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Background: Systemic inflammation (SI) and insulin resistance (IR) are correlated to the progression of gastrointestinal (GI) cancer. Therefore, this study aimed to analyze the potential clinical value of the C-reactive protein-triglyceride-glucose index (CTI) in relation to SI and IR in patients with GI cancer. Methods: This prospective cohort study included patients with GI cancer. Patient data were collected from Fujian Cancer Hospital as an external validation cohort. Prognostic AUC, time-dependent ROC curve, C-index, and calibration curve analyses were used to predict the efficacy and accuracy of CTI survival prediction. Multivariate survival analysis was performed to evaluate the potential prognostic value of the CTI. Multiple logistic regression was performed to evaluate the relationship between the CTI and 90-day and 180-day mortalities. Results: We divided 1520 patients with GI cancer (mean age, 60.39 ± 11.3 years; male sex, 67%) into a training cohort and internal validation cohort; the external validation cohort included 476 patients. Prognostic AUC, time-dependent ROC curve, C-index, and calibration curve analyses of all cohorts indicated that the CTI could reliably and accurately predict the short- and long-term survival outcomes of patients with GI cancer. Multivariate survival analysis showed that for each standard deviation increase in the CTI, the risk of death increased by 32%, 21%, and 40% in the training, internal validation, and external validation cohorts, respectively. A high CTI was correlated to worse survival in patients with GI cancer (training cohort, hazard ratio [HR]=1.67, 95% confidence interval [CI]=1.35–2.08; internal validation cohort, HR=1.51, 95% CI=1.07–2.14, and external validation cohort, HR=1.59, 95% CI=1.18–2.13). In different tumor subgroups, a high CTI predicted worse survival outcomes for upper GI cancer (HR=1.54, 95% CI=1.18–2.01) and lower GI cancer (HR=1.98, 95% CI=1.36–2.86). Multivariate logistic regression analysis showed that a high CTI was positively correlated with 90-day (odds ratio [OR]=3.25, 95% CI=1.75–6.23) and 180-day mortalities (OR=2.66, 95% CI=1.72–4.15). Conclusions: The CTI is related to SI and IR and can predict the short- and long-term prognosis of patients with GI cancer. Evaluation of the CTI could provide clinicians with an effective tool for predicting the prognosis of patients with GI cancer. Clinical trial registration: https://www.chictr.org.cn/showproj.html?proj=31813 , identifier ChiCTR1800020329. [ABSTRACT FROM AUTHOR]

Purpose: To develop a simple and convenient inflammation-nutrition-adiposity biomarker to complement the TNM staging system, further assess the prognosis of patients with colorectal cancer cachexia. Methods: This study was a multi-centre cohort study. The triceps skinfold thickness-albumin index (TA) was calculated by combining the triceps skinfold thickness (TSF) and serum albumin levels. Kaplan–Meier analysis and Cox proportional risk regression models were used to assess the relationship between the TA and all-cause mortality. Internal validation was carried out. Results: We included 1025 patients with colorectal cancer cachexia, 61.2% of whom were male, with a mean age of 58.91 (12.45) years. As the TA increased, overall mortality decreased in female patients (hazard ratio [HR], 0.95) but not in male patients (HR, 0.99). Multivariate Cox analysis showed that patients in the normal TA group had a significantly lower risk of death than those in the low TA group (HR, 0.53, 95% CI, 0.40–0.72). Patients with a normal TA had a lower risk of malnutrition, poor quality of life, and poor short-term prognosis than those with a low TA. Conclusions: TA index enables clinicians to assess the prognosis of patients as early as possible to improve the survival of patients with colorectal cancer cachexia. [ABSTRACT FROM AUTHOR]

