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Yao Y, Zhang M, Liu D, Liu X, Li Q, Wang X. Changes in systemic immune-inflammation index (SII) predict the prognosis of patients with hepatitis B-related hepatocellular carcinoma treated with lenvatinib plus PD-1 inhibitors. Clin Transl Oncol 2024:10.1007/s12094-024-03596-0. [PMID: 39153177 DOI: 10.1007/s12094-024-03596-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/03/2024] [Indexed: 08/19/2024]
Abstract
PURPOSE This study aimed to evaluate the prognostic significance of changes in inflammatory markers in patients with Hepatitis B virus-related hepatocellular carcinoma (HBV-HCC) treated with first-line lenvatinib plus a programmed cell death protein 1 (PD-1) inhibitor. METHODS This study retrospectively included 117 HBV-HCC patients treated with first-line lenvatinib in combination with a PD-1 inhibitor. Independent factors affecting progression-free survival (PFS) and overall survival (OS) were explored based on baseline indicators and inflammatory markers changes after one treatment cycle. RESULTS Multivariate analysis revealed that an alpha-fetoprotein (AFP) level ⩾ 400 ng/mL [hazard ratio (HR), 1.69; 95% confidence interval (CI), 1.11-2.58; P = 0.01] was identified as an independent risk factor, platelet-to-neutrophil ratio (PNR) ⩽ 65.43 (HR 0.50; 95% CI 0.30-0.84; P < 0.01 ) and SII ⩽ 539.47 (HR 0.54; 95% CI 0.30-0.96; P = 0.03) were identified as independent protective factors for PFS. Additionally, multivariate analysis demonstrated that AFP ⩾ 400 ng/mL, HBV-HCC patients with diabetes mellitus (DM), and SII > 303.66 were independent risk factors of OS. The patients whose SII had increased after one cycle of treatment showed a poorer PFS (HR 1.61; 95 %CI 1.10-2.37; P = 0.015) and OS (HR 1.76; 95 % CI 1.15-2.70; P = 0.009) than patients whose SII had decreased. The objective response rate (ORR) was higher in the SII-decreased patients (47.5% vs 32.5%, P = 0.11). Mann-Whitney test found a significant difference in therapeutic response between the SII-increased patients and the SII-decreased patients (P = 0.04). CONCLUSION SII can be associated with outcomes in patients with HBV-HCC treated with first-line lenvatinib plus PD-1 inhibitors.
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Affiliation(s)
- Yang Yao
- Department of Integrated Traditional Chinese and Western Medicine, Beijing Youan Hospital, Capital Medical University, No. 8 Xi Tou Tiao, You An Men Wai, Feng Tai District, Beijing, 100069, China
| | - Minyue Zhang
- Department of Integrated Traditional Chinese and Western Medicine, Beijing Youan Hospital, Capital Medical University, No. 8 Xi Tou Tiao, You An Men Wai, Feng Tai District, Beijing, 100069, China
| | - Di Liu
- Department of Integrated Traditional Chinese and Western Medicine, Beijing Youan Hospital, Capital Medical University, No. 8 Xi Tou Tiao, You An Men Wai, Feng Tai District, Beijing, 100069, China
| | - Xiaoni Liu
- Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, No. 8 Xi Tou Tiao, You An Men Wai, Feng Tai District, Beijing, 100069, China
| | - Quanwei Li
- Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, No. 8 Xi Tou Tiao, You An Men Wai, Feng Tai District, Beijing, 100069, China
| | - Xiaojun Wang
- Department of Integrated Traditional Chinese and Western Medicine, Beijing Youan Hospital, Capital Medical University, No. 8 Xi Tou Tiao, You An Men Wai, Feng Tai District, Beijing, 100069, China.
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Zhang B, Li ZW, Tong Y, Yuan C, Liu XY, Wei ZQ, Zhang W, Peng D. The predictive value of advanced lung cancer inflammation index for short-term outcomes and prognosis of colorectal cancer patients who underwent radical surgery. Int J Clin Oncol 2023; 28:1616-1624. [PMID: 37700210 DOI: 10.1007/s10147-023-02410-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 08/26/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE The purpose of this study was to investigate the predictive value of advanced lung cancer inflammation index (ALI) for short-term outcomes and prognosis of colorectal cancer (CRC) patients who underwent radical surgery. METHODS CRC patients who underwent radical resection were included from Jan 2011 to Jan 2020 in our single clinical centre. Short-term outcomes, overall survival (OS), and disease-free survival (DFS) were compared in different groups. Cox analysis was conducted to identify independent risk factors for OS and DFS. RESULTS A total of 4010 patients who underwent radical CRC surgery were enrolled in the current study. As a result, the low ALI group had longer operation time (p = 0.02), more intra-operative blood loss (p < 0.01), longer postoperative hospital stay (p < 0.01), and more overall complications (p < 0.01). Moreover, ALI (p < 0.01, OR = 0.679, 95% CI = 0.578-0.798) was an independent risk factor for overall complications. As for survival, the low ALI group had worse OS in all TNM stages (p < 0.01), stage II (p < 0.01) and stage III (p < 0.01). Similarly, the low ALI group had worse DFS in all TNM stages (p < 0.01), stage II (p < 0.01), and stage III (p < 0.01). In Cox analysis, ALI was an independent risk factors for OS (p < 0.01, HR = 0.707, 95% CI = 0.589-0.849) and DFS (p < 0.01, HR = 0.732, 95% CI = 0.622-0.861). CONCLUSION Lower ALI was associated with more postoperative complications, worse OS, and DFS for CRC patients who underwent radical surgery. Furthermore, ALI was an independent risk factor for overall complications, OS, and DFS. Surgeons should pay close attention to patients with low ALI before surgery and make clinical strategies cautiously.
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Affiliation(s)
- Bin Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Department of Gastrointestinal Surgery, Sichuan Mianyang 404 Hospital, Mianyang, 621000, China
| | - Zi-Wei Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yue Tong
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Chao Yuan
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiao-Yu Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zheng-Qiang Wei
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Wei Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Dong Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Xiao Z, Wang X, Chen X, Zhou J, Zhu H, Zhang J, Deng W. Prognostic role of preoperative inflammatory markers in postoperative patients with colorectal cancer. Front Oncol 2023; 13:1064343. [PMID: 37064153 PMCID: PMC10095152 DOI: 10.3389/fonc.2023.1064343] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundInflammatory response markers are prognostic factors for several cancers, but their role in postoperative colorectal cancer (CRC) is unclear. The purpose was to evaluate the role of preoperative Neutrophil-to-Lymphocyte ratio (NLR), Platelet-to-Lymphocyte-ratio (PLR), and Lymphocyte-to-Monocyte ratio (LMR) in the prognosis of postoperative CRC patients.MethodsWe retrospectively reviewed 448 CRC patients who had undergone surgical resection from December 2015 to December 2017 in our hospital. The plasma NLR, PLR, LMR, CEA, and CA19-9 were collected within 2 weeks before the operation. We recorded the clinical characteristics and survival data by reviewing medical records and phone calls. We analyzed preoperative inflammatory markers and clinical features using Pearson chi-squared tests or Fisher’s tests. Uni- and multivariate Cox regression analyses were performed, and overall survival (OS) was estimated with the Kaplan–Meier method.ResultsHigh NLR and PLR were associated with worse overall survival in postoperative CRC (HR = 2.140, 95%CI = (1.488-3.078), P < 0.001; HR =1.820, 95%CI = (1.271-2.605), P = 0.001). High LMR was associated with improved overall survival in postoperative CRC (HR = 0.341, 95%CI = (0.188-0.618), P < 0.001). In the multivariate regression analysis, the increase of NLR resulted in an increase in the risk of death (HR = 1.678, 95%CI = (1.114-2.527), P = 0.013), and for the LMR, a reduction of the risk of death (HR = 0.480, 95%CI = (0.256 - 0.902), P = 0.023). Moreover, TNM stage, CA-199, CEA, nerve or vascular invasion (NVI) and adjuvant chemotherapy after surgery also were associated with worse overall survival in postoperative CRC.ConclusionCurrent evidence indicates that preoperative inflammatory markers NLR, LMR, and PLR are associated with overall survival in postoperative patients with colorectal cancer. NLR is an independent risk factor, and LMR is an independent protective factor in CRC patients after surgery.
