Effect of the systemic immune-inflammation index on postoperative complications and the long-term prognosis of patients with colorectal cancer: a retrospective cohort study

Construction and validation of a nomogram for predicting disease-free survival after radical resection of rectal cancer using perioperative inflammatory indicators

Background

Colorectal cancer is a common digestive tract malignancy that seriously affects patients' quality of life and survival time. Surgery is the main treatment modality, but postoperative prognosis varies greatly. This study sought to explore the impact of perioperative inflammatory indicators on disease-free survival (DFS) in patients after radical resection of rectal cancer and to construct a nomogram for clinical reference.

Methods

A retrospective analysis was performed on 304 primary rectal adenocarcinoma patients who underwent laparoscopic radical resection of rectal cancer at the Affiliated Hospital of Xuzhou Medical University from May 1, 2018 to September 30, 2020. The patients were divided into a training set (n=213) and a validation set (n=91) at a ratio of 7:3. The cut-off values of each inflammatory indicator based on the receiver operating characteristic (ROC) curve were determined and each indicator was divided into high and low groups. The least absolute shrinkage and selection operator (LASSO)-Cox regression model was used to analyze the independent risk factors affecting DFS, and a nomogram was established. The model was internally validated using the validation set, and the discrimination, calibration, and clinical application value of the nomogram were evaluated using ROC curve, calibration curve, and clinical decision curve analysis (DCA).

Results

Tumor-node-metastasis (TNM) stage III, neural invasion, preoperative neutrophil-to-lymphocyte ratio (NLR) ≥1.995, postoperative systemic immune-inflammation index (SII) ≥451.05, and Δpan-immune-inflammation value (ΔPIV) ≥144.36 (P<0.05) were independent factors for predicting the 3-year DFS of patients after rectal cancer surgery. The area under the ROC curve (AUC) of the nomogram was 0.811 [95% confidence interval (CI): 0.778-0.889] in the training set and 0.808 (95% CI: 0.785-0.942) in the validation set. The nomogram showed good calibration, indicating good consistency between predicted and actual risks. DCA demonstrated the clinical utility of the nomogram.

Conclusions

The nomogram constructed based on TNM stage III, neural invasion, preoperative NLR ≥1.995, postoperative SII ≥451.05, and ΔPIV ≥144.36 can predict the risk of 3-year DFS in patients undergoing curative surgery for rectal cancer, enabling strict postoperative follow-up and timely adjuvant treatment for high-risk patients.

Effect of preoperative pan-immune-inflammation value on clinical and oncologic outcomes after colorectal cancer surgery: a retrospective study

Purpose

Surgical resection, the primary treatment for colorectal cancer (CRC), is often linked with postoperative complications that adversely affect the overall survival rates (OS). The pan-immune-inflammation value (PIV), a novel biomarker, is promising in evaluating cancer prognoses. We aimed to explore the impact of preoperative immune inflammation status on postoperative and long-term oncological outcomes in patients with CRC.

Methods

A retrospective analysis of 203 patients with CRC who underwent surgery (January 2016-June 2020) was conducted. The preoperative PIV was calculated as [(neutrophil count + platelet count + monocyte count) / lymphocyte counts]. The PIV optimal cutoff value was determined based on the OS using the Contal and O'Quigley methods.

Results

A PIV value ≥155.90 was defined as high. Patients were categorized into low-PIV (n = 85) and high-PIV (n = 118) groups. Perioperative clinical outcomes (total operation time, time to gas out, sips of water, soft diet, and hospital stay) were not significantly different between the groups. The high-PIV group exhibited more postoperative complications (P = 0.024), and larger tumor size compared with the low-PIV group. Multivariate analysis identified that American Society of Anesthesiologists grade III (P = 0.046) and high-PIV (P = 0.049) were significantly associated with postoperative complications. The low-PIV group demonstrated higher OS (P = 0.001) and disease-free survival rates (DFS) (P = 0.021) compared with the high-PIV group. Advanced N stage (P = 0.005) and high-PIV levels (P = 0.047) were the identified independent prognostic factors for OS, whereas advanced N stage (P = 0.045) was an independent prognostic factor for DFS.

Conclusion

Elevated preoperative PIV was associated with an increased incidence of postoperative complications and served as an independent prognostic factor for OS.

Prognostic value of preoperative combined with postoperative systemic immune-inflammation index for disease-free survival after radical rectal cancer surgery: a retrospective cohort study

Background

Colorectal cancer (CRC) ranks highly in malignant tumor incidence and mortality rates, severely affecting human health. The predictive value of the systemic immune-inflammation index (SII) in CRC prognosis is gaining attention, but there is limited research on the combined preoperative and postoperative SII. This study aims to explore the prognostic value of combined SII on disease-free survival (DFS) in patients undergoing radical surgery for rectal cancer.

