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A Composite Low-Grade Inflammation Score and Cancer Outcomes: Results from the Moli-sani Study
Simona Costanzo1,2, Augusto Di Castelnuovo1, Marialaura Bonaccio1
1Research Unit of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy.
Background:
Epidemiologic evidence links low-grade inflammation to an increased risk of chronic degenerative diseases, but its relationship with cancer remains controversial. This study aimed to investigate the association between a composite low-grade inflammation score and different cancer outcomes on a large epidemiologic scale.
Methods:
A prospective analysis was conducted among 18,933 individuals (51.8% women; age ≥35 years) free of cancer, chronic inflammation, or hematologic diseases from the Moli-sani cohort. Low-grade inflammation was assessed using the INFLA-score, derived from C-reactive protein, granulocyte-to-lymphocyte ratio, and leukocyte and platelet counts. Hazard ratios (HR) and 95% confidence intervals (CI) for cancer mortality, cancer-related hospitalization, and colorectal cancer were estimated across INFLA-score fifths using multivariable Cox proportional hazard models.
Results:
During a 13.1-year follow-up, 612 cancer deaths, 1,854 cancer-related hospitalizations, and 287 colorectal cancer cases were ascertained. Individuals in the highest INFLA-score fifth showed higher hazard of cancer mortality (HRQ5vsQ1-Q4: 1.19; 95% CI, 0.99-1.44), cancer-related hospitalization (1.21; 1.08-1.34), and colorectal cancer (1.68; 1.30-2.18), compared with lowest fifths, independently of health-related behaviors and chronic diseases. Associations were more pronounced for cancer mortality and hospitalization in older individuals and those with a cancer family history and for colorectal cancer among women (all P for interaction >0.05). Increased cancer mortality hazard was observed among normal-weight and overweight individuals but not in obese individuals (P for interaction = 0.039).
Conclusions:
Higher INFLA-score is associated with increased hazard of cancer hospitalization and colorectal cancer.
Impact:
Subclinical inflammation may be a prognostic indicator for cancer, underscoring the potential role of lifestyle interventions and systemic inflammation monitoring in cancer prevention.
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