Relationship of nutritional status and inflammation with survival in patients with advanced cancer in palliative care

Abstract

Objective: This study aimed to evaluate the prognostic value of nutritional and inflammatory status in patients with advanced cancer receiving palliative care. Methods: The systemic inflammatory response was assessed using the modified Glasgow Prognostic Score (mGPS), and nutritional status was evaluated according to the Patient-Generated Subjective Global As sessment (PG-SGA) in 172 patients evaluated on their first visit in the Palliative Care Unit at the National Cancer Institute in Brazil. The receiver operating characteristic (ROC) curve was used to define the best cutoff point for the death-related PG-SGA score in 90 d. Kaplan-Meier curves were conducted for sur vival analyses, and logistic regression analyses were performed using the Cox proportional hazards model. Results: According to the PG-SGA, 83.6% of the patients (n = 143) were malnourished (B + C) and 34.8% (n = 53) had mGPS ≥1. The best cutoff of the PG-SGA score for death was ≥19 points (area under the curve, 0.69; P = 0.041). Patients with scores ≥19, mGPS ≥1, albumin <3.5 g/dL, and C-reactive protein ≥10 mg/L had a significantly lower overall survival. According to the multivariate analysis, albumin <3.5 g/dL (hazard ratio [HR], 2.04; 95% confidence interval [CI], 1.16–3.58), mGPS ≥1 (HR, 1.46; 95% CI, 1.09–2.22), and PG SGA score ≥19 (HR, 1.66; 95% CI, 1.08–2.55) were independent prognostic factors for overall survival. Conclusion: The severity of the systemic inflammation and the poor nutritional status predict survival and were considered independent prognostic factors. Thus they can be useful tools for nutritional eval uation in palliative care.