Methods

We enrolled 292 patients with rectal cancer who underwent radical resection at the Affiliated Hospital of Xuzhou Medical University from May 2018 to September 2020, along with regular follow-ups to document the DFS. Patients' complete blood cell counts were assessed before surgery and between 21-56 days postoperatively. Calculating preoperative and postoperative SII, patients were categorized into four groups based on the optimal cutoff values: (I) low-low group (preoperative SII <449.325 and postoperative SII <568.13); (II) high-low group (preoperative SII ≥449.325 and postoperative SII <568.13); (III) low-high group (preoperative SII <449.325 and postoperative SII ≥568.13); and (IV) high-high group (preoperative SII ≥449.325 and postoperative SII ≥568.13). The receiver operating characteristic (ROC) curve analysis evaluated the prediction efficacy of preoperative, postoperative, and combined SII. Kaplan-Meier analysis generated DFS curves, and Cox regression analysis determined prognostic factors.

Results

With a median follow-up of 41 months, 65.4% (191/292) patients reached DFS. The clinical pathological features between the four groups are balanced and comparable (P>0.05). The area under the ROC curve for preoperative, postoperative, and combined SII was 0.668 [95% confidence interval (CI): 0.6-0.737], 0.696 (95%CI: 0.63-0.763), and 0.741 (95% CI: 0.681-0.802), respectively. After adjusting for confounding factors such as adjuvant therapy, differentiation, vascular invasion, neural invasion, tumor-node-metastasis (TNM) stage, carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA19-9), significant differences were observed between the high-low group [hazard ratio (HR) =2.403; 95% CI: 1.255-4.602; P=0.008], low-high group (HR =5.058; 95% CI: 2.389-10.71; P<0.001), and high-high group (HR =6.214; 95% CI: 3.474-11.115; P<0.001) compared to the low-low group, with higher risks of adverse outcomes.

Conclusions

Combined SII has better predictive efficacy than monitoring preoperative or postoperative SII alone in rectal cancer patients undergoing radical surgery.

Prognostic role of the controlling nutritional status (CONUT) score in patients with biliary tract cancer: a meta-analysis

BACKGROUND

Previous reports have not reached consistent results regarding the prognostic significance of the controlling nutritional status (CONUT) score in biliary tract cancer (BTC). Therefore, the present meta-analysis was conducted to investigate the precise role of the CONUT score in predicting the prognosis of BTC.

METHODS

Electronic platforms including Web of Science, PubMed, Cochrane Library, and Embase were comprehensively searched up to May 2, 2023. We also determined combined hazard ratios (HRs) and 95% confidence intervals (CIs) to estimate the role of the CONUT score in predicting the prognosis of patients with BTC.

RESULTS

Ten studies involving 1,441 patients were included in the present study. Nine studies treated patients with surgical resection, and one study used percutaneous transhepatic biliary stenting (PTBS) plus 125I seed intracavitary irradiation. Based on the combined data, a higher CONUT score significantly predicted dismal overall survival (OS) (HR = 1.94, 95%CI = 1.41-2.66, p < 0.001), inferior recurrence-free survival (RFS) (HR = 1.79, 95%CI = 1.48-2.17, p < 0.001) in BTC, and low differentiation (OR = 1.57, 95%CI = 1.15-2.14, p = 0.004). Nonetheless, the CONUT score was not related to sex, lymph node metastasis, microvascular invasion, perineural invasion, distant metastasis, TNM stage, or tumor number in patients with BTC.

CONCLUSION

Higher CONUT scores significantly predicted worse OS and RFS in patients with BTC. Moreover, BTC patients with high CONUT scores tended to have poor tumor differentiation. The CONUT score could help clinicians stratify high-risk patients with BTC and devise individualized treatment plans.

Prognostic roles of hematological indicators for the efficacy and prognosis of immune checkpoint inhibitors in patients with advanced tumors: a retrospective cohort study

BACKGROUND

Immunocheckpoint inhibitor(ICI) is a major breakthrough in tumor treatment. It can activate the patient's own immune system and play an anti-tumor role, but not all patients can benefit from it. At present, there is still a lack of effective biomarkers to guide clinical application. The systemic immune inflammation(SII) index reflects the systemic inflammatory state and immune state of patients. Prognostic nutrition index(PNI) can be used to evaluate immune status of patients. Therefore, SII and PNI indexes may have some value in predicting the efficacy and prognosis of immunotherapy, but there is still a lack of relevant research. The purpose of our study was to explore the influence of SII and PNI index on the efficacy and prognosis of immunotherapy.

METHODS

A total of 1935 patients treated with ICIs treatment in the Fourth Hospital of Hebei Medical University from November 2016 to October 2021 were retrospectively collected. 435 patients who met the inclusion criteria and did not meet the exclusion criteria. The imaging data, blood results of each patient were collected within 1 week before ICIs treatment. The neutrophil lymphocyte ratio(NLR), platelet lymphocyte ratio(PLR), monocyte lymphocyte ratio(MLR), PNI,systemic inflammatory response index(SIRI),neutrophil-eosinophil ratio(NER) was calculated. The patients were followed up by in-patient, out-patient reexamination and telephone contact, and the efficacy evaluation and survival status were recorded. The deadline of follow-up: January 2021. SPSS-24.0 software was employed for statistical analysis.

