| Background: Inflammation is considered essential in cancer progression,as it affects the nutritional status and prognosis of patients.In this study,we aim to analyze the efficacy of various inflammatory markers in predicting prognosis in cancer patients.Methods: Patients with malignant tumor were included as training and validation cohort.Basic clinical information,anthropometric indicators,body composition analysis,and serological indicators were recorded.After proposing the optimal thresholds by time-dependent receiver operating characteristic（ROC）,univariate and multivariate Cox regression analyses were performed to analyze the association between inflammatory markers and overall survival（OS）.A nomogram was established to develop a scored-inflammatory marker system.Eight inflammatory models based on combinations of inflammatory markers were assessed.Cox regression analysis was used to analyze the relationship of each inflammatory model and mortality of participants.Then,sub analysis of specific tumor types was conducted by Cox regression.Logistic regression models were used to analyze the relationship between different inflammatory models and malnutrition.Results: 1.A total of 2415 patients were included as a training cohort,of which 41.2% were male and 58.8% were female.The majority of patients was lung cancer,followed by breast cancer,digestive system neoplasms and gynecological oncology.1595 were diagnosed with malnutrition in training cohort.Then 2014 patients with the same inclusion and exclusion criteria were included as the validation cohort.2.In the training cohort,univariate and multivariate Cox regression analyses showed that pack-years of cigarette smoking,C-reactive protein（CRP）and systemic immune-inflammation index（SII）were associated with OS in cancer patients,and cutoff values were 8,5,and 940 for smoking pack-years,CRP,and SII,respectively,determined by timedependent ROC curves.3.Based on tumor type,tumor stage,pack-years of cigarette smoking,CRP and SII,a scored-inflammatory marker system was constructed in the training cohort with corresponding nomogram.C-index of this scoredinflammatory marker system for OS prediction was 0.771,and AUCs of 0.825,0.763,and 0.682 for predicting 1-year,3-year,and 5-year survival rates,respectively;The same scored-inflammatory marker system was constructed in the validation cohort with a C-index of 0.680 and the AUCs for predicting 1-year,3-year,and 5-year survival rates were 0.828,0.830,and 0.675,respectively;the calibration curves showed that the predicted survival probabilities closely corresponded to the actual survival probabilities both in training and validation cohort.4.Eight inflammatory models were formed by the combination of pack-years of cigarette smoking,CRP,and SII,and among the overall study population,patients in inflammatory model A had the worst prognosis compared with patients in other models;further subgroup analysis according to tumor type showed that patients with lung cancer,breast cancer,and digestive tumors had the worst prognosis in inflammatory model A,but for gynecologic tumors,patients in inflammatory model D had the worst prognosis.5.Logistic regression showed that patients with inflammatory model A had a significantly higher risk of malnutrition（HR=1.631,95% CI: 1.054-2.467,P= 0.027）.Conclusion: 1.Pack-years of cigarette smoking,CRP and SII are prognosis related inflammatory markers in patients with malignant tumors.2.The scored-inflammatory marker system constructed by tumor type,tumor stage,pack-years of cigarette smoking,CRP and SII can accurately predict the survival of patients with malignant tumors.3.For lung cancer,breast cancer,and digestive system neoplasms,patients with inflammatory model A had the worst prognosis;For gynecologic oncology,patients with inflammatory model D had the worst prognosis.4.Inflammatory model A has good predictive ability for malignancyassociated malnutrition. |
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