Predictive significance of inflammatory markers in the survival of older Indian patients with cancer: a single-center prospective analysis

Aim: To evaluate the prognostic impact of neutrophil-lymphocyte ratio (NLR), plateletlymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) on overall survival (OS) among Indian older patients with cancer.Methods: This observational study was conducted in the geriatric oncology clinic of Tata Memorial Hospital (India).We included all patients who underwent a geriatric assessment (GA) and had a complete blood count available for analysis.The NLR was dichotomized at 3.5, PLR and LMR at the median.Our primary study outcome was OS.Results: Between June 2018 and November 2021, 786 patients were enrolled (median age: 69 years).The most common primary tumour was lung (308, 39.5%), followed by gastrointestinal (261, 33.5%).Metastatic disease was present in 54.3% of patients.Univariate analysis revealed that patients with NLR >3.5 had shorter OS (9.1 months) than NLR <3.5 (15.7 months) (HR: 1.56).Similarly, patients with PLR >183.5 had reduced OS (9.3 months) compared to PLR <183.5 (16.6 months) (HR: 1.56).Conversely, patients with LMR >3.1 showed better OS (14.2) compared to LMR <3.1 (9.8 months) (HR: 0.74).After adjusting for age, performance status, primary tumour, metastatic status and GAderived factors (function, nutrition and cognition), NLR (HR: 1.25, 95%CI: 1.03-1.52),PLR (HR: 1.34, 95%CI: 1.11-1.63)and LMR (HR: 0.79, 95%CI: 0.65-0.95)were associated with OS. Conclusion:In our study of older cancer patients, we identified three key inflammatory markers (NLR >3.5, PLR >183.5, LMR <3.1) as strong predictors of poor OS.These markers remain predictive even after accounting for traditional prognostic factors and GAderived scales.