancer (CRC), the basis of this relationship is unclear. AIM Examine the relationship between frailty, malnutrition, body composition, systemic inflammation and short-term clinical outcomes in patients undergoing surgery for colorectal cancer. METHODS Consecutive patients who underwent potentially curative resection for colorectal cancer, between April 2008 and April 2018, were identified from a prospectively maintained database. Frailty was defined using the modified five-item frailty index (mFI-5). Body composition measures included CT-derived skeletal muscle index (SMI) and density (SMD). Systemic inflammatory status was determined using Systemic Inflammatory Grade (SIG). Outcomes of interest were the incidence of post-operative complications and thirty-day mortality. Associations between categorical variables were examined using χ2 test and binary logistics regression analysis. RESULTS 1002 patients met the inclusion criteria. 28% (n = 221) scored 2 or more on the mFI-5. 39% (n = 388) of patients had a post-operative complication (Clavien-Dindo I-IV) and 1% (n = 11) died within thirty days of surgery. On univariate analysis, mFI-5 frailty score, was significantly associated with advanced age (p < 0.001), colonic tumours (p < 0.001), reduced use of neo-adjuvant chemotherapy (p < 0.05), higher BMI (p < 0.05), low SMD (p < 0.001), elevated NLR (p < 0.05), elevated mGPS (p < 0.05), elevated SIG (p < 0.05), incidence of post-operative complications (p < 0.001) and thirty-day mortality (p < 0.05). On multivariate analysis, male sex (p < 0.05), elevated SIG (p < 0.05) and mFI-5 score (p < 0.01) remained significantly associated with the incidence of post-operative complications. mFI-5 frailty was found to remain significantly associated with the incidence post-operative complications in patients who were SIG 0 (p < 0.05). CONCLUSION mFI-5 frailty score was found to be significantly associated with age, systemic inflammation and post-operative outcomes in patients undergoing potentially curative resections for CRC. Incorporation of an assessment of systemic inflammatory status in future frailty screening tools may improve their prognostic value.
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Affiliation(s)
- Josh McGovern
- grid.8756.c0000 0001 2193 314XAcademic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Level 2, New Lister Building, G31 2ER Glasgow, UK
| | - Alexander Grayston
- grid.8756.c0000 0001 2193 314XAcademic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Level 2, New Lister Building, G31 2ER Glasgow, UK
| | - Dominic Coates
- grid.8756.c0000 0001 2193 314XAcademic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Level 2, New Lister Building, G31 2ER Glasgow, UK
| | - Stephen Leadbitter
- grid.8756.c0000 0001 2193 314XAcademic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Level 2, New Lister Building, G31 2ER Glasgow, UK
| | - Adam Hounat
- grid.8756.c0000 0001 2193 314XAcademic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Level 2, New Lister Building, G31 2ER Glasgow, UK
| | - Paul G. Horgan
- grid.8756.c0000 0001 2193 314XAcademic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Level 2, New Lister Building, G31 2ER Glasgow, UK
| | - Ross D. Dolan
- grid.8756.c0000 0001 2193 314XAcademic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Level 2, New Lister Building, G31 2ER Glasgow, UK
| | - Donald C McMillan
- grid.8756.c0000 0001 2193 314XAcademic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Level 2, New Lister Building, G31 2ER Glasgow, UK
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13
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McGovern J, Delaney J, Forshaw MJ, McCabe G, Crumley AB, McIntosh D, Laird BJ, Horgan PG, McMillan DC, McSorley ST, Dolan RD. The relationship between computed tomography‐derived sarcopenia, cardiopulmonary exercise testing performance, systemic inflammation, and survival in good performance status patients with oesophago‐gastric cancer undergoing neoadjuvant treatment. JCSM Clinical Reports 2022. [DOI: 10.1002/crt2.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Josh McGovern
- Academic Unit of Surgery, School of Medicine University of Glasgow G31 2ER Glasgow Level 2, New Lister Building, Glasgow Royal Infirmary UK
| | - Jenna Delaney
- Academic Unit of Surgery, School of Medicine University of Glasgow G31 2ER Glasgow Level 2, New Lister Building, Glasgow Royal Infirmary UK
| | | | - Gerard McCabe
- Academic Unit of Surgery, School of Medicine University of Glasgow G31 2ER Glasgow Level 2, New Lister Building, Glasgow Royal Infirmary UK
| | - Andrew B. Crumley
- Academic Unit of Surgery, School of Medicine University of Glasgow G31 2ER Glasgow Level 2, New Lister Building, Glasgow Royal Infirmary UK
| | - David McIntosh
- Academic Unit of Surgery, School of Medicine University of Glasgow G31 2ER Glasgow Level 2, New Lister Building, Glasgow Royal Infirmary UK
| | - Barry J. Laird
- Institute of Genetics and Molecular Medicine University of Edinburgh Edinburgh UK
| | - Paul G. Horgan
- Academic Unit of Surgery, School of Medicine University of Glasgow G31 2ER Glasgow Level 2, New Lister Building, Glasgow Royal Infirmary UK
| | - Donald C. McMillan
- Academic Unit of Surgery, School of Medicine University of Glasgow G31 2ER Glasgow Level 2, New Lister Building, Glasgow Royal Infirmary UK
| | - Stephen T. McSorley
- Academic Unit of Surgery, School of Medicine University of Glasgow G31 2ER Glasgow Level 2, New Lister Building, Glasgow Royal Infirmary UK
| | - Ross D. Dolan
- Academic Unit of Surgery, School of Medicine University of Glasgow G31 2ER Glasgow Level 2, New Lister Building, Glasgow Royal Infirmary UK
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14
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Savioli F, Morrow ES, Dolan RD, Romics L, Lannigan A, Edwards J, McMillan DC. Prognostic role of preoperative circulating systemic inflammatory response markers in primary breast cancer: meta-analysis. Br J Surg 2022; 109:1206-1215. [PMID: 36130112 DOI: 10.1093/bjs/znac319] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/27/2022] [Accepted: 08/17/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Circulating markers of the systemic inflammatory response are prognostic in several cancers, but their role in operable breast cancer is unclear. A systematic review and meta-analysis of the literature was carried out. METHODS A search of electronic databases up to August 2020 identified studies that examined the prognostic value of preoperative circulating markers of the systemic inflammatory response in primary operable breast cancer. A meta-analysis was carried out for each marker with more than three studies, reporting a HR and 95 per cent confidence interval for disease-free survival (DFS), breast cancer-specific survival (BCSS) or overall survival (OS). RESULTS In total, 57 studies were reviewed and 42 were suitable for meta-analysis. Higher neutrophil-to-lymphocyte ratio (NLR) was associated with worse overall survival (OS) (pooled HR 1.75, 95 per cent c.i. 1.52 to 2.00; P < 0.001), disease-free survival (DFS) (HR 1.67, 1.50 to 1.87; P < 0.001), and breast cancer-specific survival (BCSS) (HR 1.89, 1.35 to 2.63; P < 0.001). This effect was also seen with an arithmetically-derived NLR (dNLR). Higher platelet-to-lymphocyte ratio (PLR) was associated with worse OS (HR 1.29, 1.10 to 1.50; P = 0.001) and DFS (HR 1.58, 1.33 to 1.88; P < 0.001). Higher lymphocyte-to-monocyte ratio (LMR) was associated with improved DFS (HR 0.65, 0.51 to 0.82; P < 0.001), and higher C-reactive protein (CRP) level was associated with worse BCSS (HR 1.22, 1.07 to 1.39; P = 0.002) and OS (HR 1.24, 1.14 to 1.35; P = 0.002). CONCLUSION Current evidence suggests a role for preoperative NLR, dNLR, LMR, PLR, and CRP as prognostic markers in primary operable breast cancer. Further work should define their role in clinical practice, particularly reproducible thresholds and molecular subtypes for which these may be of most value.
