Supportive Care in Cancer

, Volume 23, Issue 2, pp 385–391 | Cite as

The relationship between nutritional status, inflammatory markers and survival in patients with advanced cancer: a prospective cohort study

  • Cindy S. Y. Tan
  • Jane A. Read
  • Viet H. Phan
  • Philip J. Beale
  • Jennifer K. Peat
  • Stephen J. Clarke
Original Article



Malnutrition and elevated inflammatory markers have a negative impact on clinical outcomes in cancer patients. Few studies have investigated the associations between inflammatory makers, nutritional status and survival. This study investigates the association between nutritional status, inflammatory markers and overall survival (OS) in patients with advanced cancer.


This prospective cohort study recruited 114 adult patients from January 2007 to January 2010. It included patients diagnosed with advanced cancer, good Eastern Cooperative Oncology Group (ECOG) performance status 0–2, a prognosis of more than 3 months and had not received chemotherapy for advanced cancer prior to enrolment. Baseline data were collected prior to commencement of chemotherapy. Patients were followed up from the date of baseline nutritional assessment until the date of death or the date that data were last updated, whichever came first.


Malnourished cancer patients had statistically significant higher concentrations of serum C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR) or modified Glasgow Prognostic Score (mGPS) prior to starting chemotherapy. In univariate analyses to predict survival, mGPS 1 or 2 had a hazard ratio (HR) of 1.81 (95 % confidence interval (CI) 1.13–2.89) and NLR ≥ 5 had a HR of 1.13 (95 % CI 1.08–4.60) and malnutrition (HR of 1.66 for Patient-Generated Subjective Global Assessment (PG-SGA) B (95 % CI 1.02–2.71), and HR for severely malnourished patients (PG-SGA C) was 2.73 (95 % CI 1.50–4.96).


Inflammatory markers were statistically associated with malnutrition. Malnutrition and mGPS were significant independent predictors of overall survival in patients with advanced cancer.


Nutritional status Malnutrition Inflammatory markers mGPS NLR PG-SGA Overall survival 



The authors gratefully acknowledge Dr. Edmund Fitzgerald for reviewing this manuscript. The authors also like to acknowledge the support received from colleagues from Medical Oncology and Nutrition & Dietetics Department, Concord Hospital.

Conflict of interest

None of the authors have a conflict of interest to declare. Access to data in the study is available if requested.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Cindy S. Y. Tan
    • 1
    • 4
  • Jane A. Read
    • 2
  • Viet H. Phan
    • 3
  • Philip J. Beale
    • 4
  • Jennifer K. Peat
    • 5
  • Stephen J. Clarke
    • 6
  1. 1.Nutrition and Dietetics DepartmentConcord HospitalSydneyAustralia
  2. 2.Prince of Wales HospitalSydneyAustralia
  3. 3.Gosford HospitalSydneyAustralia
  4. 4.Medical Oncology DepartmentSydney Cancer Center Concord HospitalSydneyAustralia
  5. 5.Biostatistician, Concord Repatriation General HospitalSydneyAustralia
  6. 6.Medical Oncology DepartmentRoyal North Shore HospitalSydneyAustralia

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