Neutrophil-to-lymphocyte ratio, a predictor for mortality and unplanned hospital readmissions in patients aged 75 years and older with cancer.

Introduction

Assessing the prognosis of older patients with cancer is essential to determine the best strategy for oncological care, given the heterogeneous profiles of this population. Evaluation should consider frailty, comorbidities, geriatric parameters, and oncological parameters. Finding early prognostic indicators would be helpful to optimize care. We aimed to investigate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in patients aged 75 and above with solid cancers.

Materials and Methods

Retrospective review of the ANCRAGE (ANalyse CanceR et sujet AGE) cohort that included all patients ≥75 years of age with solid cancer who were consecutively assessed in the geriatric oncology clinic of the University Hospital of Poitiers (France) between January 1, 2016 and August 31, 2023. Pretreatment assessment included socio-demographic data, oncological, clinical frailty scale (CFS) and geriatric assessment (GA). Geriatric domains assessed were level of dependence, risk of falls, nutrition, mood, and cognition. We defined frailty as the presence of at least one impairment in any of the geriatric domains. The NLR was determined within seven days before or after the GA and before any specific cancer treatment. Survival curves and Cox regression analyses were performed to assess the prognostic values in terms of overall survival (OS) and unplanned hospital readmissions (UHR).

Results

Overall, 1446 patients were included. Mean age was 86.6 years (± 5.2 years), with a male predominance (59 %). Most prevalent cancer sites were prostate (20 %, n = 283), colorectal (16 %, n = 230), breast (15 %, n = 217), skin (9 %, n = 134), and lung (7 %, n = 103), with metastatic status in over one-third of cases. The pretreatment GA identified frailty in 70 % of cases (n = 1012), with malnutrition (54 %, n = 774) and risk of falls (37 %, n = 538) being the main contributing factors. Median NLR was 3.50 [2.34–5.31]. There was a significant association between NLR and frailty using the CFS score (p < 0.001). The median follow-up time for OS analysis was 487 days [186–957]. The results of the multivariate analysis indicated that pretreatment NLR was an independent predictor of OS (hazard ratio [HR] 1.010, 95 % CI: 1.005–1.015, p < 0.001) and of UHR (HR 1.057, 95 % CI: 1.014–1.101, p = 0.008). Cut-off value >3.5 was associated with lower OS (p < 0.001).

Discussion

In our study, NLR was independently associated with higher mortality and high risk of unplanned hospital readmissions within one year of GA in older patients with solid tumors.