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Affiliation(s)
- Francesca Savioli
- Academic Unit of Surgery, School of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Elizabeth S Morrow
- Academic Unit of Surgery, School of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Ross D Dolan
- Academic Unit of Surgery, School of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Laszlo Romics
- Academic Unit of Surgery, School of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Alison Lannigan
- Department of Breast Surgery, University Hospital Wishaw, Wishaw, UK
| | - Joanne Edwards
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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McGovern J, Dolan RD, Maguire D, Horgan PG, Laird BJ, McMillan DC. A comparison of CT-body composition measurements in non-cancer and cancer patients from a single UK centre. J Frailty Sarcopenia Falls 2022; 7:117-122. [PMID: 36119551 PMCID: PMC9433946 DOI: 10.22540/jfsf-07-117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives: Establish the prevalence of low skeletal muscle index and density in our population, by comparing age and sex matched cohorts of patients with and without cancer, using standardized methodology for CT-Body composition (CT-BC). Methods: A retrospective analysis of prospectively collected data. Patients admitted to our institution between 17th March 2020 - 1st May 2020, with confirmed coronavirus disease and imaging suitable for CT-BC (n=52), were age and sex matched with patients undergoing resection for colorectal cancer (n=52). Results: 104 patients were included in the final analysis. 43% (n=45) were male, 77% (n=80) were aged 65 years or older, 50% (n=50) were overweight (BMI ≥25) and 53% (n=55) were systemically inflamed (mGPS ≥1). The prevalence of a low SMI (56% vs. 65%) and low SMD (83% vs. 67%) was similar between cohorts. A low SMI and SMD were both associated with age (p<0.05 and p<0.01, respectively) on univariate analysis. On multivariate analysis, a low SMD was independently associated with age (OR 2.38 (1.34-4.22), p=0.003) and mGPS (OR 2.10 (1.20-3.68), p=0.01). Conclusions: In conclusion, the prevalence of a low SMI and low SMD was similar in non-cancer and cancer cohorts in our institution.
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Affiliation(s)
- Josh McGovern
- Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, UK
- Corresponding author: Josh McGovern, Academic Unit of Surgery, University of Glasgow, Level 2, New Lister Building, Glasgow Royal Infirmary, Glasgow, United Kingdom, G31 2ER E-mail:
| | - Ross D. Dolan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, UK
| | | | - Paul G. Horgan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, UK
| | - Barry J. Laird
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Donald C. McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, UK
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McGovern J, Dolan RD, Skipworth RJ, Laird BJ, McMillan DC. Cancer cachexia: a nutritional or a systemic inflammatory syndrome? Br J Cancer 2022; 127:379-382. [PMID: 35523879 PMCID: PMC9073809 DOI: 10.1038/s41416-022-01826-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/23/2022] [Accepted: 04/08/2022] [Indexed: 12/13/2022] Open
Abstract
Cancer cachexia has long been perceived as a nutritional syndrome. However, nutritional interventions have continued to be ineffective. With the recent recognition of the importance of systemic inflammation in the definition of this syndrome and treatment, has the time come to consider whether this syndrome is primarily a manifestation of systemic inflammation with the consequent implications for future treatment?
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Affiliation(s)
- Josh McGovern
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK.
| | - Ross D. Dolan
- grid.411714.60000 0000 9825 7840Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Richard J. Skipworth
- grid.4305.20000 0004 1936 7988Institute of Cancer, University of Edinburgh, Edinburgh, UK
| | - Barry J. Laird
- grid.4305.20000 0004 1936 7988Institute of Cancer, University of Edinburgh, Edinburgh, UK ,St Columba’s Hospice, Edinburgh, UK
| | - Donald C. McMillan
- grid.411714.60000 0000 9825 7840Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
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McGovern J, Golder AM, Dolan RD, Roxburgh CS, Horgan PG, McMillan DC. The combination of computed tomography‐derived muscle mass and muscle density and relationship with clinicopathological characteristics and survival in patients undergoing potentially curative surgery for colorectal cancer. JCSM Clinical Reports 2022. [DOI: 10.1002/crt2.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Josh McGovern
- Academic Unit of Surgery, School of Medicine University of Glasgow, New Lister, Building, Royal Infirmary Glasgow UK
| | - Allan M. Golder
- Academic Unit of Surgery, School of Medicine University of Glasgow, New Lister, Building, Royal Infirmary Glasgow UK
| | - Ross D. Dolan
- Academic Unit of Surgery, School of Medicine University of Glasgow, New Lister, Building, Royal Infirmary Glasgow UK
| | - Campbell S.D. Roxburgh
- Academic Unit of Surgery, School of Medicine University of Glasgow, New Lister, Building, Royal Infirmary Glasgow UK
| | - Paul G. Horgan
- Academic Unit of Surgery, School of Medicine University of Glasgow, New Lister, Building, Royal Infirmary Glasgow UK
| | - Donald C. McMillan
- Academic Unit of Surgery, School of Medicine University of Glasgow, New Lister, Building, Royal Infirmary Glasgow UK
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McGovern J, Dolan RD, Horgan PG, Laird BJ, McMillan DC. The prevalence and prognostic value of frailty screening measures in patients undergoing surgery for colorectal cancer: observations from a systematic review. BMC Geriatr 2022; 22:260. [PMID: 35351011 PMCID: PMC8962494 DOI: 10.1186/s12877-022-02928-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/11/2022] [Indexed: 02/08/2023] Open
Abstract
Introduction Frailty is a complex multifactorial syndrome characterised by a significant increase in vulnerability and worsened health outcomes. Despite a range of proposed frailty screening measures, the prevalence and prognostic value of frailty in patients undergoing surgery for colorectal cancer is not clear. Aim The aim of this present review was to examine the use of commonly employed frailty screening measures in patients undergoing surgery for colorectal cancer. Methods A systematic search of PubMed and Medline was carried out to identify studies reporting the use of frailty screening tools or measures in patients undergoing surgery for colorectal cancer. The screening measure used and prevalence of frailty within the population were recorded. Outcomes of interest were the incidence of post-operative complications, 30-day mortality and overall survival. Results Of the 15 studies included (n = 97, 898 patients), 9 studies were retrospective and included patients aged 70 years or older (n = 96, 120 patients). 5 of 12 studies reported that frailty was independently associated with the incidence of post-operative complications. There was also evidence that frailty was independently associated with 30-day mortality (1 of 4 studies, n = 9, 252 patients) and long-term survival (2 of 3 studies, n = 1, 420 patients). Conclusions Frailty was common in patients with colorectal cancer and the assessment of frailty may have prognostic value in patients undergoing surgery. However, the basis of the relationship between frailty and post-operative outcomes is not clear and merits further study.
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Affiliation(s)
- Josh McGovern
- Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK.
| | - Ross D Dolan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Paul G Horgan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Barry J Laird
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
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McGovern J, Al-Azzawi Y, Kemp O, Moffitt P, Richards C, Dolan RD, Laird BJ, McMillan DC, Maguire D. The relationship between frailty, nutritional status, co-morbidity, CT-body composition and systemic inflammation in patients with COVID-19. J Transl Med 2022; 20:98. [PMID: 35189900 PMCID: PMC8860274 DOI: 10.1186/s12967-022-03300-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 02/08/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Frailty, determined by the Canadian Study of Health and Aging-Clinical Frailty Scale (CFS), is strongly associated with clinical outcomes including mortality in patients with COVID-19. However, the relationship between frailty and other recognised prognostic factors including age, nutritional status, obesity, sarcopenia and systemic inflammation is poorly understood. Therefore, the aim of this study was to examine the relationship between frailty and other prognostic domains, in patients admitted with COVID-19. METHODS Patients who presented to our institutions between 1st April 2020-6th July 2020 with confirmed COVID-19 were assessed for inclusion. Data collected included general demographic details, clinicopathological variables, CFS admission assessment, Malnutrition Universal Screening Tool (MUST), CT-BC measurements and markers of systemic inflammation. RESULTS 106 patients met the study inclusion criteria. The majority of patients were aged ≥ 70 years (67%), male (53%) and frail (scoring > 3 on the CFS, 72%). The majority of patients were not malnourished (MUST 0, 58%), had ≥ 1 co-morbidity (87%), were sarcopenic (low SMI, 80%) and had systemic inflammation (mGPS ≥ 1, 81%, NLR > 5, 55%). On multivariate binary logistics regression analysis, age (p < 0.01), COPD (p < 0.05) and NLR (p < 0.05) remained independently associated with frailty. On univariate binary logistics regression, NLR (p < 0.05) was significantly associated with 30-day mortality. CONCLUSION Frailty was independently associated with age, co-morbidity, and systemic inflammation. The basis of the relationship between frailty and clinical outcomes in COVID-19 requires further study. Trial registration Registered with clinicaltrials.gov (NCT04484545).