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Affiliation(s)
- Zilong Xiao
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang, China
- Laboratory of Digestive Surgery, Nanchang University, Nanchang, China
| | - Xinxin Wang
- Department of Radiation Oncology, The Third Hospital of Nanchang, Nanchang, China
| | - Xiaoxiao Chen
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jiawei Zhou
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang, China
- Laboratory of Digestive Surgery, Nanchang University, Nanchang, China
| | - Haitao Zhu
- Department of Intensive Care Unit, Jining Public Health Medical Center, Jining, China
| | - Jiangnan Zhang
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang, China
- Laboratory of Digestive Surgery, Nanchang University, Nanchang, China
- *Correspondence: Wensheng Deng, ; Jiangnan Zhang,
| | - Wensheng Deng
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang, China
- Laboratory of Digestive Surgery, Nanchang University, Nanchang, China
- *Correspondence: Wensheng Deng, ; Jiangnan Zhang,
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Sugimoto A, Fukuoka T, Shibutani M, Kasashima H, Kitayama K, Ohira M, Maeda K. Prognostic significance of the Naples prognostic score in colorectal cancer patients undergoing curative resection: a propensity score matching analysis. BMC Gastroenterol 2023; 23:88. [PMID: 36966294 PMCID: PMC10040130 DOI: 10.1186/s12876-023-02722-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 03/13/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Systemic inflammation is recognized as a hallmark of cancer that contributes to tumor development and progression in various malignancies. The Naples prognostic score (NPS) was established as a prognostic indicator for colorectal cancer (CRC). This study aims to examine the predictive value of the NPS for survival in CRC patients undergoing curative resection by a propensity score matching (PSM) analysis. METHODS A total of 533 CRC patients were enrolled in this study. Overall survival (OS) and disease-free survival (DFS) were compared between high-NPS and low-NPS groups. A time-dependent receiver operator characteristic (ROC) curve analysis was conducted to calculate the area under curve (AUC) of the NPS for OS. A multivariable Cox-proportional hazards regression analysis and PSM analysis were used to identify independent prognostic factors for OS and DFS. We compared the predictive value of the NPS to that of the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), Onodera prognostic nutritional index (PNI), and controlling nutritional status score (CONUT) for OS. RESULTS High-NPS was significantly associated with worse OS and DFS. After PSM, 123 patients were included in each group. A multivariate analysis revealed that Age ≥ 68, ASA-PS ≥ 3, high NPS and undifferentiated tumor type were independently associated with OS, while high NPS, advanced T and N stage were independently associated with DFS after PSM. The NPS had the greatest AUC for OS in comparison to the NLR, LMR, PNI and CONUT. CONCLUSIONS We successfully validated the prognostic utility of the NPS for CRC patients after curative resection.
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Affiliation(s)
- Atsushi Sugimoto
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Tatsunari Fukuoka
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-Ku, Osaka, 545-8585, Japan.
| | - Masatsune Shibutani
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Hiroaki Kasashima
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Kishu Kitayama
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Masaichi Ohira
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Kiyoshi Maeda
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-Ku, Osaka, 545-8585, Japan
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Zhang F, Qiao S, Yao N, Li C, Weber MC, Jefferies B, Friess H, Reischl S, Neumann PA. Anastomotic Rings and Inflammation Values as Biomarkers for Leakage of Stapled Circular Colorectal Anastomoses. Diagnostics (Basel) 2022; 12:diagnostics12122902. [PMID: 36552909 PMCID: PMC9777459 DOI: 10.3390/diagnostics12122902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/14/2022] [Accepted: 11/19/2022] [Indexed: 11/24/2022] Open
Abstract
Reliable markers to predict or diagnose anastomotic leakage (AL) of stapled circular anastomoses following colorectal resections are an important clinical need. Here, we aim to quantitatively investigate the morphology of anastomotic rings as an early available prognostic marker for AL and compare them to established inflammatory markers. We perform a prospective single-center cohort study, including patients undergoing stapled circular anastomosis between August 2020 and August 2021. The predictive value of the anastomotic ring configuration and the neutrophil-to-lymphocyte ratio (NLR) regarding anastomotic leakage is examined by ROC analyses and compared to the C-reactive protein (CRP) as an established marker. We included 204 patients, of which 19 suffered from anastomotic leakage (LEAK group), while in 185 patients the anastomoses healed well (HEAL group). The minimal height of the anastomotic rings as a binary classifier had a good ROC-AUC of 0.81 but was inferior to the NLR at postoperative day (POD) 5, with an excellent ROC-AUC of 0.93. Still, it was superior to the NLR at POD 3 (0.74) and the CRP at POD 3 (ROC-AUC 0.54) and 5 (ROC-AUC 0.70). The minimal height of the anastomotic rings as indicator for technically insufficient anastomoses is a good predictor of AL, while postoperatively the NLR was superior to the CRP in prediction of AL.
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Affiliation(s)
- Feng Zhang
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich (TUM), 81675 Munich, Germany
- Department of General Surgery, Tongren Municipal People’s Hospital of Guizhou Medical University (GMU), Tongren 554300, China
| | - Song Qiao
- Department of General Surgery, Tongren Municipal People’s Hospital of Guizhou Medical University (GMU), Tongren 554300, China
| | - Ning Yao
- Department of Pathology, Tongren Municipal People’s Hospital of Guizhou Medical University (GMU), Tongren 554300, China
| | - Chunqiao Li
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich (TUM), 81675 Munich, Germany
| | - Marie-Christin Weber
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich (TUM), 81675 Munich, Germany
| | - Benedict Jefferies
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich (TUM), 81675 Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich (TUM), 81675 Munich, Germany
| | - Stefan Reischl
- Institute of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich (TUM), 81675 Munich, Germany
| | - Philipp-Alexander Neumann
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich (TUM), 81675 Munich, Germany
- Correspondence: ; Tel.: +49-89-4140-8480
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Polk N, Budai B, Hitre E, Patócs A, Mersich T. High Neutrophil-To-Lymphocyte Ratio (NLR) and Systemic Immune-Inflammation Index (SII) Are Markers of Longer Survival After Metastasectomy of Patients With Liver-Only Metastasis of Rectal Cancer. Pathol Oncol Res 2022; 28:1610315. [PMID: 35570841 PMCID: PMC9091167 DOI: 10.3389/pore.2022.1610315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/23/2022] [Indexed: 11/13/2022]
Abstract
Background: The literature data regarding colon cancer patients with liver-only metastases (CLM) show that NLR determined before metastasectomy is a prognostic marker of shorter relapse-free survival (RFS), but no results has been reported to date for rectal cancer patients with liver-only metastases (RLM). This study aimed to investigate the NLR and SII in CLM and RLM. Methods: Relapse-free (RFS) and overall survival (OS) were evaluated in 67 CLM and 103 RLM patients with a median follow-up of 46.5 and 59.8 months, respectively. Pre- and/or postoperative chemotherapy ± targeted treatment was applied in 96% and 87% of CLM and RLM patients, respectively. The cut-off level for hematologic parameters were determined by receiver operating characteristic (ROC) analysis. Univariate analysis was performed by Kaplan-Meier method and log rank test. For multivariate analysis Cox regression was applied. Results: In univariate analysis low NLR (cut-off 2) and SII (535) were predictors of longer RFS in case of CLM (p < 0.01). In contrast, for RLM high NLR (2.42) and SII (792) were predictors of longer RFS (p < 0.001). For RLM both NLR and SII proved to be independent markers of RFS (HR 0.66 (95% CI 0.52–0.84) and 0.73 (0.57–0.91), respectively) and OS (0.76 (0.58–0.99) and 0.66 (0.5–0.87), respectively). Only NLR (1.44 (1.04–1.99)) was independent marker of RFS for CLM. The preoperative treatment has not influenced the role of NLR or SII. Conclusion: In contrast to CLM, in RLM the high NLR or SII determined before metastasectomy proved to be independent prognostic factors of longer RFS and OS.
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Affiliation(s)
- Nándor Polk
- Departmet of Visceral Surgery, National Institute of Oncology, Budapest, Hungary
| | - Barna Budai
- Department of Molecular Genetics, National Institute of Oncology, Budapest, Hungary
| | - Erika Hitre
- Medical Oncology and Clinical Pharmacology "B" Department, National Institute of Oncology, Budapest, Hungary
| | - Attila Patócs
- Department of Molecular Genetics, National Institute of Oncology, Budapest, Hungary.,Clinical Central Laboratory, National Institute of Oncology, Budapest, Hungary.,Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Tamás Mersich
- Departmet of Visceral Surgery, National Institute of Oncology, Budapest, Hungary
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Nakamura K, Seishima R, Matsui S, Shigeta K, Okabayashi K, Kitagawa Y. The prognostic impact of preoperative mean corpuscular volume in colorectal cancer. Jpn J Clin Oncol 2022; 52:562-570. [PMID: 35253057 DOI: 10.1093/jjco/hyac023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/11/2022] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The relationship between preoperative mean corpuscular volume and postoperative prognosis has been reported in some cancers recently, but no certain consensus has been reached, especially for colorectal cancer. We evaluated the usefulness of mean corpuscular volume as a prognostic factor in colorectal cancer patients. METHODS This study included 1003 patients with colorectal cancer who underwent curative surgery in a single institution. The relationship between mean corpuscular volume values and postoperative recurrence was evaluated by fractional polynomial model. Based on the result, patients were divided into groups according to mean corpuscular volume values. Clinicopathological factors and long-term outcomes were compared between the groups. RESULTS The risk of postoperative recurrence according to mean corpuscular volume value showed a J-shaped curve, suggesting that both low and high mean corpuscular volume have high risk. Low mean corpuscular volume (≤84 fl) group was oncologically advanced in terms of pathological tumor stage, histological grade and lymphatic invasion with higher inflammation markers. High mean corpuscular volume (>95 fl) group had higher frequency of drinking habit with higher values of aspartate aminotransferase, alanine aminotransferase and γ-glutamyl transpeptidase. Abnormal mean corpuscular volume group including these two groups showed significantly worse disease-free survival than the other (P < 0.001). Multivariate analysis suggested that abnormal mean corpuscular volume was an independent risk factor for postoperative recurrence (hazard ratio, 1.344; 95% confidence interval, 1.005-1.796; P = 0.046). Furthermore, its prognostic impact was more significant in pStage III than in other stages. CONCLUSION Preoperative low and high mean corpuscular volume is a poor prognostic factor in colorectal cancer patients. It could be a predictive marker to estimate worse survival outcome after surgery.
