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Paul Walker



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    P1 - Poster Viewing (ID 5)

    • Event: NACLC 2019
    • Type: Poster Session
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 10/11/2019, 16:45 - 18:00, Exhibit Hall
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      P1.10 - Inflammatory Signature Difference in Rural Urban and Regional Occupational Exposure in Lung Cancer  (ID 99)

      16:45 - 18:00  |  Presenting Author(s): Paul Walker

      • Abstract

      Background:
      Lung Cancer remains the major cause of cancer related mortality in the state of North Carolina. Hog and poultry farming is an important part of agriculture in Eastern NC, where more than 2/3rd of the counties fall under rural distribution per US Census data. There is a growing body of evidence that implicates inflammation as a mechanism of disease progression and reduced survival in patients with advanced cancer (Laird et al, Oncologist 2013). Smoldering inflammation in the tumor microenvironment regulates and escalates cancer invasion, angiogenesis and immune surveillance escape (Balkwill and Mantovani, Lancet 2001). Modified Glasgow Progonostic Score (mGPS) is a composite inflammatory score based on CRP and serum albumin with proven prognostic and predictive value in various tumor types (Simmons et al, Lung Cancer 2017).


      Method:
      A prospective observational single institutional study was conducted whereby serum albumin and CRP were drawn at baseline for 333 patients with diagnosis of cancer regardless of stage from 30 counties in Eastern North Carolina. The mGPS score was compared according to rural urban divide and regional occupational exposure of various counties stratified per US Census Data.


      Results:
      Lung cancer was the predominant cancer type in 93% of patients. The median age was 65 years with equal distribution of males and females. The racial distribution was: White(52%), Black(26%), other (22%). The mGPS of zero was seen in 96(29%), mGPS of one in 124 (37%), mGPS of two in 118 patients(35%). The mGPS of zero in Urban and Rural counties was noted in 50% patients. The mGPS score of two in Urban vs Rural counties was noted in 32.2% and 67.7% respectively. The mGPS of two in areas of hog farming, cattle farming and wet waste lands was seen in 41%, 38% and 43% (p = 0.0019). The mGPS of zero was seen in 24%, 20% and 27% respectively (p = 0.0008).


      Conclusion:
      This study suggests a strikingly unfavorable inflammatory signature in rural population as well as areas of hog farm, cattle farm and wet waste lands. The hog and poultry operations heighten the harmful effect on waterways and can adversely affect the inflammatory signature, hence the tumor biology. This underscores additional interventions in these high risk populations that can have significant implications for quality of life and survival, especially in the era of immunotherapy.