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Affiliation(s)
- Josh McGovern
- Academic Unit of Surgery, University of Glasgow, Level 2, New Lister Building, Glasgow, G31 2ER, UK.
| | - Yassir Al-Azzawi
- Academic Unit of Surgery, University of Glasgow, Level 2, New Lister Building, Glasgow, G31 2ER, UK
| | - Olivia Kemp
- Emergency Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Peter Moffitt
- Emergency Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Conor Richards
- Emergency Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Ross D Dolan
- Academic Unit of Surgery, University of Glasgow, Level 2, New Lister Building, Glasgow, G31 2ER, UK
| | - Barry J Laird
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Donald C McMillan
- Academic Unit of Surgery, University of Glasgow, Level 2, New Lister Building, Glasgow, G31 2ER, UK
| | - Donogh Maguire
- Emergency Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
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Patton R, Cook J, Haraldsdottir E, Brown D, Dolan RD, McMillan DC, Skipworth RJE, Fallon M, Laird BJA. REVOLUTION (Routine EValuatiOn of people LivIng with caNcer)-Protocol for a prospective characterisation study of patients with incurable cancer. PLoS One 2021; 16:e0261175. [PMID: 34914733 PMCID: PMC8675681 DOI: 10.1371/journal.pone.0261175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 11/28/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction There is a pressing need for a holistic characterisation of people with incurable cancer. In this group, where quality of life and improvement of symptoms are therapeutic priorities, the physical and biochemical manifestations of cancer are often studied separately, giving an incomplete picture. In order to improve care, spur therapeutic innovation, provide meaningful endpoints for trials and set priorities for future research, work must be done to explore how the tumour influences the clinical phenotype. Characterisation of the host-tumour interaction may also provide information regarding prognosis, allowing appropriate planning of investigations, treatment and referral to palliative medicine services. Methods Routine EValuatiOn of people LivIng with caNcer (REVOLUTION) is a prospective observational study that aims to characterise people with incurable cancer around five key areas, namely body composition, physical activity, systemic inflammatory response, symptoms, and quality of life by developing a bio-repository. Participants will initially be recruited from a single centre in the UK and will have assessments of body composition (bio-impedance analysis [BIA] and computed tomography [CT]), assessment of physical activity using a physical activity monitor, measurement of simple markers of inflammation and plasma cytokine proteins and three symptom and quality of life questionnaires. Discussion This study aims to create a comprehensive biochemical and clinical characterisation of people with incurable cancer. Data in this study can be used to give a better understanding of the ‘symptom phenotype’ and quality of life determinants, development of a profile of the systemic inflammatory response and a detailed characterisation of body composition.
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Affiliation(s)
- Rebekah Patton
- St Columba’s Hospice, Edinburgh, United Kingdom
- * E-mail:
| | - Jane Cook
- St Columba’s Hospice, Edinburgh, United Kingdom
| | | | | | - Ross D. Dolan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Donald C. McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Richard J. E. Skipworth
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Marie Fallon
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Barry J. A. Laird
- St Columba’s Hospice, Edinburgh, United Kingdom
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
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21
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McGovern J, Dolan RD, Horgan PG, Laird BJ, McMillan DC. Computed tomography-defined low skeletal muscle index and density in cancer patients: observations from a systematic review. J Cachexia Sarcopenia Muscle 2021; 12:1408-1417. [PMID: 34664431 PMCID: PMC8718024 DOI: 10.1002/jcsm.12831] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 09/09/2021] [Accepted: 09/11/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Computed tomography (CT) analysis of body composition has garnered interest as a potential prognostic tool in those with cancer. A range of pre-defined thresholds currently exist within the literature to define low skeletal muscle mass and density. The aim of the present systematic review was to assess the prevalence of low skeletal muscle index (SMI) and density (SMD) within the literature, across a range of common solid tumours. METHODS A systematic search of PubMed was carried out to identify studies reporting CT analysis of SMI and SMD in patients with colorectal, oesophageal, gastric, hepatobiliary, pancreatic, breast, and lung cancer. The type of cancer, whether curative or non-curative disease, the anthropomorphic parameter studied, threshold used to define low SMI and SMD, and the prevalence of these anthropomorphic measurements within the population were recorded. RESULTS Of the 160 studies included, 156 reported an assessment of SMI and 35 reported assessment of SMD. The median prevalence of low SMI was 43% (30.1-57.1) and low SMD 49.4% (31.7-58.5) across the entire cohort. There was little variation in the prevalence of low SMI and SMD when studies were divided into curative and non-curative cohorts-40.7% (27.5-51.3) vs. 48.4% (30.9-60.1) and 37.8% (32.2-52.2) vs. 55.3% (38.5-64.7) respectively. When divided into colorectal, oesophageal, gastric, hepatobiliary, pancreatic, breast and lung cancers, similar prevalence of low SMI (46.0% %, 49.8%, 35.7%, 41.1%, 32.3%, 34%, and 49.5%) and low SMD were also observed (52.1%, 54.3%, 71.2%, 56.8%, 55.3%, and 52.6%). This was maintained when studies were stratified into cohorts by threshold used-low SMI (Martin 48.9%, Prado 49.9%, and Others 36.0%) and low SMD (Martin 52.4% and Others 48.6%). CONCLUSIONS Low SMI and SMD are endemic across a range of cancer types and disease stage, challenging pre-existing dogma of the determinants of prevalence.
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Affiliation(s)
- Josh McGovern
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK
| | - Ross D Dolan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK
| | - Paul G Horgan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK
| | - Barry J Laird
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK
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Dolan RD, Abbass T, Sim WMJ, Almasaudi AS, Dieu LB, Horgan PG, McSorley ST, McMillan DC. Longitudinal Changes in CT Body Composition in Patients Undergoing Surgery for Colorectal Cancer and Associations With Peri-Operative Clinicopathological Characteristics. Front Nutr 2021; 8:678410. [PMID: 34485358 PMCID: PMC8415565 DOI: 10.3389/fnut.2021.678410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/08/2021] [Indexed: 01/06/2023] Open
Abstract
There is evidence for the direct association between body composition, the magnitude of the systemic inflammatory response, and outcomes in patients with colorectal cancer. Patients with a primary operable disease with and without follow-up CT scans were examined in this study. CT scans were used to define the presence and changes in subcutaneous fat, visceral fat, skeletal muscle mass, and skeletal muscle density (SMD). In total, 804 patients had follow-up scans and 83 patients did not. Furthermore, 783 (97%) patients with follow-up scans and 60 (72%) patients without follow-up scans were alive at 1 year. Patients with follow-up scans were younger (p < 0.001), had a lower American Society of Anaesthesiology Grade (p < 0.01), underwent a laparoscopic surgery (p < 0.05), had a higher BMI (p < 0.05), a higher skeletal muscle index (SMI) (p < 0.01), a higher SMD (p < 0.01), and a better 1-year survival (p < 0.001). Overall only 20% of the patients showed changes in their SMI (n = 161) and an even lower percentage of patients showed relative changes of 10% (n = 82) or more. In conclusion, over the period of ~12 months, a low–skeletal muscle mass was associated with a systemic inflammatory response and was largely maintained following surgical resection.
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Affiliation(s)
- Ross D Dolan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Tanvir Abbass
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Wei M J Sim
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Arwa S Almasaudi
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Ly B Dieu
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Paul G Horgan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Stephen T McSorley
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom
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Dolan RD, Maclay JD, Abbass T, Colville D, Buali F, MacLeod N, McSorley ST, Horgan PG, McMillan DC. The relationship between 18F-FDG-PETCT-derived tumour metabolic activity, nutritional risk, body composition, systemic inflammation and survival in patients with lung cancer. Sci Rep 2020; 10:20819. [PMID: 33257741 PMCID: PMC7705735 DOI: 10.1038/s41598-020-77269-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 11/04/2020] [Indexed: 12/23/2022] Open
Abstract
The aim of this study was to examine the relationship between PET-CT derived tumour glucose uptake as measured by maximum standard glucose uptake (SUVmax) and total lesion glycolysis (TLG), nutritional risk as measured by the malnutrition universal screening tool (MUST), CT derived body composition as measured by skeletal muscle index (SMI) and skeletal muscle radiodensity (SMD), the systemic inflammatory response as measured by the modified Glasgow prognostic score (mGPS) and the neutrophil to lymphocyte ratio (NLR) and survival in patients with lung cancer, treated with radiotherapy. In a retrospective cohort study, 119 patients were included in final analyses. The majority of patients were over 65 (86%), female (52%), had a performance status (ECOG-PS) of 0 or 1 (57%), were at nutritional risk (57%), were overweight (53%), had visceral obesity (62%), had a normal SMI (51%), had a low SMD (62%) and were systemically inflammed (mGPS 1/2, 51%). An elevated TLG was associated with sex (p < 0.05), TNM stage (p < 0.001), MUST (p < 0.01) and mGPS (p < 0.01). An elevated mGPS was associated with age (p < 0.05), NLR (p < 0.01), MUST (p < 0.01), and TLG (p < 0.01). On univariate survival analysis, TNM stage (p < 0.01), mGPS (p < 0.05), NLR (p < 0.01), MUST (p ≤ 0.001), Low SMD (p < 0.05), SUVmax (p ≤ 0.001) and TLG (p < 0.001) were associated with overall survival. On multivariate survival analysis MUST (HR: 1.49 95%CI 1.12–01.98 p < 0.01) and TLG (HR: 2.02 95%CI 1.34–3.04 p = 0.001) remained independently associated with survival. In conclusion, elevated tumour metabolic activity was associated with more advanced stage, greater nutritional risk, the systemic inflammatory response and poorer survival but not body composition analysis in patients with lung cancer. These results suggest that detrimental body composition is not directly determined by tumour metabolic activity but rather an ongoing systemic inflammatory response.