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Affiliation(s)
- Kimihiko Nakamura
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Ryo Seishima
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shimpei Matsui
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kohei Shigeta
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Koji Okabayashi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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Ma CJ, Hu WH, Huang MC, Chiang JM, Hsieh PS, Wang HS, Chiang CL, Hsieh HM, Chen CC, Wang JY. Taiwan Society of Colon and Rectum Surgeons (TSCRS) Consensus for Anti-Inflammatory Nutritional Intervention in Colorectal Cancer. Front Oncol 2022; 11:819742. [PMID: 35111685 PMCID: PMC8801427 DOI: 10.3389/fonc.2021.819742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/22/2021] [Indexed: 12/20/2022] Open
Abstract
Malnutrition and systemic inflammatory response (SIR) frequently occur in patients with colorectal cancer (CRC) and are associated with poor prognosis. Anti-inflammatory nutritional intervention is not only a way to restore the malnourished status but also modulate SIR. Nine experts, including colorectal surgeons, physicians and dieticians from 5 hospitals geographically distributed in Taiwan, attended the consensus meeting in Taiwan Society of Colon and Rectum Surgeons for a 3-round discussion and achieved the consensus based on a systematic literature review of clinical studies and published guidelines. The consensus recommends that assessment of nutritional risk and SIR should be performed before and after CRC treatment and appropriate nutritional and/or anti-inflammatory intervention should be adapted and provided accordingly.
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Affiliation(s)
- Cheng-Jen Ma
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wan-Hsiang Hu
- Division of Colorectal Surgery, Department of Surgery, Chang Gung Memorial Hospital-Kaohsiung, Kaohsiung, Taiwan
| | - Meng-Chuan Huang
- Division of Nutrition and Dietetics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jy-Ming Chiang
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan
| | - Pao-Shiu Hsieh
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan
| | - Huann-Sheng Wang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chien-Ling Chiang
- Division of Nutrition, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan
| | - Hui-Min Hsieh
- Division of Nutrition, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chou-Chen Chen
- Division of Colorectal Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jaw-Yuan Wang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan.,Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan.,Clinical Pharmacogenomics and Pharmacoproteinomics, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.,Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan
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Yang Z, Li Y, Zhang K, Deng X, Yang S, Wang Z. Combined detection of preoperative neutrophil to lymphocyte ratio and interleukin-6 as an independent prognostic factor for patients with non-metastatic colorectal cancer. J Gastrointest Oncol 2021; 12:2838-2845. [PMID: 35070411 PMCID: PMC8748038 DOI: 10.21037/jgo-21-763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/15/2021] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND This study sought to explore the value of the neutrophil to lymphocyte ratio (NLR) and interleukin-6 (IL-6) in predicting the prognosis of patients with non-metastatic colorectal cancer (CRC). METHODS The data of 88 surgical CRC patients were retrospectively analyzed. A receiver operating characteristic (ROC) curve analysis was conducted to determine the patients' thresholds for the NLR and IL-6. Kaplan-Meier curve and Cox regression models were used to assess the prognostic values. RESULTS A ROC analysis was conducted to calculate the NLR cut-off value. The area under the curve (AUC) of the NLR was 0.739 [95% confidence interval (CI): 0.634 to 0.844] for overall survival (OS), and 0.799 (95% CI: 0.705 to 0.892) for disease-free survival (DFS). The AUC of IL-6 was 0.773 (95% CI: 0.670 to 0.876) for OS, and 0.817 (95% CI: 0.728 to 0.906) for DFS. The AUC of NLR + IL-6 was 0.805 (95% CI: 0.710 to 0.899) for OS and 0.853 (95% CI: 0.774 to 0.933) for DFS, which were higher than the NLR or IL-6 alone AUCs for OS and DFS. In addition, a high NLR and IL-6 value was significantly correlated with tumor differentiation and tumor-node-metastasis staging. The NLR was positively correlated with IL-6 level (r=0.481). The results of the Kaplan-Meier analysis showed that a high NLR + IL-6 value was correlated with worse OS and DFS. CONCLUSIONS A high NLR and IL-6 value is a better independent prognostic biomarker of CRC than the NLR or IL-6 level alone, and may be applied in clinical practice to identify high-risk patients.
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Affiliation(s)
- Zhifeng Yang
- Department of Laboratory, Liaocheng Maternal and Child Health Hospital, Liaocheng, China
| | - Yongjing Li
- Department of Laboratory, Liaocheng Maternal and Child Health Hospital, Liaocheng, China
| | - Ke Zhang
- Department of Laboratory, Liaocheng Maternal and Child Health Hospital, Liaocheng, China
| | - Xuejie Deng
- Department of Gastroenterology, People’s Hospital of Leshan, Leshan, China
| | - Shaoqi Yang
- Department of Gastroenterology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Zhen Wang
- Department of Gastroenterology, People’s Hospital of Leshan, Leshan, China
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10
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Yucel M, Yildiz A, Basak F. The role of leukocytes in predicting whether laparotomy is required in patients with penetrating abdominal stab wound. Surgery 2021; 171:549-554. [PMID: 34426011 DOI: 10.1016/j.surg.2021.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/16/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND This study aimed to determine the importance of leukocytes, leukocyte subgroups, platelets, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio in deciding whether laparotomy is required during observation in patients with penetrating abdominal stab wounds who were followed up because there was no indication for an emergency laparotomy. METHODS Patients who did not indicate an emergency laparotomy were monitored. After 48 hours from initial hospitalization, patients who did not require laparotomy were discharged nonoperatively. The total leukocytes, leukocyte subsets, platelets, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio of patients who underwent laparotomy during the follow-up compared with those who were discharged nonoperatively. The sensitivity and specificity of these laboratory values in predicting the necessity of laparotomy were calculated. RESULTS In the operated group (n = 71), leukocytes, neutrophils, monocytes, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio examined during observation were significantly higher (P < .001). Eosinophils and lymphocytes were significantly lower (P < .001) than in nonoperated (n = 476). Based on the deviation in the reference ranges of leukocyte and its subgroups, we report the sensitivity and specificity for predicting the necessity of laparotomy as 86% and 72% for leukocyte, 88% and 75% for neutrophil, 92% and 83% for neutrophil-to-lymphocyte ratio, and 72% and 77% for platelet-to-lymphocyte ratio, respectively. In receiver operating characteristic curve analysis, the cut-off value was found to be 4 for neutrophil-to-lymphocyte ratio and 125 for platelet-to-lymphocyte ratio (area under the curve/receiver operating characteristic curve of 0.929 and 0.808, respectively). CONCLUSION Leukocyte, leukocyte subgroups, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio may be useful to determine if a laparotomy is necessary in patients in whom the necessity of laparotomy is undetermined owing to unclear examination findings.
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Affiliation(s)
- Metin Yucel
- Department of General Surgery, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
| | - Abdullah Yildiz
- Department of General Surgery, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Fatih Basak
- Department of General Surgery, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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11
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Naszai M, Kurjan A, Maughan TS. The prognostic utility of pre-treatment neutrophil-to-lymphocyte-ratio (NLR) in colorectal cancer: A systematic review and meta-analysis. Cancer Med 2021; 10:5983-5997. [PMID: 34308567 PMCID: PMC8419761 DOI: 10.1002/cam4.4143] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/03/2021] [Accepted: 07/03/2021] [Indexed: 12/24/2022] Open
Abstract
Background Inflammation is a hallmark of cancer, and systemic markers of inflammation are increasingly recognised as negative prognostic factors for clinical outcome. Neutrophil‐to‐lymphocyte ratio (NLR) is readily available from routine blood testing of patients diagnosed with cancer. Methods Peer‐reviewed publications from PubMed/MEDLINE, Web of Science and EMBASE were identified according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines. Hazard ratios (HR) for overall survival (OS) and surrogate endpoints (SE; comprising disease‐, recurrence‐ and progression‐free survival) were pooled using a random effects model. Additional analysis was carried out to further investigate NLR as an independent prognostic factor and account for heterogeneity. Results Seventy‐one eligible papers comprising 32,788 patients were identified. High NLR was associated with poor clinical outcomes. Significant publication bias was observed, and larger studies also adjusted for more covariates. Correcting for publication bias in multivariate studies brought our best estimate for true effect size to HR = 1.57 (95% CI 1.39–1.78; p < 0.0001) for OS and to HR = 1.38 (95% CI 1.16–1.64; p = 0.0003) for SE. Conclusions NLR is confirmed as an easily available prognostic biomarker in colorectal cancer, despite the limitations of some studies previously reporting this finding. As such, it should be routinely collected in prospective clinical trials. While more standardised and rigorous large‐scale studies are needed before high NLR can be fully assessed as an independent predictor of CRC progression and outcome, the data suggest that it may be used to highlight individuals with tumour‐promoting inflammatory context.