RESULTS

Among the 435 patients receiving ICI treatment, 61,236 and 138 patients were evaluated respectively as partial response (PR), stable disease (SD) and progressive disease (PD). The overall response rate(ORR) and disease control rate (DCR) of this cohort were 14.0% and 68.3%, respectively. Median progression-free survival (mPFS) is 4.0 months, The overall survival (mOS) of this cohort is 6.8 months. Multivariate analysis showed that SIRI(Hazard Ratio, HR = 1.304, P = 0.014), PNI (HR = 0.771, P = 0.019), prealbumin (PAB) (HR = 0.596, P = 0.001), and PNI(HR = 0.657, P = 0.008) were independent risk factors for PFS and OS, respectively.

CONCLUSIONS

Patients with high SIRI value and low PNI value before ICI treatment have shorter PFS. Patients with higher PNI value have better prognosis. Therefore, hematological indicators may become predictors of immunotherapy.

Prognostic significance of systemic immune-inflammation index in patients with ovarian cancer: a meta-analysis

Background

The prognosis of several malignancies has been influenced by the systemic immune-inflammation index (SII); however, its association with the prognostic outcome of ovarian cancer (OC) remains controversial. The present meta-analysis focused on the systemic and comprehensive identification of the role of SII in predicting OC prognosis.

Methods

We searched the Web of Science, PubMed, Cochrane Library, Embase, and China National Knowledge Infrastructure (CNKI) from inception until March 6, 2023. To predict the prognostic value of SII for overall survival (OS) and progression-free survival (PFS) in patients with OC, we calculated pooled hazard ratios (HRs) and corresponding 95% confidence intervals (CIs).

Results

The meta-analysis included six studies involving 1546 patients. The combined results showed that a high SII was significantly associated with poor OS (HR=2.70, 95% CI=1.98-3.67, p<0.001) and poor PFS (HR=2.71, 95% CI=1.78-4.12, p<0.001) in OC patients. These results were confirmed using subgroup and sensitivity analyses.

Conclusion

Our results concluded that a high SII significantly predicted poor OS and PFS in patients with OC. Therefore, it can be speculated that the SII may have an independent effect on the prognosis of OC.

The value of lactate dehydrogenase to albumin ratio and immune inflammation biomarkers in colorectal cancer

Background

Colorectal cancer (CRC) is one of the most prevalent gastrointestinal cancers. Evidence for the importance of inflammation and immunology in the development and progression of CRC is growing steadily. The purpose of this study was to determine the clinical importance of Lactic Dehydrogenase (LDH) to Albumin (ALB) Ratio (LAR) and immune-inflammation biomarkers (IIBs) in patients with CRC.

Methods

This study enrolled 382 CRC patients. The LAR was determined as the serum LDH(U/l) to ALB(g/l) ratio. We compared the levels of LAR and IIBs in different TNM stages and tumor differentiation. The relationship between LAR and IIBs and overall survival (OS) of CRC was determined by Cox regression models. A prognostic nomogram was created using the results of the multivariate analysis and the effectiveness of the nomogram was assessed using the ROC, calibration, and decision curves. We evaluated the relationship between LAR and IIBs and clinical features of CRC.

Results

The levels of LAR, SII, NLR and PLR in TNM IV stage group (LAR:5.92 (5.23-8.24); SII: 1040.02 (499.51-1683.54); NLR: 2.87 (2.07-5.3); PLR:187.08 (125.31-276.63)) were significantly higher than those in other groups. LAR and NLR showed no significant difference in different tumor differentiation groups, while SII and PLR in undifferentiated groups (SII:543.72 (372.63-1110.20); PLR: 147.06 (106.04-203.92)) were significantly higher than those in well and moderate groups (SII: 474.29 (323.75-716.01); PLR: 126.28 (104.31-167.88)). LAR (HR = 1.317, 95% CI = 1.019-1.454), TNM stage (HR = 2.895, 95% CI = 1.838-4.559), age (HR = 1.766, 95% CI = 1.069-2.922) and lymphocytes (HR = 0.663, 95% CI = 0.456-0.963) were predictors of OS. IIBs, including SII, NLR, and PLR are independent of OS. The LAR-based nomogram AUCs of 1-year, 3-year and 5-year survival probabilities in the training cohort were 0.86, 0.72, and 0.71, respectively, and the AUCs of the validation cohort were 0.85, 0.71, and 0.69 respectively. The LAR-based nomogram's ROC curves and calibration curves demonstrated higher OS discriminative performance. The decision curves demonstrated greater net benefit in the survival prediction.

Conclusion

Preoperative LAR is a potential prognostic marker in CRC patients, while SII, NLR, and PLR are independent of OS. LAR was associated with tumor stage in CRC patients, but not with tumor differentiation.