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Affiliation(s)
- Ross D Dolan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, New Lister Building, Glasgow, G4 0SF, UK.
| | - John D Maclay
- Department of Respiratory Medicine, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Tanvir Abbass
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, New Lister Building, Glasgow, G4 0SF, UK
| | - David Colville
- West of Scotland PET Centre, Gartnavel Hospital, Tom Wheldon Building, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - Fatema Buali
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, New Lister Building, Glasgow, G4 0SF, UK
| | - Nicholas MacLeod
- Department of Oncology, Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - Stephen T McSorley
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, New Lister Building, Glasgow, G4 0SF, UK
| | - Paul G Horgan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, New Lister Building, Glasgow, G4 0SF, UK
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, New Lister Building, Glasgow, G4 0SF, UK
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Dolan RD, Alwahid M, McSorley ST, Park JH, Stevenson RP, Roxburgh CS, Horgan PG, McMillan DC. A comparison of the prognostic value of composite ratios and cumulative scores in patients with operable rectal cancer. Sci Rep 2020; 10:17965. [PMID: 33087753 PMCID: PMC7578034 DOI: 10.1038/s41598-020-73909-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 09/03/2020] [Indexed: 01/22/2023] Open
Abstract
The aim of this study was to directly compare the prognostic value of cumulative scores and composite ratios in patients with operable rectal cancer. Within a single surgical unit preoperative differential blood cell results including neutrophil (N), lymphocyte (L), monocyte (M) and platelet (P) counts, as well as CRP (C) and albumin (A) levels were recorded. These results were used to construct a series of composite ratios (NLR, PLR, LMR, CAR) and cumulative scores (NLS, PLS, LMS, NPS, mGPS). The relationship between composite ratios and the cumulative scores and clinicopathological characteristics, cancer specific survival (CSS) and overall survival (OS) were examined. A total of 413 patients were included. When adjusted for TNM stage, surgical approach, time of surgery and margin involvement mGPS (p < 0.05) was associated with CSS. In addition, most composite ratios/scores showed correlations with neoadjuvant therapy (p < 0.001). When a direct comparison between NPS (myeloid) and mGPS (liver) was carried out they showed similar associations with both CSS and OS. Therefore, both composite ratios and cumulative scores have been shown to be prognostic in patients with operable rectal cancer.
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Affiliation(s)
- Ross D Dolan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, New Lister Building, Glasgow, G4 0SF, UK.
| | - Muhammed Alwahid
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, New Lister Building, Glasgow, G4 0SF, UK
| | - Stephen T McSorley
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, New Lister Building, Glasgow, G4 0SF, UK
| | - James H Park
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, New Lister Building, Glasgow, G4 0SF, UK
| | - Richard P Stevenson
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, New Lister Building, Glasgow, G4 0SF, UK
| | - Campbell S Roxburgh
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, New Lister Building, Glasgow, G4 0SF, UK
| | - Paul G Horgan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, New Lister Building, Glasgow, G4 0SF, UK
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, New Lister Building, Glasgow, G4 0SF, UK
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Abbass T, Tsz Ho YT, Horgan PG, Dolan RD, McMillan DC. The relationship between computed tomography derived skeletal muscle index, psoas muscle index and clinical outcomes in patients with operable colorectal cancer. Clin Nutr ESPEN 2020; 39:104-113. [PMID: 32859302 DOI: 10.1016/j.clnesp.2020.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Computed tomography-based measures of body composition are emerging as important prognostic factors for patients with colorectal cancer (CRC). The aim of this study was to examine the relationship between total skeletal muscle index (SMI), psoas muscle index (PMI) and clinical outcomes in patients with operable CRC. METHODS A retrospective cohort study of prospectively maintained database at Glasgow Royal Infirmary. CT image at L3 was carried out to assess total skeletal and psoas muscle areas and these were normalized for height squared to calculate SMI and PMI respectively. Patients were classified into high and low groups using calculated optimal thresholds and their relationship to clinical outcomes was studied using logistic regression analysis. RESULTS Of the 1002 patients included, 55% were male, 50% had low SMI and 42% had low PMI. A moderate correlation was found between total skeletal muscle and psoas areas (rs = 0.70, p < 0.001). On univariate analysis, low SMI was associated with length of hospital stay (OR, 1.47; 95% CI, 1.15-1.89, p = 0.002) and overall survival (HR, 2.29; 95% CI, 1.47-3.58, p < 0.001). On multivariate analysis, low SMI was independently associated with length of hospital stay (HR 1.32; 95% CI, 1.02-1.70, p < 0.05). On univariate analysis, low PMI was associated with length of hospital stay (OR, 1.34; 95% CI, 1.04-1.73, p < 0.05) and overall survival (OR, 1.43; 95% CI, 1.10-1.86 p < 0.01). On multivariate analysis, low PMI was not independently significant. CONCLUSION The present study shows that though both total skeletal muscle index and psoas muscle index were directly associated and had prognostic value, total skeletal muscle index had independent prognostic value in patients with operable CRC.
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Affiliation(s)
- Tanvir Abbass
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK.
| | - Yeung Timothy Tsz Ho
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Paul G Horgan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Ross D Dolan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
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Almasaudi AS, Dolan RD, Edwards CA, McMillan DC. Hypoalbuminemia Reflects Nutritional Risk, Body Composition and Systemic Inflammation and Is Independently Associated with Survival in Patients with Colorectal Cancer. Cancers (Basel) 2020; 12:cancers12071986. [PMID: 32708140 PMCID: PMC7409314 DOI: 10.3390/cancers12071986] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/11/2020] [Accepted: 07/15/2020] [Indexed: 02/06/2023] Open
Abstract
It has long been recognized that albumin has prognostic value in patients with cancer. However, although the Global Leadership Initiative on Malnutrition GLIM criteria (based on five diagnostic criteria, three phenotypic criteria and two etiologic criteria) recognize inflammation as an important etiologic factor in malnutrition, there are limited data regarding the association between albumin, nutritional risk, body composition and systemic inflammation, and whether albumin is associated with mortality independent of these parameters. The aim of this study was to examine the relationship between albumin, nutritional risk, body composition, systemic inflammation, and outcomes in patients with colorectal cancer (CRC). A retrospective cohort study (n = 795) was carried out in which patients were divided into normal and hypoalbuminaemic groups (albumin < 35 g/L) in the presence and absence of a systemic inflammatory response C-reactive protein (CRP > 10 and <10 mg/L, respectively). Post-operative complications, severity of complications and mortality were considered as outcome measures. Categorical variables were analyzed using Chi-square test χ2 or linear-by-linear association. Survival data were analyzed using univariate and multivariate Cox regression. In the presence of a systemic inflammatory response, hypoalbuminemia was directly associated with Malnutrition Universal Screening Tool MUST (p < 0.001) and inversely associated with Body Mass Index BMI (p < 0.001), subcutaneous adiposity (p < 0.01), visceral obesity (p < 0.01), skeletal muscle index (p < 0.001) and skeletal muscle density (p < 0.001). There was no significant association between hypoalbuminemia and either the presence of complications or their severity. In the absence of a systemic inflammatory response (n = 589), hypoalbuminemia was directly associated with MUST (p < 0.05) and inversely associated with BMI (p < 0.01), subcutaneous adiposity (p < 0.05), visceral adiposity (p < 0.05), skeletal muscle index (p < 0.01) and skeletal muscle density (p < 0.001). Hypoalbuminemia was, independently of inflammatory markers, associated with poorer cancer-specific and overall survival (both p < 0.001). The results suggest that hypoalbuminemia in patients with CRC reflects both increased nutritional risk and greater systemic inflammatory response and was independently associated with poorer survival in patients with CRC.