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Affiliation(s)
- Mate Naszai
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Alina Kurjan
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Timothy S Maughan
- MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
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12
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Prognostic Significance of Preoperative Fibrinogen-to-Prealbumin Ratio in Patients with Stage I-III Colorectal Cancer Undergoing Surgical Resection: A Retrospective Cohort Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:3905353. [PMID: 33521127 PMCID: PMC7817313 DOI: 10.1155/2021/3905353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/11/2020] [Accepted: 01/04/2021] [Indexed: 11/29/2022]
Abstract
Background The objective of this study was to explore the role of preoperative fibrinogen-to-prealbumin ratio (FPR) in evaluating the prognosis of patients with stage I–III colorectal cancer (CRC). Methods This retrospective study enrolled 584 stage I–III CRC patients undergoing surgical resection. Logistic regression analysis was used to explore the correlation between FPR and postoperative complications. The Kaplan-Meier curve and Cox proportional hazards model were used to identify the prognostic factors. The nomograms were constructed based on the prognostic factors. The concordance index and calibration curve were used to determine the accuracy of the nomograms. Time-dependent receiver operating characteristic was used to compare the predictive prognostic efficacy of nomograms and TNM stage. Results FPR was determined to be an independent factor affecting postoperative complications. Patients with a low-FPR had a significantly better prognosis than those with a high-FPR (disease-free survival, p = 0.028; overall survival, p = 0.027), especially patients with stage I CRC (disease-free survival, p = 0.015; overall survival, p = 0.017). The Cox proportional hazards model identified FPR as an independent poor prognostic factor of disease-free survival (hazard ratio (HR) = 1.459, 95% confidence interval (CI) = 1.074–1.954, p = 0.011) and overall survival (HR = 1.405, 95% CI = 1.034–1.909, p = 0.030). The prognostic nomograms had good accuracy and were superior to the traditional TNM stage. Conclusions FPR is a potential indicator for predicting short- and long-term prognosis of stage I–III CRC patients undergoing surgical resection.
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Xie H, Huang S, Yuan G, Kuang J, Yan L, Wei L, Tang S, Gan J. The advanced lung cancer inflammation index predicts short and long-term outcomes in patients with colorectal cancer following surgical resection: a retrospective study. PeerJ 2020; 8:e10100. [PMID: 33083140 PMCID: PMC7548071 DOI: 10.7717/peerj.10100] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/14/2020] [Indexed: 12/24/2022] Open
Abstract
Background and Purpose Several studies have proposed that the advanced lung cancer inflammation index (ALI), a new inflammation-related index, can be used for the prognosis assessment of various malignancies. However, few studies have reported its prognostic value in colorectal cancer (CRC). Therefore, this study explored the relationship between ALI and outcomes in CRC patients. Methods A total of 662 CRC patients who underwent surgery between 2012 and 2014 were included. The ALI was defined as: body mass index × serum albumin/neutrophil to lymphocyte ratio. The X-tile program identified the optimal cut-off value of ALI. Logistic regression analyses determined factors affecting postoperative complications. The Kaplan-Meier method and Cox proportional hazards analyses evaluated potential prognostic factors. Results The optimal cut-off of ALI in males and females were 31.6 and 24.4, respectively. Low-ALI was an independent risk factor for postoperative complications in CRC patients (odds ratio: 1.933, 95% CI [1.283-2.911], p = 0.002). Low-ALI groups also had significantly lower progression-free survival (PFS) and overall survival (OS), when compared with the high-ALI group, especially at advance tumor stages. Using multivariate analysis, ALI was determined as an independent prognostic factor for PFS (hazard ratio: 1.372, 95% CI [1.060-1.777], p = 0.016) and OS (hazard ratio: 1.453, 95% confidence interval: 1.113-1.898, p = 0.006). Conclusion ALI is an independent predictor of short and long-term outcomes in CRC patients, especially at advance tumor stages. The ALI-based nomograms can provide accurate and individualized prediction of postoperative complication risk and survival for CRC patients.
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Affiliation(s)
- Hailun Xie
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Shizhen Huang
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Guanghui Yuan
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Jiaan Kuang
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Ling Yan
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Lishuang Wei
- Department of Respiratory Medicine, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Shuangyi Tang
- Department of Pharmacy, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Jialiang Gan
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, P.R. China
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14
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Kondo H, Hirano Y, Ishii T, Hara K, Obara N, Wang L, Asari M, Kato T, Yamaguchi S. E-PASS Scoring System May Be Useful for Prediction of Postoperative Complications in Super Elderly Colorectal Cancer Surgery Patients. JOURNAL OF THE ANUS RECTUM AND COLON 2020; 4:137-144. [PMID: 32743116 PMCID: PMC7390610 DOI: 10.23922/jarc.2020-017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/22/2020] [Indexed: 02/04/2023]
Abstract
Objectives: Japan is facing an aging society. Elderly individuals are generally more prone to comorbidities and have weaker immune defenses, with ominous prognostic implications if postoperative complications arise. The aim of this study was to explore scoring systems for predicting postoperative morbidity risk in super elderly patients (≥85 years old) after colorectal surgery for cancer. Methods: A population of elderly patients (n = 145) surgically treated for primary colorectal cancer within our department between April 2007 and December 2018 was examined retrospectively, assessing the capacities of various indices, such as Estimation of Physiologic Ability and Surgical Stress (E-PASS), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), prognostic nutritional index (PNI), and modified Glasgow Prognostic Score (mGPS), to predict postoperative complications. Results: NLR, PLR, and mGPS did not differ significantly in the presence or absence of complications, whereas PNI tended to be lower if complications developed. The E-PASS system showed no group-wise differences in preoperative risk score (PRS), but the surgical stress score (SSS) and the comprehensive risk score (CRS; a composite of PRS and SSS) was significantly higher in patients with complications. Based on the cutoff value calculated from the Receiver operating curve (ROC) for the E-PASS CRS (−0.0580), patients were stratified into low-scoring and high-scoring (HSG) groups. Although not significantly different, the overall survival in the HSG tended to be lower by comparison. Conclusions: The E-PASS scoring system may be a useful predictor of postoperative complications in super elderly patients requiring colorectal cancer surgery.
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Affiliation(s)
- Hiroka Kondo
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Yasumitsu Hirano
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Toshimasa Ishii
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Kiyoka Hara
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Nao Obara
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Liming Wang
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Masahiro Asari
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Takuya Kato
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Shigeki Yamaguchi
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
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15
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Zhang J, Luo Y, Li C, Liu J, Xiang H, Wen T. The combination of the preoperative albumin-bilirubin grade and the fibrosis-4 index predicts the prognosis of patients with hepatocellular carcinoma after liver resection. Biosci Trends 2020; 13:351-357. [PMID: 31527331 DOI: 10.5582/bst.2019.01212] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
There is little information regarding the use of a combination of the albumin-bilirubin (ALBI) grade and the fibrosis-4 index (FIB-4) in predicting hepatocellular carcinoma (HCC) patient outcomes after liver resection. In this study, we aimed to analyze the predictive ability of a combination of the ALBI grade and the FIB-4 score (ALBI-FIB-4) for HCC patients within the Milan criteria after liver resection. The data of HCC patients within the Milan criteria who underwent liver resection between 2011 and 2019 at our center were reviewed (n = 544). Patients with an FIB-4 index > 3.25 were considered to have a high FIB-4 index and were given a score of 1, whereas patients with an FIB-4 index ≤ 3.25 were considered to have a low FIB-4 index and were given a score of 0. The ALBI-FIB-4 score was a summary score that combined the ALBI grade and the score based on the FIB-4 index. During the follow-up period, 279 patients experienced recurrence, and 175 patients died. Multivariate analysis showed that tumor size, the presence of multiple tumors, the presence of microvascular invasion and the ALBI-FIB-4 score were four independent risk factors for both postoperative recurrence-free survival (RFS) and overall survival (OS). The 5-year RFS of patients with high ALBI-FIB-4 scores of 1, 2, and 3 were 55.0%, 44.2% and 35.3%, respectively (p = 0.004). The 5-year OS rates of patients with high ALBI-FIB-4 scores of 1, 2, and 3 were 72.9%, 66.4% and 54.8%, respectively (p = 0.011). The ALBI-FIB-4 score may be a surrogate marker for predicting the prognosis of patients with HCC after liver resection. A high ALBI-FIB-4 score was associated with a high incidence of postoperative recurrence and mortality.
