Preoperative PIV, MHR Act as Independent Risk Factors in CRC

According to a study published in BMC Cancer,¹ independent risk factors of colorectal cancer prognosis included preoperative pan-immune inflammation value (PIV) and monocyte to high-density lipoprotein ratio (MHR). A nomogram using these factors to predict colorectal cancer proved to be helpful in making decisions about treatment.

The second leading cause of cancer-related death in the United States is colorectal cancer² due to high rates of recurrence and metastasis. The pathogenesis and progression of colorectal cancer can be associated with inflammation, but PIV has not been as thoroughly evaluated as a marker of prognosis for colorectal cancer. The study aimed to evaluate inflammation, immunity, and cholesterol metabolism through the PIV and MHR markers to assess how effective they are as a marker of colorectal cancer prognosis.¹

Human intestine | Image credit: mi_viri - stock.adobe.com

Patients who had radical resection at the Second Hospital of Lanzhou University in China from March 2018 to May 2019 were eligible for the study. Patients who were pathologically diagnosed with colorectal cancer, had a radical resection, and had complete clinicopathological and follow-up data were included. Patients who had other malignant tumors or a previous history of hematological, autoimmune, or chronic inflammatory diseases were excluded from the study.

Electronic medical records from the hospital information system were used to collect data for all of the patients. This included demographic details and pathological information of all patients. The overall survival (OS) of the patients was the primary endpoint.

A total of 172 patients diagnosed with colorectal cancer were included in the study. There were 107 patients (62.2%) with low preoperative PIV levels, while 65 (37.8%) had high preoperative PIV levels. MHR levels were low prior to the operation in 32.6% of the patients. OS was 91.8% after 1 year, 76.1% in 2 years, and 66.3% after 3 years.

Tumor location, tumor diameter, and T stage were all significantly associated with PIV levels, whereas MHR levels were closely related to gender, tumor diameter, and T stage. Patients with higher preoperative levels of PIV had a lower 3-year OS rate when compared with people with lower levels before the operation (46.1% vs 78.5%). This same association was found in MHR levels, with patients with higher MHR levels prior to their operation having reduced 3-year OS rates (55.2% vs 89.2%). A multivariable analysis found that both PIV (HR, 2.476; 95% CI, 1.410-4.348) and MHR (HR, 3.803; 95% CI, 1.609-8.989).

The development of the nomogram model proved to be efficient in helping to predict OS, with the C-index value of the model being 0.748 (95% CI, 0.688-0.794), to indicate good predictive accuracy. The model was also able to correctly predict that the low-risk group would have better survival outcomes.

There were some limitations to the study. The study was conducted in a single center and was a retrospective analysis with a small sample size, which could limit the generalizability. There was a brief follow-up period, and future studies should look at data from a 5-year follow-up and should be conducted at multiple centers.

PIV and MHR were found to be independent risk factors for colorectal cancer prognosis, as they are indicators for inflammation, immunity, and cholesterol metabolism. Looking for these factors in a nomogram model can help to identify patients who are at a high risk for adverse events.

"By integrating markers that reflect inflammation, immunity, and cholesterol metabolism, we have developed a novel nomogram model. This model serves as a robust tool for identifying patients at high risk of adverse outcomes, thereby enhancing the clinical decision-making process," the authors concluded. "Its application has the potential to influence patient management strategies, tailoring interventions to individual risk profiles and improving prognosis in colorectal cancer patients."

References

1. Liu Q, Wang H, Chen Q, Luo R, Luo C. Nomogram incorporating preoperative pan-immune-inflammation value and monocyte to high-density lipoprotein ratio for survival prediction in patients with colorectal cancer: a retrospective study. BMC Cancer. 2024;24:740. doi:10.1186/s12885-024-12509-x
2. ACS Medical Content and News Staff. Risk of dying from cancer continues to drop at an accelerated pace. American Cancer Society. January 12, 2022. Accessed June 18, 2024. https://www.cancer.org/research/acs-research-news/facts-and-figures-2022.html