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Affiliation(s)
- Arwa S. Almasaudi
- Department of Clinical Nutrition, Faculty of Applied Medical Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life of Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow G31 2ER, UK;
- Correspondence: or
| | - Ross D. Dolan
- Academic Unit of Surgery, College of Medical, Veterinary and Life of Sciences-University of Glasgow, Royal Infirmary, Glasgow G31 2ER, UK; (R.D.D.); (D.C.M.)
| | - Christine A. Edwards
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life of Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow G31 2ER, UK;
| | - Donald C. McMillan
- Academic Unit of Surgery, College of Medical, Veterinary and Life of Sciences-University of Glasgow, Royal Infirmary, Glasgow G31 2ER, UK; (R.D.D.); (D.C.M.)
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Abbass T, Dolan RD, Horgan PG, McMillan DC. The relationship between systemic inflammation, body composition and clinical outcomes in patients with operable colorectal cancer at low and medium to high nutritional risk. JCSM Clinical Reports 2020. [DOI: 10.1002/crt2.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Tanvir Abbass
- Academic Unit of Surgery, School of Medicine University of Glasgow, Glasgow Royal Infirmary Glasgow G4 0SF UK
| | - Ross D. Dolan
- Academic Unit of Surgery, School of Medicine University of Glasgow, Glasgow Royal Infirmary Glasgow G4 0SF UK
| | - Paul G. Horgan
- Academic Unit of Surgery, School of Medicine University of Glasgow, Glasgow Royal Infirmary Glasgow G4 0SF UK
| | - Donald C. McMillan
- Academic Unit of Surgery, School of Medicine University of Glasgow, Glasgow Royal Infirmary Glasgow G4 0SF UK
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Daly LE, Dolan RD, Power DG, Ní Bhuachalla É, Sim W, Cushen SJ, Fallon M, Simmons C, McMillan DC, Laird BJ, Ryan AM. Determinants of quality of life in patients with incurable cancer. Cancer 2020; 126:2872-2882. [DOI: 10.1002/cncr.32824] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/19/2019] [Accepted: 01/24/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Louise E. Daly
- School of Food and Nutritional Sciences College of Science, Engineering and Food Science University College Cork Cork Ireland
| | - Ross D. Dolan
- Academic Unit of Surgery University of Glasgow Glasgow United Kingdom
| | - Derek G. Power
- Department of Medical Oncology Mercy and Cork University Hospital Cork Ireland
| | - Éadaoin Ní Bhuachalla
- School of Food and Nutritional Sciences College of Science, Engineering and Food Science University College Cork Cork Ireland
| | - Wei Sim
- Academic Unit of Surgery University of Glasgow Glasgow United Kingdom
| | - Samantha J. Cushen
- School of Food and Nutritional Sciences College of Science, Engineering and Food Science University College Cork Cork Ireland
| | - Marie Fallon
- Edinburgh Cancer Research Centre Institute of Genetics and Molecular Medicine University of Edinburgh Edinburgh United Kingdom
| | - Claribel Simmons
- Edinburgh Cancer Research Centre Institute of Genetics and Molecular Medicine University of Edinburgh Edinburgh United Kingdom
| | | | - Barry J. Laird
- Edinburgh Cancer Research Centre Institute of Genetics and Molecular Medicine University of Edinburgh Edinburgh United Kingdom
| | - Aoife M. Ryan
- School of Food and Nutritional Sciences College of Science, Engineering and Food Science University College Cork Cork Ireland
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Dolan RD, Daly L, Sim WMJ, Fallon M, Ryan A, McMillan DC, Laird BJ. Comparison of the prognostic value of ECOG-PS, mGPS and BMI/WL: Implications for a clinically important framework in the assessment and treatment of advanced cancer. Clin Nutr 2019; 39:2889-2895. [PMID: 31926762 DOI: 10.1016/j.clnu.2019.12.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/26/2019] [Accepted: 12/18/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The systemic inflammatory response is associated with the loss of lean tissue, anorexia, weakness, fatigue and reduced survival in patients with advanced cancer and therefore is important in the definition of cancer cachexia. The aim of the present study was to carry out a direct comparison of the prognostic value of Eastern Cooperative Oncology Group Performance Status (ECOG-PS), modified Glasgow Prognostic Score (mGPS) and Body Mass Index/Weight Loss Grade (BMI/WL grade) in patients with advanced cancer. METHOD All data were collected prospectively across 18 sites in the UK and Ireland. Patient's age, sex, ECOG-PS, mGPS and BMI/WL grade were recorded, as were details of underlying disease including metastases. Survival data were analysed using univariate and multivariate Cox regression. RESULTS A total of 730 patients were assessed. The majority of patients were male (53%), over 65 years of age (56%), had an ECOG-PS>0/1 (56%), mGPS≥1 (56%), BMI≥25 (51%), <2.5% weight loss (57%) and had metastatic disease (86%). On multivariate cox regression analysis ECOG-PS (HR 1.61 95%CI 1.42-1.83, p < 0.001), mGPS (HR 1.53, 95%CI 1.39-1.69, p < 0.001) and BMI/WL grade (HR 1.41, 95%CI 1.25-1.60, p < 0.001) remained independently associated with overall survival. In patients with a BMI/WL grade 0/1 both ECOG and mGPS remained independently associated with overall survival. CONCLUSION The ECOG/mGPS framework may form the basis of risk stratification of survival in patients with advanced cancer.
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Affiliation(s)
- Ross D Dolan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK.
| | - Louise Daly
- School of Food and Nutritional Sciences, College of Science, Engineering and Food Science, University College Cork, Cork, Ireland
| | - Wei M J Sim
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Marie Fallon
- Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Aoife Ryan
- School of Food and Nutritional Sciences, College of Science, Engineering and Food Science, University College Cork, Cork, Ireland
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Barry J Laird
- Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
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Almasaudi AS, McSorley ST, Dolan RD, Edwards CA, McMillan DC. The relation between Malnutrition Universal Screening Tool (MUST), computed tomography-derived body composition, systemic inflammation, and clinical outcomes in patients undergoing surgery for colorectal cancer. Am J Clin Nutr 2019; 110:1327-1334. [PMID: 31529042 DOI: 10.1093/ajcn/nqz230] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/20/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Nutritional status is an important factor affecting a patient's clinical outcomes. Early identification of patients who are at risk of malnutrition is important to improve clinical outcomes and reduce health cost. The Malnutrition Universal Screening Tool (MUST) has been recommended as part of the routine nursing assessment for all patients at hospital admission. OBJECTIVE The aim of this study was to examine the association between nutritional status (MUST), systemic inflammatory response (SIR), body composition, and clinical outcomes in patients undergoing surgery for colorectal cancer. METHODS The malnutrition risk was examined using MUST in patients admitted for surgery for colorectal cancer between March 2013 and June 2016. Preoperative computed tomography scans were used to define the body composition. The presence of SIR was evidenced by the modified Glasgow prognostic score and the neutrophil to lymphocyte ratio. Postoperative complications, severity of complication, length of hospital stay, and mortality were considered as outcome measures. RESULTS The study included 363 patients (199 males, 164 females); 21% of the patients presented with a medium or high nutritional risk. There were significant associations between MUST and subcutaneous adiposity (P < 0.001), visceral obesity (P < 0.001), and low skeletal muscle index (P < 0.001). No statistically significant association was identified between MUST score and presence of any complication or severity of complication. On multivariate analysis, MUST remained independently associated with the length of hospital stay (OR: 2.17; 95% CI: 1.45, 3.26; P < 0.001). Kaplan-Meier survival curves showed an increased number of deaths for patients at medium or high risk of malnutrition (P < 0.001). This association was found to be independent of other confounding factors (HR: 1.45; 95% CI: 1.06, 1.99; P = 0.020). CONCLUSIONS MUST score is an independent marker of risk in those undergoing surgery for colorectal cancer and should remain a key part of preoperative assessment.