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Affiliation(s)
- Jingyi Zhang
- Department of Ultrasound, West China Hospital, Sichuan University.,Department of Medical Informatics, West China Hospital, Sichuan University
| | - Yan Luo
- Department of Ultrasound, West China Hospital, Sichuan University
| | - Chuan Li
- Department of Hepatic Surgery, West China Hospital, Sichuan University
| | - Jialin Liu
- Department of Ultrasound, West China Hospital, Sichuan University
| | - Hongjin Xiang
- Department of Ultrasound, West China Hospital, Sichuan University
| | - Tianfu Wen
- Department of Hepatic Surgery, West China Hospital, Sichuan University
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16
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Bello DM, Panageas KS, Hollmann T, Shoushtari AN, Momtaz P, Chapman PB, Postow MA, Callahan MK, Wolchok JD, Brady MS, Coit DG, Ariyan CE. Survival Outcomes After Metastasectomy in Melanoma Patients Categorized by Response to Checkpoint Blockade. Ann Surg Oncol 2019; 27:1180-1188. [PMID: 31848819 DOI: 10.1245/s10434-019-08099-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Checkpoint inhibitors have improved outcomes in metastatic melanoma, with 4-year overall survival (OS) of 46% for anti-PD-1 alone or 53% in combination with anti-CTLA-4. However, the median progression free survival is 6.9 and 11.5 months, respectively. Many who progress have gone on to alternative treatments, including surgery, yet the outcome of patients selected for surgery after checkpoint blockade remains unclear. METHODS Patients who were treated with checkpoint blockade from 2003 to 2017, followed by metastasectomy, were identified from a prospectively maintained institutional melanoma database. Response to immunotherapy was assessed at the time of surgery. Patients were categorized as having responding, isolated progressing, or multiple progressing lesions. RESULTS Of the 237 total patients identified, 208 (88%) had stage IV disease, and 29 (12%) had unresectable stage III disease at the start of immunotherapy. Median OS following first resection was 21 months. Median follow-up among survivors was 23 months. Complete resection at the first operation (n = 87, 37%) was associated with improved survival compared with patients with incomplete resection (n = 150, 63%) [median OS not reached (NR) vs. 10.8 months, respectively; 95% CI: 7.3, 14.8; p < 0.0001]. Patients resected for an isolated progressing or responding tumor had a longer median survival compared with those with multiple progressing lesions (NR vs. 7.8 months, 95% CI: 6.2, 11.2; p < 0.0001). CONCLUSIONS Patients selected for surgical resection following checkpoint blockade have a relatively favorable survival, especially if they had a response to immunotherapy and undergo complete resection of isolated progressing or responding disease.
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Affiliation(s)
- Danielle M Bello
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
| | - Katherine S Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Travis Hollmann
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Parisa Momtaz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul B Chapman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael A Postow
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Margaret K Callahan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jedd D Wolchok
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mary S Brady
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Daniel G Coit
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Charlotte E Ariyan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
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17
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Kosuga T, Konishi T, Kubota T, Shoda K, Konishi H, Shiozaki A, Okamoto K, Fujiwara H, Kudou M, Arita T, Morimura R, Murayama Y, Kuriu Y, Ikoma H, Nakanishi M, Otsuji E. Clinical significance of neutrophil-to-lymphocyte ratio as a predictor of lymph node metastasis in gastric cancer. BMC Cancer 2019; 19:1187. [PMID: 31805894 PMCID: PMC6896257 DOI: 10.1186/s12885-019-6404-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/26/2019] [Indexed: 01/19/2023] Open
Abstract
Background Precise staging is indispensable to select the appropriate treatment strategy for gastric cancer (GC); however, the diagnostic accuracy of conventional modalities needs to be improved. This study investigated the clinical significance of the preoperative neutrophil-to-lymphocyte ratio (NLR) for the prediction of pathological lymph node metastasis (pN+) in GC. Methods This was a retrospective study of 429 patients with GC who underwent curative gastrectomy. The predictive ability of NLR for pN+ was examined in comparison with that of computed tomography. Results The preoperative NLR ranged from 0.6 to 10.8 (median, 2.0), and the optimal cut-off value for predicting pN+ was 1.6 according to the receiver operating characteristic curve with the maximal Youden index. Multivariate analysis identified a NLR ≥ 1.6 (odds ratio (OR) 3.171; 95% confidence interval (CI) 1.448–7.235, p = 0.004) and cN+ (OR 2.426; 95% CI 1.221–4.958, p = 0.011) to be independent factors associated with pN+ in advanced GC (cT2-T4). On the other hand, a NLR ≥ 1.6 was not useful for predicting pN+ in early GC (cT1). In advanced GC, a NLR ≥ 1.6 detected pN+ with a higher sensitivity (84.9%) and negative predictive value (NPV) (63.9%) than conventional modalities (50.0 and 51.7%, respectively). When the subjects were limited to those with advanced GC with cN0, the sensitivity and NPV of a NLR ≥ 1.6 for pN+ increased further (90.7 and 81.0%, respectively). Conclusion The preoperative NLR may be a useful complementary diagnostic tool for predicting pN+ in advanced GC because of its higher sensitivity and NPV than conventional modalities.
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Affiliation(s)
- Toshiyuki Kosuga
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Tomoki Konishi
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takeshi Kubota
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Katsutoshi Shoda
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hirotaka Konishi
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Atsushi Shiozaki
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kazuma Okamoto
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hitoshi Fujiwara
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Michihiro Kudou
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Tomohiro Arita
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Ryo Morimura
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yasutoshi Murayama
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yoshiaki Kuriu
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hisashi Ikoma
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Masayoshi Nakanishi
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Eigo Otsuji
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
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Pozza A, Pauletti B, Scarpa M, Ruffolo C, Bassi N, Massani M. Prognostic role of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in patients with midgut neuroendocrine tumors undergoing resective surgery. Int J Colorectal Dis 2019; 34:1849-1856. [PMID: 31520198 DOI: 10.1007/s00384-019-03356-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2019] [Indexed: 02/04/2023]
Abstract
AIM Several studies demonstrated the prognostic value of the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and platelet-to-white blood cells ratio (PWR) in different types of tumors. However, there is no information about a possible role of NLR, PLR and PWR as predictor of presence of metastasis or multifocal disease in patients undergoing surgery with curative intent for midgut NET. The aim of our study was to test the role of preoperative NLR, PLR and PWR as predictors of patients undergoing surgery with curative intent for midgut NET. METHODS We retrospectively enrolled seven foregut, 35 midgut and six hindgut NET patients with gastrointestinal neuroendocrine tumors operated in our Units from January 2005 to June 2016. Details about preoperative laboratory data, surgical operation, histology and follow-up were retrieved. Non-parametric statistics, ROC curve analysis and survival analysis were used. RESULTS NLR was significantly higher in patients with distant metastasis (p = 0.04). The ROC curve analysis indicated that a threshold value of NLR of 2.6 predicted the presence of peritoneal metastasis with a specificity of 100% and a sensitivity of 71% and an overall accuracy of AUC = 0.81 (95%CI: 0.59-0.94), p = 0.05. PLR and PWR was not be associated to metastasis but tended to be associated to multifocal disease. CONCLUSION In patients with midgut NET, an impaired adaptive immune response, as suggested by a high NLR ratio, was associated to the presence of distant metastasis and in particular of peritoneal metastasis. This information may be helpful when planning the treatment of a patient with a midgut NET.
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Affiliation(s)
- Anna Pozza
- Department of Surgery, Azienda ULSS2 Marca Trevigiana, 31100, Treviso, Italy
| | - Bruno Pauletti
- Department of Surgery, Azienda ULSS2 Marca Trevigiana, 31100, Treviso, Italy
| | - Marco Scarpa
- General Surgery Unit, Azienda Ospedaliera di Padova, 35128, Padua, Italy.
| | - Cesare Ruffolo
- General Surgery Unit, Azienda Ospedaliera di Padova, 35128, Padua, Italy
| | - Nicolò Bassi
- Department of Surgery, Azienda ULSS2 Marca Trevigiana, 31100, Treviso, Italy
| | - Marco Massani
- Department of Surgery, Azienda ULSS2 Marca Trevigiana, 31100, Treviso, Italy
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Pu N, Yin H, Zhao G, Nuerxiati A, Wang D, Xu X, Kuang T, Jin D, Lou W, Wu W. Independent effect of postoperative neutrophil-to-lymphocyte ratio on the survival of pancreatic ductal adenocarcinoma with open distal pancreatosplenectomy and its nomogram-based prediction. J Cancer 2019; 10:5935-5943. [PMID: 31762803 PMCID: PMC6856566 DOI: 10.7150/jca.35856] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 08/26/2019] [Indexed: 02/06/2023] Open
Abstract
Background: The prognosis of pancreatic ductal adenocarcinoma (PDAC) remains poor. Open distal pancreatosplenectomy (ODPS) is prevalent in the patients of early PDAC located in pancreatic body or tail. However, the models for relapse or survival prediction in those patients are still limited. Postoperative neutrophil-to-lymphocyte rate (poNLR), a novel inflammation-based score, has been formulated to analyze the prognostic significance in PDAC patients with ODPS. Therefore, this study aims to generate a valuable prognostic nomogram for PDAC following ODPS. Methods: We retrospectively enrolled 97 patients of PDAC undergoing ODPS in this study. The Cox proportional hazards regression methodology was used in univariate and multivariate survival analyses to identify significant independent prognostic factors. The prognostic nomograms integrating poNLR into the American Joint Commission on Cancer (AJCC) staging system (8th edition) for predicting overall survival (OS) and relapse free survival (RFS) were established to achieve superior discriminatory abilities. Further, these prognostic nomograms were verified according to concordance index (C-index), calibrations and decision curve analyses (DCA). Results: The optimal cut-off value of poNLR for assessing OS determined by X-tile program was 14.1. Higher poNLR was associated with higher postoperative neutrophil (poNeutrophil), lower postoperative lymphocyte (poLymphocyte), lower preoperative lymphocyte-to-monocyte rate (preLMR) and higher △NLR (postoperative-preoperative NLR). In the univariate and multivariate analysis, poNLR was identified as an independent prognostic indicator for OS and RFS (P=0.044 and 0.028, respectively) and patients with higher poNLR level were probable to have shorter OS and RFS. Compared with the TNM staging system of the AJCC 8th edition, the nomogram comprising of poNLR and AJCC 8th edition exhibited superior predictive accuracy for OS and RFS. Conclusions: poNLR can be a proven, inexpensive and novel survival predictor of PDAC patients with ODPS. One more advanced and accurate predictive model will be achieved to assist in risk stratification via the incorporation of poNLR into nomograms.
