Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Sep 15, 2024; 16(9): 3865-3874
Published online Sep 15, 2024. doi: 10.4251/wjgo.v16.i9.3865
Impact of preoperative inflammatory and nutritional markers on the prognosis of patients with peritoneal metastasis of colorectal cancer
Zhi-Jie Wu, Bing Lan, Jian Luo, Ayniyazi Ameti, Hui Wang, Qiong-Yu Hu
Zhi-Jie Wu, Bing Lan, Jian Luo, Hui Wang, Qiong-Yu Hu, Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Zhi-Jie Wu, Bing Lan, Jian Luo, Hui Wang, Qiong-Yu Hu, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Zhi-Jie Wu, Bing Lan, Jian Luo, Hui Wang, Qiong-Yu Hu, Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Ayniyazi Ameti, Department of Anesthesiology, Kashgar First People’s Hospital, Kashgar 844000, Xinjiang Uygur Autonomous Region, China
Qiong-Yu Hu, Department of Anesthesiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
Co-first authors: Zhi-Jie Wu and Bing Lan.
Co-corresponding authors: Hui Wang and Qiong-Yu Hu.
Author contributions: Wu ZJ and Wang H contributed to the study concept and design; Wu ZJ, Lan B, Luo J, and Ameti A participated in the analysis and interpretation of data; Wu ZJ and Lan B drafted the manuscript; Wang H and Hu QY contributed to the revision of the manuscript; and all authors approved the manuscript. Wu ZJ and Lan B are co-first authors of the manuscript. They contribute equally to data analysis and article writing. Wang H and Hu QY are co-corresponding authors of the manuscript. They contribute equally to the revision of the manuscript.
Institutional review board statement: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later. The study was approved by the Sixth Affiliated Hospital, Sun Yat-sen University, No. 2020ZSLYEC-109.
Informed consent statement: All patients provided written informed consent to participate.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All the data are available without resection. Researchers can obtain data by contacting the corresponding.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qiong-Yu Hu, MD, Department of Anesthesiology, The Sixth Affiliated Hospital, Sun Yat-sen University, No. 26 Yuancun Road, Tianhe District, Guangzhou 510000, Guangdong Province, China. huqy@mail.sysu.edu.cn
Received: January 31, 2024
Revised: June 10, 2024
Accepted: July 16, 2024
Published online: September 15, 2024
Processing time: 222 Days and 2.4 Hours
Abstract
BACKGROUND

Identifying patients with peritoneal metastasis (PMs) of colorectal cancer (CRC) who will benefit from cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is crucial before surgery. Inflammatory and nutritional indicators play essential roles in cancer development and metastasis.

AIM

To investigate the association of preoperative inflammatory and nutritional markers with prognosis in patients with CRC-PM.

METHODS

We included 133 patients diagnosed with CRC-PM between July 2012 and July 2018. Patients’ demographics, overall survival (OS), and preoperative inflammatory and nutritional markers were evaluated. The Kaplan-Meier method and log-rank test were used to estimate differences.

RESULTS

Of the 133 patients, 94 (70.6%) had normal hemoglobin (Hb) and 54 (40.6%) had a high neutrophil-to-lymphocyte ratio (NLR). The median OS (mOS) was significantly lower for patients with high NLR (7.9 months) than for those with low NLR (25.4 months; P = 0.002). Similarly, patients with normal Hb had a longer mOS (18.5 months) than those with low Hb (6.3 months; P < 0.001). Multivariate analysis identified age, carbohydrate antigen 199 levels, NLR, Hb, and peritoneal cancer index as independent predictors of OS. Based on these findings, a nomogram was constructed, which demonstrated a good capacity for prediction, with a C-index of 0.715 (95% confidence interval: 0.684-0.740). Furthermore, the 1- and 2-year survival calibration plots showed good agreement between predicted and actual OS rates. The areas under the curve for the 1- and 2-year survival predictions of the nomogram were 0.6238 and 0.6234, respectively.

CONCLUSION

High NLR and low Hb were identified as independent predictive risk factors for poor prognosis in patients with CRC-PM. The established nomogram demonstrated high accuracy in predicting OS for patients with CRC-PM, indicating its potential as a valuable prognostic tool for this patient population.

Keywords: Colorectal cancer; Peritoneal metastasis; Neutrophil-to-lymphocyte ratio; Hemoglobin; Prognosis; Overall survival

Core Tip: The clinical data of single-center patients in our hospital were analyzed retrospectively. High neutrophil-to-lymphocyte ratio and low hemoglobin are independent predictive risk factors for poor prognosis in patients with peritoneal metastasis of colorectal cancer. The established nomogram predicted the overall survival of patients with colorectal cancer having peritoneal metastasis with high accuracy, indicating its usefulness as a valuable prognostic tool for the designated patient cohort.