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Predictive significance of inflammatory markers in the survival of older Indian patients with cancer: a single-center prospective analysis

22 Aug 2024
Abhijith Rajaram Rao, Vanita Noronha, Anant Ramaswamy, Anbarasan Sekar, Anita Kumar, Anupa Pillai, Shreya Gattani, Arshiya Sehgal, Sharath Kumar, Renita Castelino, Ratan Dhekale, Jyoti Krishnamurthy, Sarika Mahajan, Anuradha Daptardar, Lekhika Sonkusare, Jayita Deodhar, Nabila Ansari, Manjusha Vagal, Purabi Mahajan, Shivshankar Timmanpyati, Manjunath Nookala, Ankita Chitre, Akhil Kapoor, Vikram Gota, Shripad Banavali, Rajendra A Badwe, Kumar Prabhash

Aim: To evaluate the prognostic impact of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) on overall survival (OS) among Indian older patients with cancer.

Methods: This observational study was conducted in the geriatric oncology clinic of Tata Memorial Hospital (India). We included all patients who underwent a geriatric assessment (GA) and had a complete blood count available for analysis. The NLR was dichotomized at 3.5, PLR and LMR at the median. Our primary study outcome was OS.

Results: Between June 2018 and November 2021, 786 patients were enrolled (median age: 69 years). The most common primary tumour was lung (308, 39.5%), followed by gastrointestinal (261, 33.5%). Metastatic disease was present in 54.3% of patients. Univariate analysis revealed that patients with NLR >3.5 had shorter OS (9.1 months) than NLR <3.5 (15.7 months) (HR: 1.56). Similarly, patients with PLR >183.5 had reduced OS (9.3 months) compared to PLR <183.5 (16.6 months) (HR: 1.56). Conversely, patients with LMR >3.1 showed better OS (14.2) compared to LMR <3.1 (9.8 months) (HR: 0.74). After adjusting for age, performance status, primary tumour, metastatic status and GA-derived factors (function, nutrition and cognition), NLR (HR: 1.25, 95%CI: 1.03–1.52), PLR (HR: 1.34, 95%CI: 1.11–1.63) and LMR (HR: 0.79, 95%CI: 0.65–0.95) were associated with OS.

Conclusion: In our study of older cancer patients, we identified three key inflammatory markers (NLR >3.5, PLR >183.5, LMR <3.1) as strong predictors of poor OS. These markers remain predictive even after accounting for traditional prognostic factors and GA-derived scales.

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