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Affiliation(s)
- Ning Pu
- Department of General Surgery, Zhongshan Hospital, Institute of General Surgery and Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Hanlin Yin
- Department of General Surgery, Zhongshan Hospital, Institute of General Surgery and Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Guochao Zhao
- Department of General Surgery, Zhongshan Hospital, Institute of General Surgery and Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Abulimiti Nuerxiati
- Department of General Surgery, Zhongshan Hospital, Institute of General Surgery and Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Dansong Wang
- Department of General Surgery, Zhongshan Hospital, Institute of General Surgery and Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Xuefeng Xu
- Department of General Surgery, Zhongshan Hospital, Institute of General Surgery and Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Tiantao Kuang
- Department of General Surgery, Zhongshan Hospital, Institute of General Surgery and Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Dayong Jin
- Department of General Surgery, Zhongshan Hospital, Institute of General Surgery and Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Wenhui Lou
- Department of General Surgery, Zhongshan Hospital, Institute of General Surgery and Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Wenchuan Wu
- Department of General Surgery, Zhongshan Hospital, Institute of General Surgery and Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
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20
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Zhang YY, Li WQ, Li ZF, Guo XH, Zhou SK, Lin A, Yan WH. Higher Levels of Pre-operative Peripheral Lymphocyte Count Is a Favorable Prognostic Factor for Patients With Stage I and II Rectal Cancer. Front Oncol 2019; 9:960. [PMID: 31612109 PMCID: PMC6769073 DOI: 10.3389/fonc.2019.00960] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/10/2019] [Indexed: 12/13/2022] Open
Abstract
The clinical significance of peripheral blood parameters has been considered to be a potential prognostic indicator for malignancies. In this study, 224 colorectal cancer (CRC; ncolon = 103; nrectal = 121) patients who underwent resection were enrolled, and the pre- and post-operative clinical laboratory data within 1 week, before and after surgery, were collected. The prognostic value of the counts of white blood cell (WBC), neutrophil, lymphocyte and platelet, the neutrophil to lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) were analyzed. Data revealed that pre-operative lymphocyte count (pre-LC) was much higher than that of post-LC (p < 0.001), and only rectal cancer patients with pre-LChigh (>median: 1.61 × 109/L) had a significantly better overall survival (OS) and 5-year survival rate (SR) than those with pre-LClow (OS: 62.3 vs. 49.5 months; SR: 74.0 vs. 43.0%; p = 0.006). Cox's proportional hazard models revealed that pre-LChigh was an independent, favorable prognostic factor for rectal cancer patients (hazard ratio = 0.348; p = 0.003). Moreover, when the disease stages were stratified, the pre-LChigh was significantly associated with better prognosis of rectal cancer patients with stage I + II rectal cancer (n = 65; OS: 67.5 vs. 54.3 months; p = 0.011). Taken together, our study revealed that pre-operative lymphocyte count is an independent prognostic factor for patients with stage I and II rectal cancer.
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Affiliation(s)
- Ying-Ying Zhang
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Wan-Qing Li
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Zhen-Fa Li
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Xiao-Hua Guo
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Shen-Kang Zhou
- Department of Gastrointestinal Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China
| | - Aifen Lin
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Wei-Hua Yan
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
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21
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Abstract
The postoperative survival of patients with stage III colorectal cancer (CRC) various obviously. We sought to develop novel nomograms for predicting the survival of these patients after radical surgery and postoperative chemotherapy.A total of 620 consecutive patients with stage III CRC who underwent curative resection and postoperative chemotherapy between January 2009 and December 2015 were retrospectively collected and randomly allocated to the training (n = 372) or validation cohort (n = 248). Clinicopathological factors were collected and analyzed. On the basis of data from 372 patients in the training set, predictive factors for overall survival (OS) and disease-free survival (DFS) were identified using multivariate Cox regression and used to construct nomograms. The predictive performance of the nomograms was assessed by concordance index (C-index) and calibration plots. An external cohort of 248 patients was used to validate the nomograms. Furthermore, nomogram performance was compared with the performance of T and N stage stratification.Tumor differentiation grade, lymph node metastasis ratio, intravascular emboli (IVE), preoperative serum carcinoembryonic antigen (CEA) level, albumin to globulin ratio (AGR), T stage and N stage were significant prognostic factors for OS on multivariate analysis; whereas, Tumor differentiation grade, lymph node metastasis ratio, IVE, AGR and N stage were significant for DFS. Nomograms to predict 3- and 5-year OS and DFS were established that performed well (C-indexes of 0.734 [95% CI, 0.691-0.779] for OS and 0.699 [95% CI, 0.657-0.740] for DFS prediction), and nomogram accuracy was confirmed in the validation cohort. Furthermore, model comparison proved that the nomograms were superior to risk stratification by T and N stage for stage III CRC.We propose 2 practical nomograms for stage III CRC patients that provide more accurate prognostic predictions and should be helpful for guiding individualized treatment and postoperative surveillance.
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Affiliation(s)
| | - Qian Pei
- Department of Gastrointestinal Surgery
| | - Hong Zhu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | | | | | - Yuan Zhou
- Department of Gastrointestinal Surgery
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22
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Li C, Zhang XY, Peng W, Wen TF, Yan LN, Li B, Yang JY, Wang WT, Xu MQ. Postoperative Albumin-Bilirubin Grade Change Predicts the Prognosis of Patients with Hepatitis B-Related Hepatocellular Carcinoma Within the Milan Criteria. World J Surg 2018; 42:1841-1847. [PMID: 29138913 DOI: 10.1007/s00268-017-4355-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Albumin-bilirubin (ALBI) grade has been validated as a simple, evidence-based, and objective prognostic tool for patients with hepatocellular carcinoma (HCC). However, minimal information is available concerning postoperative ALBI grade changes in HCC. This study aimed to investigate the prognostic value of postoperative ALBI grade changes in patients with hepatitis B virus (HBV)-related HCC within the Milan criteria after liver resection. METHODS Patients with HBV-related HCC within the Milan criteria who underwent liver resection between 2010 and 2016 at West China Hospital were reviewed (N = 258). A change in ALBI grade was defined as first postoperative month ALBI grade-preoperative ALBI grade. If the value was >0, postoperative worsening of ALBI grade was considered; otherwise, stable ALBI grade was considered. Cox proportional hazard regression analyses were used to determine the factors that influence recurrence and survival. RESULTS During the follow-up, 130 patients experienced recurrence and 47 patients died. Multivariate analyses revealed that postoperative worsening of ALBI grade (HR 1.541, 95% CI 1.025-2.318, P = 0.038), microvascular invasion (MVI, HR 1.802, 95% CI 1.205-2.695, P = 0.004), and multiple tumors (HR 1.676, 95% CI 1.075-2.615, P = 0.023) were associated with postoperative recurrence, whereas MVI (HR 2.737, 95% CI 1.475-5.080, P = 0.001), postoperative worsening of ALBI grade (HR 2.268, 95% CI 1.227-4.189, P = 0.009), high alpha-fetoprotein level (HR 2.055, 95% CI 1.136-3.716, P = 0.017), and transfusion (HR 2.597, 95% CI 1.395-4.834, P = 0.003) negatively influenced long-term survival. Patients with postoperative worsening of ALBI grade exhibited increased incidence of recurrence and worse long-term survival. CONCLUSION Postoperative worsening of ALBI grade was associated with increased recurrence and poorer overall survival for patients with HBV-related HCC within the Milan criteria. We should pay attention to liver function changes in HCC patients after liver resection.
