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Association between the Lymphocyte-to-C-Reactive Protein Ratio and Survival Outcomes in Cancer Patients with GLIM-Defined Malnutrition: A Multicenter Study

  • Original Research
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The journal of nutrition, health & aging

Abstract

Background & Aims

This study assessed the prognostic value of LCR in patients with cancer-associated malnutrition (CAM). Systemic inflammatory markers, particularly the lymphocyte-to-C-reactive protein ratio (LCR), are related to the survival of patients with CAM. The present retrospective analysis based on a prospective multicenter cohort study, which involved 1,437 hospitalized patients with CAM.

Methods

The area under the receiver operating characteristic curve (AUC) of ten inflammatory indicators — LCR, advanced lung cancer inflammation index, neutrophil-to-lymphocyte ratio, prognostic nutritional index, modified Glasgow prognostic score, systemic immune-inflammation index, albumin-to-globulin ratio, LCR score, glucose-to-lymphocyte ratio, and platelet-to-lymphocyte ratio—were constructed. Nutritional status, blood markers, and quality of life (QoL) were evaluated within 48 h of admission. The overall survival (OS) was evaluated from September 1 to December 29, 2021.

Results

A total of 1,431 cancer patients diagnosed with malnutrition based on the Global Leadership Initiative on Malnutrition (GLIM) criteria. Male patients were 62.8% of all, and the mean age was 60.66 years old. The AUC of LCR was higher than that of other inflammatory markers. The restricted cubic spline (RCS) of the Hazard ratios (HRs) showed an inverse L-shaped relationship with LCR. In addition, patients with low LCR had significantly poorer OS than those with high LCR. The addition of LCR to the model increased the predictive ability of 1-year mortality (AUC increase of 0.036), 3-year mortality (AUC increase of 0.038), and 5-year mortality (AUC increase of 0.031).

Conclusions

Assessing the LCR can help the medical staff identify cancer patients with nutritional deficiency at high risk of oncological outcomes and develop individualized therapeutic strategies.

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Acknowledgments

All authors are grateful to the participants and investigators of the Investigation on the Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) Group for the rigorous data collection and sharing.

Funding

Funding: This work was supported by the National Multidisciplinary Cooperative Diagnosis and Treatment Capacity Project for Major Diseases: Comprehensive Treatment and Management of Critically Ill Elderly Inpatients (No. 2019.YLFW).

Author information

Authors and Affiliations

  1. Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China

    K.-P. Zhang, X. Zhang, Q. Zhang, G.-T. Ruan, M.-M. Song, H.-L. Xie, H.-Y. Zhang, X.-R. Li, M. Yang, Y.-Y. Liu, Q.-Q. Li, Y.-Z. Ge, X.-Y. Liu, S.-Q. Lin,  Li Deng &  Han-Ping Shi

  2. Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China

    K.-P. Zhang, X. Zhang, Q. Zhang, G.-T. Ruan, M.-M. Song, H.-L. Xie, H.-Y. Zhang, X.-R. Li, M. Yang, Y.-Y. Liu, Q.-Q. Li, Y.-Z. Ge, X.-Y. Liu, S.-Q. Lin,  Li Deng &  Han-Ping Shi

  3. Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China

    K.-P. Zhang, X. Zhang, Q. Zhang, G.-T. Ruan, M.-M. Song, H.-L. Xie, H.-Y. Zhang, X.-R. Li, M. Yang, Y.-Y. Liu, Q.-Q. Li, Y.-Z. Ge, X.-Y. Liu, S.-Q. Lin,  Li Deng &  Han-Ping Shi

  4. Cancer Center of the First Hospital of Jilin University, Changchun, China

    W. Li

  5. Department of Clinical Nutrition, Daping Hospital, Third Military Medical University (Army Medical University), Chongqing, China

    H.-X. Xu

  6. Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China

    Li Deng

Authors
  1. K.-P. Zhang
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  2. X. Zhang
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  3. Q. Zhang
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  4. G.-T. Ruan
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  5. M.-M. Song
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  6. H.-L. Xie
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  7. H.-Y. Zhang
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  8. X.-R. Li
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  9. M. Yang
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  10. Y.-Y. Liu
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  11. Q.-Q. Li
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  17. Li Deng
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  18. Han-Ping Shi
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Contributions

Authorship: Han-Ping Shi, Li Deng, and Qi Zhang have made substantial contributions to conception and design. Kang-Ping Zhang, Guo-Tian Ruan and Xi Zhang have made substantial contributions to acquisition of data. Kang-Ping Zhang have performed the analysis of data and wrote the manuscript. Guo-Tian Ruan, Meng-Meng Song, Hai-Lun Xie, He-Yang Zhang, Xiang-Rui Li, Ming Yang, Yu-Ying Liu, Qin-Qin Li, Yi-Zhong Ge, Xiao-Yue Liu, Shi-Qi Lin, Wei Li, Hong-Xia Xu have been involved in revising the manuscript critically for important intellectual content.

Corresponding authors

Correspondence to Li Deng or Han-Ping Shi.

Ethics declarations

Conflict of Interest: These authors declare that they have no conflicts of interests.

Ethical standards: This current study was approved by the research ethics committee of each participating center under the principle of the Declaration of Helsinki.

Additional information

Registration Number: This study was derived from the Investigation on Nutrition Status and its Clinical Outcome of Common Cancers (INSCOC) cohort, a prospective multicenter cohort study in China (Registration number: ChiCTR1800020329).

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Zhang, KP., Zhang, X., Zhang, Q. et al. Association between the Lymphocyte-to-C-Reactive Protein Ratio and Survival Outcomes in Cancer Patients with GLIM-Defined Malnutrition: A Multicenter Study. J Nutr Health Aging 26, 847–855 (2022). https://doi.org/10.1007/s12603-022-1835-3

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