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Affiliation(s)
- Arwa S Almasaudi
- Academic Unit of Surgery, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Royal Infirmary, Glasgow, United Kingdom.,Human Nutrition, School of Medicine, Dentistry, and Nursing, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Stephen T McSorley
- Academic Unit of Surgery, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Royal Infirmary, Glasgow, United Kingdom
| | - Ross D Dolan
- Academic Unit of Surgery, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Royal Infirmary, Glasgow, United Kingdom
| | - Christine A Edwards
- Human Nutrition, School of Medicine, Dentistry, and Nursing, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Donald C McMillan
- Academic Unit of Surgery, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Royal Infirmary, Glasgow, United Kingdom
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McSorley ST, Tham A, Dolan RD, Steele CW, Ramsingh J, Roxburgh C, Horgan PG, McMillan DC. Perioperative Blood Transfusion is Associated with Postoperative Systemic Inflammatory Response and Poorer Outcomes Following Surgery for Colorectal Cancer. Ann Surg Oncol 2019; 27:833-843. [PMID: 31664621 PMCID: PMC7000540 DOI: 10.1245/s10434-019-07984-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Indexed: 01/28/2023]
Abstract
Background The present study investigated relationships between perioperative blood transfusion, postoperative systemic inflammatory response, and outcomes following surgery for colorectal cancer. Methods Data were recorded for patients (n = 544) undergoing potentially curative, elective surgery for colorectal cancer at a single center between 2012 and 2017. Transfusion history was obtained retrospectively from electronic records. Associations between blood transfusion, postoperative C-reactive protein (CRP), albumin, hemoglobin, complications, cancer-specific survival and overall survival (OS) were assessed using propensity score matching (n =116). Results Of 544 patients, the majority were male (n =294, 54%), over 65 years of age (n =350, 64%), and with colonic (n =347, 64%) node-negative disease (n =353, 65%). Eighty-six patients (16%) required perioperative blood transfusion. In the unmatched cohort, blood transfusion was associated with higher median postoperative day (POD) 3 CRP {143 [interquartile range (IQR) 96–221 mg/L] vs. 120 (IQR 72–188 mg/L); p = 0.004}, lower median POD 3 albumin [24 (IQR 20–26 g/L) vs. 27 (IQR 24–30 g/L); p < 0.001], more postoperative complications [odds ratio (OR) 3.28, 95% confidence interval (CI) 2.03–5.29] and poorer OS [hazard ratio (HR) 3.18, 95% CI 2.08–4.84]. In the propensity score matched cohort, blood transfusion was similarly associated with higher median POD 3 CRP [130 (IQR 93–196 mg/L) vs. 113 (IQR 66–173 mg/L); p = 0.046], lower median POD 3 albumin [24 (IQR 20–26 g/L) vs. 26 (IQR 24–30 g/L); p < 0.001], more postoperative complications (OR 2.91, 95% CI 1.36–6.20) and poorer OS (HR 2.38, 95% CI 0.99–5.73). Conclusions Perioperative blood transfusion was associated with postoperative inflammation, complications, and poorer survival in patients undergoing colorectal cancer surgery, with and without propensity score techniques.
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Affiliation(s)
| | - Alexander Tham
- Academic Unit of Surgery, University of Glasgow, Glasgow, UK
| | - Ross D Dolan
- Academic Unit of Surgery, University of Glasgow, Glasgow, UK
| | - Colin W Steele
- Academic Unit of Surgery, University of Glasgow, Glasgow, UK
| | - Jason Ramsingh
- Academic Unit of Surgery, University of Glasgow, Glasgow, UK
| | | | - Paul G Horgan
- Academic Unit of Surgery, University of Glasgow, Glasgow, UK
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Dolan RD, Laird BJ, Klepstad P, Kaasa S, Horgan PG, Paulsen Ø, McMillan DC. An exploratory study examining the relationship between performance status and systemic inflammation frameworks and cytokine profiles in patients with advanced cancer. Medicine (Baltimore) 2019; 98:e17019. [PMID: 31517821 PMCID: PMC6750290 DOI: 10.1097/md.0000000000017019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The role of cytokines in the systemic inflammatory response (SIR) is now well established. This is in keeping with the role of the SIR in tumorigenesis, malignant spread, and the development of cachexia. However, the relationship between performance status/systemic inflammation frameworks and cytokine profiles is not clear. The aim of the present study was to examine the relationship between the Eastern cooperative oncology group performance status/modified Glasgow prognostic score (ECOG-PS/mGPS) and cooperative oncology group performance status/neutrophil platelet score (ECOG-PS/NPS) frameworks and their cytokine profile in patients with advanced cancer.This was a retrospective interrogation of data already collected as part of a recent clinical trial (NCT00676936). The relationship between the independent variables (ECOG-PS/mGPS and ECOG-PS/NPS frameworks), and dependent variables (cytokine levels) was examined using independent Mann-Whitney U and Kruskal Wallis tests where appropriate.Of the 40 patients included in final analysis the majority had evidence of an SIR assessed by mGPS (78%) or NPS (53%). All patients died on follow-up and the median survival was 91 days (4-933 days). With increasing ECOG-PS there was a higher median value of Interleukin 6 (IL-6, P = .016) and C-reactive protein (CRP, P < .01) and lower albumin (P < .01) and poorer survival (P < .001). With increasing mGPS there was a higher median value of IL-6 (P = .016), Macrophage migration inhibitory factor (MIF, P = .010), erythrocyte sedimentation rate (ESR, P < .01) and poorer survival (P < .01). With increasing NPS there was a higher median value of TGF-β (P < .001) and C-reactive protein (P = .020) and poor survival (P = .001). When those patients with an ECOG-PS 0/1 and mGPS0 were compared with those patients with an ECOG-PS 2 and mGPS2 there was a higher median value of IL-6 (P = .017) and poorer survival (P < .001). When those patients with an ECOG-PS 0/1 and NPS0 were compared with those patients with an ECOG-PS 2 and NPS1/2 there was a higher median value of IL-6 (P = .002), TGF-β (P < .001) and poorer survival (P < .01).In patients with advanced cancer IL-6 was associated with the ECOG-PS/mGPS and ECOG-PS/NPS frameworks and survival in patients with advanced cancer. Therefore, the present work provides supporting evidence that agents targeting IL-6 are worthy of further exploration.
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Affiliation(s)
- Ross D. Dolan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow
| | - Barry J.A. Laird
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Pål Klepstad
- Department Intensive Care Medicine, St Olavs University Hospital, 7006 Trondheim and European Palliative Care Research Centre (PRC), Oslo University Hospital and Institute of Clinical Medicine, Oslo
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Oslo University Hospital and Institute of Clinical Medicine, Oslo
| | - Paul G. Horgan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow
| | - Ørnulf Paulsen
- European Palliative Care Research Centre (PRC), Oslo University Hospital and Institute of Clinical Medicine and Palliative Care Unit, Telemark Hospital Trust, Skien, Norway
| | - Donald C. McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow
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Morrow ES, Dolan RD, Doughty J, Stallard S, Lannigan A, Romics L. Variation in the management of elderly patients in two neighboring breast units is due to preferences and attitudes of health professionals. Breast Cancer (Dove Med Press) 2019; 11:179-188. [PMID: 31190976 PMCID: PMC6520595 DOI: 10.2147/bctt.s194124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 02/19/2019] [Indexed: 11/24/2022]
Abstract
Introduction: Elderly breast cancer patients have been shown to be managed less aggressively than younger patients. There is evidence that their management varies between institutions. We audited the management of elderly patients in two neighboring units in Glasgow and aimed to identify reasons for any differences in practice found. Methods: Patients aged ≥70 years, who were managed for a new diagnosis of breast cancer in the two units between 2009 and 2013, were identified from a prospectively maintained database. Tumor pathology, treatment details, postcode and consultant in charge of care were obtained from the same database. Comorbidities were obtained from each patient’s electronic clinical record. Questionnaires were distributed to members of each multidisciplinary teams. Results: 487 elderly patients in Unit 1 and 467 in Unit 2 were identified. 76.2% patients in Unit 1 were managed surgically compared to 63.7% in Unit 2 (p<0.0001). There was no difference between the two units in patient age, tumor pathology, deprivation or comorbidity. 16.2% patients managed surgically in Unit 1 had a comorbidity score of 6 and above compared to 11% of surgically managed patients in Unit 2 (p=0.036). Responses to questionnaires suggested that staff at Unit 1 were more confident of the safety of general anesthetic in elderly patients and were more willing to consider local anesthetic procedures. Conclusion: A higher proportion of patients aged >70 years with breast cancer were managed surgically in Unit 1 compared to Unit 2. Reasons for variation in practice seem to be related to attitudes of medical professionals toward surgery in the elderly, rather than patient or pathological factors.