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Affiliation(s)
- Chuan Li
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xiao-Yun Zhang
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Wei Peng
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Tian-Fu Wen
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China.
| | - Lu-Nan Yan
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Bo Li
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Jia-Yin Yang
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Wen-Tao Wang
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Ming-Qing Xu
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
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Bailon-Cuadrado M, Perez-Saborido B, Sanchez-Gonzalez J, Rodriguez-Lopez M, Mayo-Iscar A, Pacheco-Sanchez D. A new dimensional-reducing variable obtained from original inflammatory scores is highly associated to morbidity after curative surgery for colorectal cancer. Int J Colorectal Dis 2018; 33:1225-1234. [PMID: 29926232 DOI: 10.1007/s00384-018-3100-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE Several scores have been developed to define the inflammatory status of oncological patients. We suspect they share iterative information. Our hypothesis is that we may summarise their information into one or two new variables which will be independent. This will help us to predict, more accurately, which patients are at an increased risk of suffering postoperative complications after curative surgery for CRC. METHODS Observational prospective study with those patients undergoing curative surgery for CRC between September 2015 and February 2017. We analysed the influence of inflammatory scores (PNI, GPS, NLR, PLR) on postoperative morbidity (overall and severe complications, anastomotic leakage and reoperation). RESULTS Finally, 168 patients were analysed. We checked these four original scores are interrelated among them. Using a complex and innovative statistical method, we created two new independent variables (resultant A and resultant B) which resume the information coming from them. One of these two new variables (resultant A) was statistically associated to overall complications (OR, 2.239; 95% CI, 1.541-3.253; p = 0.0001), severe complications (OR, 1.773; 95% CI, 1.129-2.785; p = 0.013), anastomotic leakage (OR, 3.208; 95% CI, 1.416-7.268; p = 0.005) and reoperation (OR, 2.349; 95% CI, 1.281-4.305; p = 0.006). CONCLUSIONS We evinced the four original scores we used share redundant information. We created two new independent new variables which resume their information. In our sample of patients, one of these variables turned out to be a great predictive factor for the four complications we analysed.
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Affiliation(s)
- Martin Bailon-Cuadrado
- General and Digestive Surgery Department, Rio Hortega University Hospital, C/ Dulzaina, n° 2, 47012, Valladolid, Spain.
| | - Baltasar Perez-Saborido
- General and Digestive Surgery Department, Rio Hortega University Hospital, C/ Dulzaina, n° 2, 47012, Valladolid, Spain
| | - Javier Sanchez-Gonzalez
- General and Digestive Surgery Department, Rio Hortega University Hospital, C/ Dulzaina, n° 2, 47012, Valladolid, Spain
| | - Mario Rodriguez-Lopez
- General and Digestive Surgery Department, Rio Hortega University Hospital, C/ Dulzaina, n° 2, 47012, Valladolid, Spain
| | | | - David Pacheco-Sanchez
- General and Digestive Surgery Department, Rio Hortega University Hospital, C/ Dulzaina, n° 2, 47012, Valladolid, Spain
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Chen F, Wang S, Fang Y, Zheng L, Zhi X, Cheng B, Chen Y, Zhang C, Shi D, Song H, Cai C, Zhou P, Xiong B. Feasibility of a novel one-stop ISET device to capture CTCs and its clinical application. Oncotarget 2018; 8:3029-3041. [PMID: 27935872 PMCID: PMC5356861 DOI: 10.18632/oncotarget.13823] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 11/24/2016] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Circulating tumor cells (CTCs) play a crucial role in cancer metastasis. In this study, we introduced a novel isolation method by size of epithelial tumor cells (ISET) device with automatic isolation and staining procedure, named one-stop ISET (osISET) and validated its feasibility to capture CTCs from cancer patients. Moreover, we aim to investigate the correlation between clinicopathologic features and CTCs in colorectal cancer (CRC) in order to explore its clinical application. RESULTS The capture efficiency ranged from 80.3% to 88% with tumor cells spiked into medium while 67% to 78.3% with tumor cells spiked into healthy donors' blood. In detection blood samples of 72 CRC patients, CTCs and clusters of circulating tumor cells (CTC-clusters) were detected with a positive rate of 52.8% (38/72) and 18.1% (13/72) respectively. Moreover, CTC positive rate was associated with factors of lymphatic or venous invasion, tumor depth, lymph node metastasis and TNM stage in CRC patients (p < 0.01). Lymphocyte count and neutrophil to lymphocyte ratio (NLR) were significantly different between CTC positive and negative groups (p < 0.01). MATERIALS AND METHODS The capture efficiency of the device was tested by spiking cancer cells (MCF-7, A549, SW480, Hela) into medium or blood samples of healthy donors. Blood samples of 72 CRC patients were detected by osISET device. The clinicopathologic characteristics of 72 CRC patients were collected and the association with CTC positive rate or CTC count were analyzed. CONCLUSIONS Our osISET device was feasible to capture and identify CTCs and CTC-clusters from cancer patients. In addition, our device holds a potential for application in cancer management.
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Affiliation(s)
- Fangfang Chen
- Department of Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China
| | - Shuyi Wang
- Department of Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China
| | - Yuan Fang
- Department of Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China
| | - Liang Zheng
- Department of Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China
| | - Xuan Zhi
- Department of Circulating Tumor Cells, YZY Medical Technological Company, Wuhan, China
| | - Boran Cheng
- Department of Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China
| | - Yuanyuan Chen
- Department of Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China
| | - Chunxiao Zhang
- Department of Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China
| | - Dongdong Shi
- Department of Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China
| | - Haibin Song
- Department of Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China
| | - Congli Cai
- Department of Circulating Tumor Cells, YZY Medical Technological Company, Wuhan, China
| | - Pengfei Zhou
- Department of Circulating Tumor Cells, YZY Medical Technological Company, Wuhan, China
| | - Bin Xiong
- Department of Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China
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Sagawa M, Yoshimatsu K, Yokomizo H, Yano Y, Okayama S, Usui T, Yamaguchi K, Shiozawa S, Shimakawa T, Katsube T, Kato H, Naritaka Y. Worse Preoperative Status Based on Inflammation and Host Immunity Is a Risk Factor for Surgical Site Infections in Colorectal Cancer Surgery. J NIPPON MED SCH 2018; 84:224-230. [PMID: 29142183 DOI: 10.1272/jnms.84.224] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The modified Glasgow Prognostic Score (mGPS) is an inflammation-based measure of malnutrition that reflects a state of cachexia in cancer patients. We evaluated mGPS as an index to predict surgical site infection (SSI) incidence in patients undergoing colorectal cancer surgery. SUBJECTS AND METHODS We retrospectively analyzed 351 patients who underwent colon cancer resection. Factors correlated with the incidence of SSIs were identified by logistic analysis and stepwise selection. RESULTS SSIs were observed in 32 patients, with an incidence of 9.1%. Univariate logistic analysis revealed mGPS (Score 2), laparotomy, resection of other organs, colostomy, excessive blood loss (>423 mL), long duration of surgery (>279 minutes), pulmonary dysfunction, prognostic nutritional index (PNI) ≤40, neutrophil lymphocyte ratio (NLR)(>4), and controlling nutritional status (CONUT) ≥2 to be associated with an increased incidence of SSIs. Multivariate analysis with variables selected by the stepwise procedure also revealed mGPS (Score 2) (Odds ratio (OR) =3.55, 95% Confidence interval (CI) 1.30-9.56; p=0.01), colostomy (OR=6.56, 95%CI 1.60-31.38; p=0.01), excessive blood loss (OR=3.20, 95%CI 1.23-8.42; p=0.02), and NLR (>4)(OR=3.24, 95%CI 1.31-8.17; p=0.01) to be independent risk factors. CONCLUSION mGPS is an independent risk factor for SSIs. Our results suggest that cachexia before surgery in patients with colorectal cancer might predict the incidence of SSIs.
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Affiliation(s)
- Masano Sagawa
- Department of Surgery, Tokyo Women's Medical University Medical Center East
| | | | - Hajime Yokomizo
- Department of Surgery, Tokyo Women's Medical University Medical Center East
| | - Yuki Yano
- Department of Surgery, Tokyo Women's Medical University Medical Center East
| | - Sachiyo Okayama
- Department of Surgery, Tokyo Women's Medical University Medical Center East
| | - Takebumi Usui
- Department of Surgery, Tokyo Women's Medical University Medical Center East
| | - Kentaro Yamaguchi
- Department of Surgery, Tokyo Women's Medical University Medical Center East
| | - Shunichi Shiozawa
- Department of Surgery, Tokyo Women's Medical University Medical Center East
| | - Takeshi Shimakawa
- Department of Surgery, Tokyo Women's Medical University Medical Center East
| | - Takao Katsube
- Department of Surgery, Tokyo Women's Medical University Medical Center East
| | - Hiroyuki Kato
- Department of Clinical Laboratory, Tokyo Women's Medical University Medical Center East
| | - Yoshihiko Naritaka
- Department of Surgery, Tokyo Women's Medical University Medical Center East
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26
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Fiorot A, Pozza A, Ruffolo C, Caratozzolo E, Bonariol L, D’Amico FE, Padoan L, Calia di Pinto F, Scarpa M, Castoro C, Bassi N, Massani M. Colorectal cancer in the young: a possible role for immune surveillance? Acta Chir Belg 2018; 118:7-14. [PMID: 28743216 DOI: 10.1080/00015458.2017.1353233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Younger patients with colorectal cancer (CRC) generally have better survival in spite of worse clinical and pathological features. METHODS Twenty-six patients under 50 years operated for primary CRC were enrolled and matched 1:2:2 according to stage, tumor site and gender with 52 patients from 50 to 70 years and 52 patients over 70 years old. RESULTS Patients under 50 years had a significantly longer overall, cancer specific and disease free survival (p = .001, p = .007 and p = .05, respectively). However, they had more frequently lymphovascular invasion (p = .006) and they more frequently developed metachronous CRC at follow-up (p = .03). Nevertheless, preoperative lymphocytes blood count/white blood count (LBC/WBC) ratio inversely correlated with age at operation (rho = -.21, p = .04) and it predicted CRC recurrence with an accuracy of 70%, p < .001 (threshold value LBC/WBC = 0.21%) and better overall, cancer specific and disease free survival (p < .0001 for all). At multivariate analysis, stage and LBC/WBC ratio resulted independent predictors of disease free survival (p = .0001 and p = .01, respectively). CONCLUSIONS Patients under 50 years had a significantly longer survival with a higher LBC/WBC ratio. These results could suggest a possible role of immunosurveillance in neoplastic control.
