Estudio de la población anciana ambulatoria con cáncer de pulmón no microcítico: análisis clínico y factores pronóstico inflamatorios”

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Lung cancer is one of the most age-related cancers, so that elderly patients represent a large percentage in routine clinical practice. However, the available scientific evidence is poor in this patients group because the elderly are underrepresented in most clinical trials. It is therefore important to know the clinical reality of this population group and identify prognostic factors that may be useful in selecting more effective and personalized treatments and avoid over or undertreatments. The aim of our study is to analyze the clinical characteristics of the elderly population with non-small cell lung cancer (NSCLC ) of our Department , attended on an outpatient basis , and the study of laboratory markers, inflammatory and nutritional indeces, to validate its prognostic value in this specific population . -Description of the population under study 147 patients with NSCLC, greater than or equal to 70 years old, valued as an outpatient at the Medical Oncology Service of the University Hospital Dr. Peset of Valencia, from January 2012 to June 2015, were included. 89.8% of the patients were male, with a median age of 77 years. Most (88.4%) had a history of smoking. The predominant histology was adenocarcinoma (60.5%), followed by squamous cell carcinoma (35.4%). The general condition of the patients was good with ECOG 0-1 in 68.7% of cases, although 80.2% were diagnosed in advanced stages III B (23.1%) and IV (57.1%). The most common site of metastasis were bone metastasis, followed by pulmonary and liver. 37% of patients had significant loss of weight pretreatment. Most patients (78.2%), received active treatment , with chemotherapy in 62.6% of cases, mainly combination schemes. In 71.6% of the patients treated, disease control was achieved. At the time of analysis, 63.9% of the patients had died. The median survival was 11.9 months (95% CI 7.6-16.1). A geriatric assessment was performed in 65.3% of the patients, being a good level of autonomy (93.8% independent for ADL and IADL 68.8% for independent). Only 11.9% of the patients had some form of cognitive impairment. Depression was present in 24.3% of patients. -Analytical, inflammatory and nutritional parameters analyzed at diagnosis Most patients had an increased PCR (median 33 mg / l) and hypoalbuminemia (median 3.4 mg / dl). Inflammatory and nutritional indices were calculated, with the following results (median): Inflammatory Index Nutrition (INI): 0.10, Ratio neutrophil / lymphocyte (NLR): 3.60 , Prognostic Index Nutrition (IPN): 42.5 and Score Prognostic Glasgow (SPG) (0 = 21.1% ,1=31.3%, 2 = 47.6%). -Analysis of survival After univariate analysis, the following variables showed significant differences, with lower survival: a) clinical: stage (p = 0.002), weight loss (p <0.001), PS 2-3 (p <0.001), response to treatment ( p <0.001), b) analytical: PCR> 10 (p <0.001), INI higher (p <0.001), GPS> 0 (p <0.001), NLR higher (p = 0.001), IPN low (p <0.001) Hb <11 (p = 0.001), c) Geriatrics vulnerable and frail elderly (p = 0.002), dependent patients (p = 0.001), with depression (p = 0.008), comorbidity (SCS) (p = 0.001) , polypharmacy (p = 0.006) and the presence of geriatric syndromes (p = 0.006). Multivariate analysis showed an independent prognostic value for variables: ECOG-PS (p <0.001), INI (p = 0.007), NLR (p = 0.004), bone metastases (p = 0.02) and Simplified Comorbidity Score (<0.001) . Conclusions Lung cancer is associated with a state of chronic inflammation. There is a significant relationship between the inflammatory indices with different clinical aspects. Geriatric assessment gives valuable additional information, which is considered appropriate its incorporation into clinical practice . The inflammatory and nutritional parameters studied demonstrated a significant independent prognostic value for survival, in elderly patients with non -small cell lung carcinoma . Their preparation is simple, inexpensive and highly accessible. Therefore, the determination could be part of usual care protocol in elderly patients with non -small cell lung carcinoma. However, prospective studies to validate their prognostic role are required.
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