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Affiliation(s)
| | - Ross D Dolan
- Academic Unit of Surgery, University of Glasgow, Glasgow, UK
| | - Julie Doughty
- Department of Surgery, Gartnavel General Hospital, Glasgow, UK
| | - Sheila Stallard
- Department of Surgery, Gartnavel General Hospital, Glasgow, UK
| | - Alison Lannigan
- Department of Surgery, Wishaw General Hospital, Lanarkshire, UK
| | - Laszlo Romics
- Academic Unit of Surgery, University of Glasgow, Glasgow, UK.,Department of Surgery, New Victoria Hospital, Glasgow, UK
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Dolan RD, Almasaudi AS, Dieu LB, Horgan PG, McSorley ST, McMillan DC. The relationship between computed tomography-derived body composition, systemic inflammatory response, and survival in patients undergoing surgery for colorectal cancer. J Cachexia Sarcopenia Muscle 2019; 10:111-122. [PMID: 30460764 PMCID: PMC6438413 DOI: 10.1002/jcsm.12357] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/16/2018] [Accepted: 09/11/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Colorectal cancer is the fourth leading cause of cancer mortality in developed countries. There is evidence supporting a disproportionate loss of skeletal muscle as an independent prognostic factor. The importance of the systemic inflammatory response as a unifying mechanism for specific loss of skeletal muscle mass in patients with cancer is increasingly recognized. The aim of the present study was to delineate the relationship between the systemic inflammatory response, skeletal muscle index (SMI), skeletal muscle density (SMD), and overall survival in patients with colorectal cancer. MATERIALS AND METHODS The study included 650 patients with primary operable colorectal cancer. Computed tomography scans were used to define the presence of visceral obesity, sarcopenia (low SMI), and myosteatosis (low SMD). Tumour and patient characteristics were recorded. Survival analysis was carried out using univariate and multivariate Cox regression. RESULTS A total of 650 patients (354 men and 296 women) were included. The majority of patients were over 65 years of age (64%) and overweight or obese (68%). On univariate survival analysis, age, ASA, TNM stage, modified Glasgow Prognostic Score (mGPS), body mass index, subcutaneous fat index, visceral obesity, SMI, and SMD were significantly associated with overall survival (all P < 0.05). A low SMI and SMD were significantly associated with an elevated mGPS (<0.05). On multivariate analysis, SMI (Martin) [hazard ratio (HR) 1.50, 95% confidence interval (CI) 1.04-2.18, P = 0.031], SMD (Xiao) (HR 1.42, 95% CI 0.98-2.05, P = 0.061), and mGPS (HR 1.44, 95% CI 1.15-1.79, P = 0.001) were independently associated with overall survival. SMD but not SMI was significantly associated with ASA (P < 0.001). CONCLUSIONS This study delineates the relationship between the loss of quantity and quality of skeletal muscle mass, the systemic inflammatory response, and survival in patients with operable colorectal cancer.
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Affiliation(s)
- Ross D Dolan
- Academic Unit of Surgery, University of Glasgow, Glasgow, United Kingdom
| | - Arwa S Almasaudi
- Academic Unit of Surgery, University of Glasgow, Glasgow, United Kingdom
| | - Ly B Dieu
- Academic Unit of Surgery, University of Glasgow, Glasgow, United Kingdom
| | - Paul G Horgan
- Academic Unit of Surgery, University of Glasgow, Glasgow, United Kingdom
| | - Stephen T McSorley
- Academic Unit of Surgery, University of Glasgow, Glasgow, United Kingdom
| | - Donald C McMillan
- Academic Unit of Surgery, University of Glasgow, Glasgow, United Kingdom
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Dolan RD, Laird BJ, Horgan PG, McMillan DC. The prognostic value of the systemic inflammatory response in randomised clinical trials in cancer: A systematic review. Crit Rev Oncol Hematol 2018; 132:130-137. [DOI: 10.1016/j.critrevonc.2018.09.016] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/10/2018] [Accepted: 09/29/2018] [Indexed: 12/18/2022] Open
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Dolan RD, McLees NG, Irfan A, McSorley ST, Horgan PG, Colville D, McMillan DC. The Relationship Between Tumor Glucose Metabolism and Host Systemic Inflammatory Responses in Patients with Cancer: A Systematic Review. J Nucl Med 2018; 60:467-471. [PMID: 30166353 DOI: 10.2967/jnumed.118.216697] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/22/2018] [Indexed: 12/14/2022] Open
Abstract
One of the most important and long recognized characteristics of tumor cells is their dysregulated cellular energetics with anaerobic driven glucose uptake. In patients with cancer, the prognostic value of the systemic inflammatory response has been well established, and the recent combination of PET and CT scanning combines the assessment of tumor physiologic activity with detailed anatomic localization. The aim of this study was to perform a systematic review of the assessment of the relationship between both the tumor and the host inflammatory responses using PET/CT. Methods: An extensive literature review using targeted subject headings was performed in the U.S. National Library of Medicine, the Excerpta Medica database, and the Cochrane Database of Systematic Reviews on March 31, 2018. On completion of the online search, the title and abstracts of each identified study were examined for relevance. Studies with duplicate datasets, not available in English, and that did not have full text availability were excluded. Full texts of relevant articles were obtained and were then examined to identify any further relevant articles. Results: Twelve studies containing 2,588 patients were included in the final analysis. All of the included studies used the 18F-FDG tracer in PET/CT imaging and had biochemical assessment of the systemic inflammatory response. Most studies showed a direct relationship between the tumor and bone marrow glucose uptake and host systemic inflammatory responses as measured by C-reactive protein (n = 2), albumin (n = 2), white cell count (n = 3), neutrophils (n = 2), and platelets (n = 2). Most of the studies (n = 8) also showed a direct relationship between tumor and bone marrow glucose uptake and poor outcomes. Conclusion: This review suggests a direct relationship between the tumor and bone marrow glucose uptake and host systemic inflammation. This may suggest new approaches for more optimal therapeutic targeting and monitoring strategies in patients with cancer.
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Affiliation(s)
- Ross D Dolan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom; and
| | - Naomi G McLees
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom; and
| | - Ahmer Irfan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom; and
| | - Stephen T McSorley
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom; and
| | - Paul G Horgan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom; and
| | - David Colville
- West of Scotland PET Centre, Gartnavel Hospital, Glasgow, United Kingdom
| | - Donald C McMillan
- West of Scotland PET Centre, Gartnavel Hospital, Glasgow, United Kingdom
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Abstract
Prognosis in colon cancer is based on pathological criteria including TNM staging. However, there are deficiencies in this approach, and the lymph node ratio (LNR) has been proposed to improve the prediction of outcomes. LNR is dependent on optimal retrieval of lymph nodes-lymph node count (LNC). Recent studies have suggested that an elevated preoperative systemic inflammatory response (SIR) was associated with a lower LNC and a higher LNR. However, there are a number of potential confounding factors. The aim of the present study was to examine, in detail, these relationships in a large cohort of patients.A prospectively maintained database of all patients undergoing colon cancer resection in our institution was examined. The SIR was measured by a number of inflammatory markers and their scores: modified Glasgow Prognostic Score (mGPS) (C-reactive protein/albumin), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and lymphocyte monocyte ratio (LMR) using standard thresholds. The relationships between LNC and LNR, and clinicopathological characteristics (including the mGPS, NLR, PLR, and LMR) were examined using chi-square test for trend and binary logistic regression analysis, where appropriate.Of the 896 patients included in the study, 418 (47%) were male, the median LNC was 17 (1-71), and the median LNR in node positive disease was 0.16 (0.03-1). On multivariate analysis, there was a significant independent relationship between an elevated LNC (≥12) and laparoscopic surgery (P < .001), right-sided tumors (P < .001), later date of resection (2007-2016) (P < .001), T stage (P < .001), and venous invasion (P < .001). In those patients with a LNC ≥12 and node-positive disease (n = 272), on multivariate analysis, there was a significant relationship between an elevated LNR (≥0.25), and T stage (P < .01) and differentiation (P < .05). Finally, in patients with node-positive disease who had surgery later (2007-2016), LNR was directly superior to N stage for both cancer-specific survival (LNR: hazard ratio [HR] 2.62, 95% confidence interval [CI] 1.25-5.52, P = .011) and overall survival (LNR: HR 2.02, 95% CI 1.12-3.68, P = .022).Neither LNC nor LNR was associated with markers of the SIR; however, LNC and LNR were directly associated. In high-quality surgical and pathological practice, LNR had superior prognostic value compared with N stage in patients undergoing surgery for colon cancer.
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Morrow ES, Dolan RD, Blackhall V, Romics L. Abstract P4-13-09: Immediate breast reconstruction versus delayed breast reconstruction: An analysis of oncological outcomes. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-13-09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Breast reconstruction is an important option for patients who undergo mastectomy for breast cancer. Several studies have investigated outcomes for patients who undergo either immediate or delayed reconstruction versus mastectomy alone but few have evaluated the relationship of the timing of reconstruction to oncological outcome.