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Affiliation(s)
- Alain Fiorot
- Department of Surgery, IV Unit of Surgery, Regional Hospital “Cà Foncello”, Treviso, Italy
| | - Anna Pozza
- Department of Surgery, IV Unit of Surgery, Regional Hospital “Cà Foncello”, Treviso, Italy
| | - Cesare Ruffolo
- Department of Surgery, IV Unit of Surgery, Regional Hospital “Cà Foncello”, Treviso, Italy
| | - Ezio Caratozzolo
- Department of Surgery, IV Unit of Surgery, Regional Hospital “Cà Foncello”, Treviso, Italy
| | - Luca Bonariol
- Department of Surgery, IV Unit of Surgery, Regional Hospital “Cà Foncello”, Treviso, Italy
| | | | - Luigi Padoan
- Department of Surgery, IV Unit of Surgery, Regional Hospital “Cà Foncello”, Treviso, Italy
| | | | - Marco Scarpa
- Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Carlo Castoro
- Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Nicolò Bassi
- Department of Surgery, IV Unit of Surgery, Regional Hospital “Cà Foncello”, Treviso, Italy
| | - Marco Massani
- Department of Surgery, IV Unit of Surgery, Regional Hospital “Cà Foncello”, Treviso, Italy
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27
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Guo D, Han A, Jing W, Chen D, Jin F, Li M, Kong L, Yu J. Preoperative to postoperative change in neutrophil-to-lymphocyte ratio predict survival in colorectal cancer patients. Future Oncol 2018; 14:1187-1196. [PMID: 29302993 DOI: 10.2217/fon-2017-0659] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AIM To evaluate the prognostic value of preoperative to postoperative neutrophil-to-lymphocyte ratio changes (ΔNLR) in patients undergoing surgical resection for colorectal cancer. PATIENTS & METHODS Data of 135 such patients managed at the Shandong Cancer Hospital and Institute were retrospectively analyzed. Clinicopathologic factors, overall survival (OS) and disease-free survival (DFS) were assessed using Kaplan-Meier curves and Cox regression models. RESULTS In the multivariate analysis, preoperative NLR (p = 0.002) and ΔNLR (p = 0.037) independently predicted OS, but preoperative NLR (p = 0.141) and ΔNLR (p = 0.297) were not significant prognosticators for DFS. CONCLUSION Our results demonstrated the prognostic value of the ΔNLR in predicting OS in patients undergoing surgical resection for colorectal cancer. However, ΔNLR could not predict DFS.
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Affiliation(s)
- Dong Guo
- Weifang Medical University, Weifang, PR China.,Department of Radiotherapy, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, PR China
| | - Anqin Han
- Department of Radiotherapy, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, PR China
| | - Wang Jing
- Department of Radiotherapy, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, PR China.,Department of Radiotherapy, the First Affiliated Hospital to Zhengzhou University, Zhengzhou, PR China
| | - Dawei Chen
- Department of Radiotherapy, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, PR China
| | - Feng Jin
- Department of Radiotherapy, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, PR China
| | | | - Li Kong
- Department of Radiotherapy, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, PR China
| | - Jinming Yu
- Department of Radiotherapy, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, PR China
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Combined Detection of Preoperative Neutrophil-to-Lymphocyte Ratio and CEA as an Independent Prognostic Factor in Nonmetastatic Patients Undergoing Colorectal Cancer Resection Is Superior to NLR or CEA Alone. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3809464. [PMID: 28685148 PMCID: PMC5480025 DOI: 10.1155/2017/3809464] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/12/2017] [Indexed: 01/02/2023]
Abstract
Objective To explore the role of combined detection of carcinoembryonic antigen (CEA) and neutrophil-to-lymphocyte ratio (NLR) in the prognostic assessment of colorectal cancer (CRC). Methods We investigated preoperative NLR and CEA in 125 surgical CRC patients, determined the patients' thresholds by receiver operating characteristic (ROC) curve analysis, and assessed their prognostic values by Kaplan–Meier curve and Cox regression models. In addition, we used nomograms of several risk factors to evaluate the risk in survival and predictive accuracy by using Harrell's concordance index (c-index). Results Results of multivariate analysis showed high NLR, high CEA, and high COCN (combination of CEA and NLR) were significantly correlated with decreased disease-free survival (DFS) [HR: 2.229, 95% CI: 1.012–4.911, and P = 0.047; HR: 3.652, 95% CI: 1.630–8.179, and P = 0.002; HR: 3.139, 95% CI: 1.800–5.472, and P < 0.001]. But high CEA and COCN remained significant only for decreased overall survival (OS) [HR: 3.713, 95% CI: 1.396–9.873, and P = 0.009; HR: 3.106, 95% CI: 1.576–6.123, and P = 0.001]. High NLR showed higher mortality rates with worse OS (P = 0.058), and nomograms containing NLR improved the predictive accuracy. Area under the curve of COCN was higher than that of CEA or NLR. Conclusion COCN acts as a better independent prognostic biomarker of CRC than NLR or CEA alone.
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Peng F, Hu D, Lin X, Chen G, Liang B, Li C, Chen Y, Cui Z, Zhang H, Lin J, Zheng X, Niu W. The monocyte to red blood cell count ratio is a strong predictor of postoperative survival in colorectal cancer patients: The Fujian prospective investigation of cancer (FIESTA) study. J Cancer 2017; 8:967-975. [PMID: 28529608 PMCID: PMC5436248 DOI: 10.7150/jca.18000] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 12/23/2016] [Indexed: 12/19/2022] Open
Abstract
Background and Aims: We sought to evaluate the prognosis of preoperative blood routine parameters for the mortality of colorectal cancer patients after surgery by eliciting a subset of data from the ongoing Fujian prospective investigation of cancer (FIESTA) study. Methods: 1318 colorectal cancer patients with completed survival data were enrolled between 2000 and 2008. Effect-size estimates are expressed as hazard ratio (HR) and 95% confidence interval (CI). Results: The median follow-up time was 58.6 months. Elevated levels of neutrophil (adjusted HR, 95% CI, P: 1.22, 1.06-1.41, 0.006) and monocyte (1.32, 1.06-1.65, 0.013) were significantly associated with an increased risk of colorectal cancer mortality, whereas that of lymphocyte (0.60, 0.44-0.82, 0.001) and red blood cell count (0.20, 0.09-0.43, <0.001) were significantly associated with a reduced risk. Additionally, remarkable significance was reached for the neutrophil-to-lymphocyte ratio (1.12, 1.06-1.19, <0.001) and lymphocyte-to-monocyte ratio (0.60, 0.46-0.79, <0.001). Based on individual effect-estimates, a new derivate, monocyte to red blood cell count ratio namely MRR was created, and its association with colorectal cancer mortality was strikingly significant (1.48, 1.18-1.85, 0.001). Notably, elevated MRR was significantly associated with the mortality of early stage colorectal cancer, especially in patients with stage I-II (1.63, 1.04-2.56, 0.034), invasion depth T1-T2 (2.85, 1.45-5.61, 0.002), regional lymph node metastasis N0 (1.89, 1.29-2.77, 0.001) and tumor size ≤ 4.5 cm (1.84, 1.25-2.70, 0.002). Conclusions: We created a new derivate MRR, which was superior over classic blood routine derivates, and importantly the MRR exhibited a stronger ability in predicting poor prognosis of colorectal cancer, especially at the early stage.
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Affiliation(s)
- Feng Peng
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Dan Hu
- Department of Pathology, Fujian Provincial Cancer Hospital, The Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Xiandong Lin
- Department of Pathology, Fujian Provincial Cancer Hospital, The Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Gang Chen
- Department of Pathology, Fujian Provincial Cancer Hospital, The Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Binying Liang
- Department of Medical Record, Fujian Provincial Cancer Hospital, The Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Chao Li
- Department of Pathology, Fujian Provincial Cancer Hospital, The Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Yan Chen
- Department of Clinical Laboratory, Fujian Provincial Cancer Hospital, The Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Zhaolei Cui
- Department of Clinical Laboratory, Fujian Provincial Cancer Hospital, The Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Hejun Zhang
- Department of Pathology, Fujian Provincial Cancer Hospital, The Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Jixiu Lin
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Xiongwei Zheng
- Department of Pathology, Fujian Provincial Cancer Hospital, The Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Wenquan Niu
- State Key Laboratory of Medical Genomics, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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