Background: Although socioeconomic factors are important determinants of population mortality, the effect of educational level on the survival of patients with cancer in China is unclear. This study aimed to assess whether educational level is associated with the prognosis of patients with cancer and to explore the mediators of this association. Methods: This multicentre cohort study included 18,251 patients diagnosed with cancer between May 2013 and December 2018. The main parameters measured were overall survival (OS) and all‐cause mortality. The relationship between educational level and all‐cause mortality was assessed using multifactor‐corrected Cox survival analysis. Logistic regression was used to analyze the association between educational level and patient‐generated subjective global assessment (PG‐SGA). Results: The mean age of the 18,251 participants (men, 9939 [54.4%]) was 57.37 ± 11.66 years. Multifactorial survival analysis showed that patients survived longer with increasing education (university and above vs. elementary school and below; p = p = <0.001, HR = 0.84, 95% CI: 0.77–0.92), and the differences were statistically significant in different subgroups. The potential impact factors included sex, age, TNM stage, and PG‐SGA score. Logistic regression showed a significant negative association between educational level and the modifiable factor PG‐SGA (secondary vs. primary and below; p = 0.004, HR = 0.90, 95% CI: 0.83–0.97; university and above vs. primary and below; p < 0.001, HR = 0.79, 95% CI: 0.71–0.88). Conclusions: Educational level was a significant prognostic factor for patients with cancer, independent of other known prognostic factors. This association was further improved by modifying the nutritional status. [ABSTRACT FROM AUTHOR]

Background: Aging is accompanied by muscle loss. In older adults with cancer sarcopenia (OACS), systemic inflammation, reduced food intake, and reduced physical activity led to a poor prognosis. This study was to investigate the prognostic ability of the inflammatory Geriatric Nutritional Risk Index (GNRI), which combines patient's inflammation, diet status, and physical activity status to predict overall survival of OACS. Methods: This prospective multi‐center study enrolled 637 OACS, with an average age of 72.78 ± 5.98 years, of which 408 (64.1%) were males. We constructed the Inflammatory Functional Prognostic Index (IFPI) of OACS based on inflammatory GNRI scores, reduced food intake, and reduced physical activity. According to the IFPI, OACS was divided into high‐, moderate‐, and low‐risk groups. Univariate and multivariate survival analyses analyzed the prognostic ability of the clinical parameters. Results: Compared with OACS with a high GNRI score, the 1‐, 3‐, and 5‐year hazard ratios (95% confidence interval) of OACS with a low GNRI score was 1.816 (1.076–3.063), 1.678 (1.118–2.518), and 1.627 (1.101–2.407), respectively. This result was consistent with that of the calibration curve. The subgroup analysis showed that the low GNRI score had a significant positive relation with patients with gastrointestinal cancer (Pinteraction < 0.001). Notably, the survival analysis of IFPI showed that the mortality risk of moderate‐ and high‐risk patients was 1.722‐and 2.509‐fold higher, respectively, than that of low‐risk patients. Conclusion: The GNRI score was a short‐term and long‐term inflammatory prognostic indicator for OACS. The IFPI score could improve patient survival prediction. [ABSTRACT FROM AUTHOR]

Background: Overweight or obese cancer patients are more likely to develop a proinflammatory status. The aim of this study was to investigate whether the nutrition‐inflammation marker can provide additional prognostic information on top of well‐established Eastern Cooperative Oncology Group performance status (ECOG‐PS) in overweight or obese patients with cancer. Methods: A total of 1667 overweight or obese cancer patients were enrolled in this study. We assessed the prediction accuracy of 10 nutrition‐inflammation markers by time‐dependent receiver operating characteristic (ROC) and elucidated their association with overall survival by the Kaplan‐Meier method and a Cox model. Results: In this analysis, the majority of patients had a good performance status (ECOG‐PS score ≤1; 88.3%). Both the area under ROC curves and the C‐index of the lymphocyte–C‐reactive protein ratio (LCR) demonstrated that LCR was the most significant nutrition‐inflammation marker correlated with survival. In patients with good ECOG‐PS, a low LCR was significantly associated with poorer prognosisand enhanced the predictive ability of one‐year mortality. For specific tumor types, a low LCR was an independent prognostic factor for lung cancer, upper gastrointestinal cancer, and colorectal cancer, and it tended to be a significant predictor for breast cancer. In addition, those patients with a combined low LCR and poorer ECOG‐PS (ECOG‐PS score >1) showed the worst prognosis. Conclusion: The LCR is more strongly associated with overall survival than other nutrition‐inflammation markers, and it is able to further detect patients with worse prognosis on top of ECOG‐PS in overweight or obese patients with cancer. [ABSTRACT FROM AUTHOR]