EP.15B.05 Predictors of 30-Day Mortality after Systemic Therapy in Hospitalized Lung Cancer Patients: A Retrospective Single-Center Observational Study

Background: Due to the aggressive nature and high incidence of disease-associated symptoms, hospitalization is often required for lung cancer patients in order to receive oncologic treatment. An accepted threshold for late systemic therapy administration is 30 days before death, but data regarding potential predictive factors of 30-day mortality following anticancer treatment are still limited. Methods: This is a retrospective single-center observational study aimed at investigating potential predictors of 30-day mortality since systemic therapy start in lung cancer patients admitted to receive anticancer treatment at the Oncology ward of University Hospital of Parma from January 2017 to January 2022. Baseline clinicopathological features, laboratory values and immunological scores were collected. Prognostic nutritional index (PNI) was calculated using the albumin level and lymphocyte count. Results: A total of 144 lung cancer patients were consecutively enrolled; 14 (9.7%) patients did not start anticancer treatment and were excluded from the study. Among 130 included patients, median age was 68 years (Range, 30-86), 79 (60.8%) patients were men and 112 (89.6%) current/former smokers. ECOG Performance Status was 0/1 in 100 (76.9%) cases. Median body mass index was 25.3 (Range, 15.3-42.9). The most frequent histology was small-cell carcinoma (n = 60, 46.2%), followed by adenocarcinoma (n = 41, 31.5%), and most of the patients had stage IV disease (n = 107, 82.3%). Baseline median hemoglobin was 12.1 g/dL (Range, 7−16.8) and median albumin was 3.3 g/dL (Range 2.4-4.4). At admission, median values of platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio (NLR) and derived NLR were 177.1 (Range, 25.1−836.0), 4.4 (Range, 0.4−23.9) and 2.8 (Range, 0.3−11.4), respectively. PNI had a median value of 41.4 (Range, 28.3−59.8). Median time from hospitalization to treatment start was 5.0 days (95% Confidence Interval [CI] 3.0−6.0). Chemotherapy was the most frequent administered treatment (n = 76, 58.5%), followed by chemoimmunotherapy (n = 33, 25.4%). The majority of patients (n = 115, 88.5%) received therapy in first-line. After a median follow-up of 30.5 months (95% CI 26.2−Not Reached), median overall survival from anticancer therapy was 6.4 months (95% CI 4.3−7.8). The 30-day mortality rate from therapy was 10% (n = 13). Age was significantly associated with 30-day mortality from therapy (≥ 65 vs < 65: 15.9% vs 0%, p = 0.002). Baseline laboratory predictors of 30-day mortality were low hemoglobin (low vs in range vs high: 18% vs 2.9% vs 0%, p = 0.013), low albumin (low vs in range: 17.7% vs 0%, p = 0.008) and low pseudocholinesterase (pCHE) (low vs in range: 22.7% vs 3.9%, p = 0.002). Among immunological scores, PNI showed a negative impact on 30-day mortality in our study population (< 45 vs ≥ 45: 16.4% vs 0%, p = 0.030). Conclusions: Older age and baseline low values of hemoglobin, albumin, pCHE and PNI were associated with increased 30-day mortality from therapy in hospitalized lung cancer patients. Special caution should be addressed when treating in-hospital lung cancer patients with the above-mentioned features.