Systemic Inflammation, Nutritional Status and Tumor Immune Microenvironment Determine Outcome of Resected Non-Small Cell Lung CancerReportar como inadecuado




Systemic Inflammation, Nutritional Status and Tumor Immune Microenvironment Determine Outcome of Resected Non-Small Cell Lung Cancer - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Background

Hypothesizing that nutritional status, systemic inflammation and tumoral immune microenvironment play a role as determinants of lung cancer evolution, the purpose of this study was to assess their respective impact on long-term survival in resected non-small cell lung cancers NSCLC.

Methods and Findings

Clinical, pathological and laboratory data of 303 patients surgically treated for NSCLC were retrospectively analyzed. C-reactive protein CRP and prealbumin levels were recorded, and tumoral infiltration by CD8+ lymphocytes and mature dendritic cells was assessed. We observed that factors related to nutritional status, systemic inflammation and tumoral immune microenvironment were correlated; significant correlations were also found between these factors and other relevant clinical-pathological parameters. With respect to outcome, at univariate analysis we found statistically significant associations between survival and the following variables: Karnofsky index, American Society of Anesthesiologists ASA class, CRP levels, prealbumin concentrations, extent of resection, pathologic stage, pT and pN parameters, presence of vascular emboli, and tumoral infiltration by either CD8+ lymphocytes or mature dendritic cells and, among adenocarcinoma type, tumor grade all p<0.05. In multivariate analysis, prealbumin levels Relative Risk RR: 0.34 0.16–0.73, p = 0.0056, CD8+ cell count in tumor tissue RR = 0.37 0.16–0.83, p = 0.0162, and disease stage RR 1.73 1.03–2.89; 2.991.07–8.37, p = 0.0374- stage I vs II vs III-IV were independent prognostic markers. When taken together, parameters related to systemic inflammation, nutrition and tumoral immune microenvironment allowed robust prognostic discrimination; indeed patients with undetectable CRP, high >285 mg-L prealbumin levels and high >96-mm2 CD8+ cell count had a 5-year survival rate of 80% 60.9–91.1 as compared to 18% 7.9–35.6 in patients with an opposite pattern of values. When stages I-II were considered alone, the prognostic significance of these factors was even more pronounced.

Conclusions

Our data show that nutrition, systemic inflammation and tumoral immune contexture are prognostic determinants that, taken together, may predict outcome.



Autor: Marco Alifano , Audrey Mansuet-Lupo, Filippo Lococo, Nicolas Roche, Antonio Bobbio, Emelyne Canny, Olivier Schussler, Hervé Derm

Fuente: http://plos.srce.hr/



DESCARGAR PDF




Documentos relacionados