Novel Comprehensive Blood Indicator Potential Prognostic Factor for CRC

The novel comprehensive blood indicator, PSI, could be used to predict clinical outcomes in patients with colorectal cancer (CRC), according to a study published in Frontiers in Oncology. Knowing these indicators could help to personalize treatment for patients with CRC.

CRC remains the second most fatal cancer in the world and has a silent early progression, which makes prognostic tools important. Survival outcomes in patients with CRC who are receiving an operation for the disease can be influenced by preoperative malnutrition, which can increase mortality within 30 days of surgery. This study aimed to use the Onodera’s Prognostic Nutritional Index (OPNI) and the blood marker Systemic Inflammation Response Index (SIRI) to see if it had value in predicting the survival of patients with cases of CRC that were resectable.

Colorectal Cancer, 3D Illustration | Image credit: Dr_Microbe - stock.adobe.com

Patients who had radical resection at the First Affiliated Hospital of Congqing Medical University in Chongqing, China, between January 2015 and December 2017 were retrospectively reviewed. Patients who had neoadjuvant radiotherapy or radhiochemotherapy before surgery, who had a history of primary or secondary malignancies, who had blood diseases that could affect biomarkers, who had emergency surgery before the study, and patients who died directly or indirectly from other diseases were excluded. Patients who were admitted to the hospital for surgery, who were newly diagnosed with CRC, had tumors that were resectable, and had the ability to express themselves and had available data were included.

All characteristics were collected from the electronic health record and reviewed in retrospect; this included age, gender, medical history, smoking history, family history, and alcohol history. All blood markers were measured within 3 days of the surgery. These blood markers included absolute neutrophil count, absolute lymphocyte count, albumin, platelets, monocyte count, and tumor marker carcinoembryonic antigen. All patients had radical resection and overall survival (OS) was calculated as the period from diagnosis to death due to cancer or the most recent follow-up.

There were 210 patients included in the study, with 56.2% being male and 78.5% diagnosed with stage II to III CRC. A comprehensive indicator named PSI was developed from OPNI and SIRI. The 210 patients were split into 3 groups based on the formula for PSI, with groups separated by high PSI, medium PSI, and low PSI.

OS was higher in patients who had OPNI that was 49.6 or more compared with patients with OPNI of less than 49.6. Patients had poorer survival when they had SIRI values of 2.0 or more. Improved OS was found in patients who had higher PSI values of 28.3 to 43.4 or more than 43.4. A lower HR of 0.293 (95% CI, 0.154-0.558) and 0.312 (95% CI, 0.153-0.636) were found in univariate and multivariate Cox models, respectively, in patients who had a PSI score of 28.3 to 43.4. Patients who had a score that was greater than 43.4 had an HR of 0.111 (95% CI, 0.051-0.242) in the univariate and 0.l46 (95% CI, 0.060-0.351) in the multivariate Cox models, which indicated a lower risk of poor survival.

PSI was able to maintain superior predictive ability when compared with OPNI, SIRI, and stage by themselves, with an area-under-curve value of 0.734 (95% CI, 0.654-0.815) compared with 0.721 (95% CI, 0.642-0.800), 0.645 (95% CI, 0.556-0.733), and 0.635 (95% CI, 0.552-0.717), respectively. Age and tumor stage were found to be prognostic factors as well. The HR for age for those aged less than 60 years vs 60 years or older was 0.365 (95% CI, 0.177-0.755) whereas the HR for tumor stage of stage III vs stage I was 5.258 (95% CI, 1.918-14.416).

There were some limitations to this study. Nutritional status was only collected at a single point in time, which left nutritional improvements unaccounted for. Generalizability could be limited due to the small sample size. Selection bias may exist due to it being a single-center study.

PSI, based on SIRI and OPNI, was found to be a potential independent prognostic factor in CRC, due to its performance in predicting clinical outcomes against other inflammatory and nutrional markers.

Reference

Cai H, Li J, Chen Y, Zhang Q, Liu Y, Jia H. Preoperative inflammation and nutrition-based comprehensive biomarker for predicting prognosis in resectable colorectal cancer. Front Onc. Published online November 22, 2023. doi:10.3389/fonc.2023.1279487