Aim
To determine if there is a difference in oncological outcomes for patients who undergo delayed versus immediate breast reconstruction following mastectomy for breast cancer.
Methods
Patients who underwent immediate or delayed breast reconstruction between 2005 and 2006 were identified from a database maintained prospectively at the regional plastic surgery unit. Tumour pathology details were obtained retrospectively from the electronic patient record and from local electronic laboratory systems. Details of treatment, and recurrence and mortality data were obtained by review of each patient's electronic record. In the delayed reconstruction cohort, patients who underwent reconstruction 6-60 months after initial cancer surgery were included. In the immediate reconstruction group, patients who had recurrence or died within the first 6 months after surgery were excluded. Logistic regression survival analysis was carried out for the two cohorts and compared using Chi square test.
Results
193 patients who underwent immediate reconstruction and 116 patients who underwent delayed reconstruction were identified. Patients who had immediate reconstruction were more likely to have DCIS only, compared to those who had delayed reconstruction, but otherwise there was no significant difference between the two groups in terms of pathological characteristics or type of reconstruction performed (autologous or implant-based). Of those who had delayed reconstruction, median time from initial cancer surgery to reconstructive surgery was 27 months (6-58 months). There were 49 breast cancer deaths, 13 deaths from other causes and 65 recurrences. Median follow up time from reconstruction, of those who survived, was 111 months (29-134 months). Median follow up from initial cancer surgery was 116 months (46-185 months). There was no difference in breast cancer specific survival between the two groups when measured from time of cancer surgery (delayed reconstruction HR 1.05, 95% CI 0.59-1.89, p=0.861) or from time of reconstruction (delayed reconstruction HR 1.33, 95% CI 0.75-2.40, p=0.334). There was no difference in recurrence rates between the two groups when measured from time of cancer surgery (delayed reconstruction HR 0.94, 95% CI 0.56-1.60, p=0.822) or from time of reconstruction (delayed reconstruction HR 1.23, 95% CI 0.73-2.07, p=0.433).
Conclusion
Our data has demonstrated no difference in cancer specific survival or recurrence rates in patients who underwent mastectomy with immediate breast reconstruction compared to patients who had delayed reconstruction.
Citation Format: Morrow ES, Dolan RD, Blackhall V, Romics L. Immediate breast reconstruction versus delayed breast reconstruction: An analysis of oncological outcomes [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-13-09.
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Affiliation(s)
- ES Morrow
- Academic Unit of Surgery, Glasgow University, United Kingdom; New Victoria Infirmary, Glasgow, United Kingdom
| | - RD Dolan
- Academic Unit of Surgery, Glasgow University, United Kingdom; New Victoria Infirmary, Glasgow, United Kingdom
| | - V Blackhall
- Academic Unit of Surgery, Glasgow University, United Kingdom; New Victoria Infirmary, Glasgow, United Kingdom
| | - L Romics
- Academic Unit of Surgery, Glasgow University, United Kingdom; New Victoria Infirmary, Glasgow, United Kingdom
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Dolan RD, McSorley ST, McMillan DC, Horgan PG. Attitudes of surgeons to the use of postoperative markers of the systemic inflammatory response following elective surgery. Ann Med Surg (Lond) 2017; 21:14-19. [PMID: 28761641 PMCID: PMC5524306 DOI: 10.1016/j.amsu.2017.07.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 07/16/2017] [Accepted: 07/17/2017] [Indexed: 01/04/2023] Open
Abstract
Background Cancer is responsible for 7.6 million deaths worldwide and surgery is the primary modality of a curative outcome. Postoperative care is of considerable importance and it is against this backdrop that a questionnaire based study assessing the attitudes of surgeons to monitoring postoperative systemic inflammation was carried out. Method A Web based survey including 10 questions on the “attitudes of surgeons to the use of postoperative markers of the systemic inflammatory response following elective surgery” was distributed via email. Two cohorts were approached to participate in the survey. Cohort 1 consisted of 1092 surgeons on the “Association of Coloproctology of Great Britain and Ireland (ACPGBI)” membership list. Cohort 2 consisted of 270 surgeons who had published in this field in the past as identified by two recent reviews. A reminder email was sent out 21 days after the initial email in both cases and the survey was closed after 42 days in both cases. Result In total 29 surgeons (2.7%) from cohort 1 and 40 surgeons (14.8%) from cohort 2 responded to the survey. The majority of responders were from Europe (77%), were colorectal specialists (64%) and were consultants (84%) and worked in teaching hospitals (54%) and used minimally invasive techniques (87%). The majority of responders measured CRP routinely in the post-operative period (85%) and used CRP to guide their decision making (91%) and believed that CRP monitoring should be incorporated into postoperative guidelines (81%). Conclusion Although there was a limited response the majority of surgeons surveyed measure the systemic inflammatory response following elective surgery and use CRP measurements together with clinical findings to guide postoperative care. The present results provide a baseline against which future surveys can be compared. Shows that there is a widespread interest in the use of markers of the systemic inflammatory response in managing patients. This is particularly true when managing complications post operatively. There would seem to be scope for incorporation of markers of the SIR into formal post operative guidelines.
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Affiliation(s)
- Ross D Dolan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Stephen T McSorley
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Paul G Horgan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
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Dolan RD, McMillan DC. Neutrophil-to-lymphocyte ratio as a bladder cancer biomarker: Assessing prognostic and predictive value in SWOG 8710. Cancer 2017; 123:3855. [PMID: 28665479 DOI: 10.1002/cncr.30872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 06/13/2017] [Indexed: 01/04/2023]
Affiliation(s)
- Ross D Dolan
- Department of Surgery, Victoria Infirmary, Glasgow Royal Infirmary, Glasgow, Scotland
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, Scotland
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Dolan RD, McSorley ST, Horgan PG, Laird B, McMillan DC. The role of the systemic inflammatory response in predicting outcomes in patients with advanced inoperable cancer: Systematic review and meta-analysis. Crit Rev Oncol Hematol 2017; 116:134-146. [PMID: 28693795 DOI: 10.1016/j.critrevonc.2017.06.002] [Citation(s) in RCA: 209] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 06/04/2017] [Accepted: 06/06/2017] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Cancer remains a leading cause of death worldwide. While a curative intent is the aim of any surgical treatment many patients either present with or go onto develop disseminated disease requiring systemic anti-cancer therapy with a palliative intent. Given their limited life expectancy appropriate allocation of treatment is vital. It is recognised that systemic chemoradiotherapy may shorten the quality/quantity of life in patients with advanced cancer. It is against this background that the present systematic review and meta-analysis of the prognostic value of markers of the systemic inflammatory response in patients with advanced cancer was conducted. METHODS An extensive literature review using targeted medical subject headings was carried out in the MEDLINE, EMBASE, and CDSR databases until the end of 2016. Titles were examined for relevance and studies relating to duplicate datasets, that were not published in English and that did not have full text availability were excluded. Full texts of relevant articles were obtained and were then examined to identify any further relevant articles. RESULTS The majority of studies were retrospective. The systemic inflammatory response, as evidenced by a number of markers at clinical thresholds, was reported to have independent prognostic value, across tumour types and geographical locations. In particular, C-reactive protein (CRP, 63 studies), albumin (33 studies) the Glasgow Prognostic Score (GPS, 44 studies) and the Neutrophil Lymphocyte Ratio (NLR, 59 articles) were consistently validated across tumour types and geographical locations. There was considerable variation in the thresholds reported to have prognostic value when CRP and albumin were examined. There was less variation in the thresholds reported for NLR and still less for the GPS. DISCUSSION The systemic inflammatory response, especially as evidenced by the GPS and NLR, has reliable prognostic value in patients with advanced cancer. Further prospective studies of their clinical utility in randomised clinical trials and in treatment allocation are warranted.
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Affiliation(s)
- Ross D Dolan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom.
| | - Stephen T McSorley
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Paul G Horgan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Barry Laird
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom
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McSorley ST, Dolan RD, Roxburgh CSD, McMillan DC, Horgan PG. How and why systemic inflammation worsens quality of life in patients with advanced cancer. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/23809000.2017.1331705] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Stephen T. McSorley
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK
| | - Ross D. Dolan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK
| | | | - Donald C. McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK
| | - Paul G. Horgan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK
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Dolan RD, Sproat TDR. Discitis with vertebral body destruction in a 28-year-old intravenous drug user. BMJ Case Rep 2010; 2010:2010/nov26_1/bcr1020103417. [PMID: 22798102 DOI: 10.1136/bcr.10.2010.3417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- R D Dolan
- Department of Neurology, University of Dundee, Dundee, UK.
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