D'Acapito F, Framarini M, Di Pietrantonio D, Ercolani G. Personalized treatment selection in colorectal cancer with peritoneal metastasis: Do we need statistically validated indicators or cultural shift? World J Gastrointest Oncol 2025; 17(4): 104110 [DOI: 10.4251/wjgo.v17.i4.104110]
Corresponding Author of This Article
Fabrizio D'Acapito, General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Via Carlo Forlanini 34, Forli 47121, Emilia-Romagna, Italy. fabrizioda@gmail.com
Research Domain of This Article
Oncology
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Apr 15, 2025; 17(4): 104110 Published online Apr 15, 2025. doi: 10.4251/wjgo.v17.i4.104110
Personalized treatment selection in colorectal cancer with peritoneal metastasis: Do we need statistically validated indicators or cultural shift?
Fabrizio D'Acapito, Massimo Framarini, Daniela Di Pietrantonio, Giorgio Ercolani
Fabrizio D'Acapito, Massimo Framarini, Daniela Di Pietrantonio, Giorgio Ercolani, General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forli 47121, Emilia-Romagna, Italy
Giorgio Ercolani, Department of Medical and Surgical Sciences, University of Bologna, Bologna 40126, Emilia-Romagna, Italy
Author contributions: D’Acapito F wrote the original draft; D'Acapito F and Framarini M contributed to conceptualization, writing, reviewing and editing; Di Pietrantonio D and Ercolani G participated in drafting the manuscript; and all authors have read and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: Fabrizio D'Acapito, General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Via Carlo Forlanini 34, Forli 47121, Emilia-Romagna, Italy. fabrizioda@gmail.com
Received: December 10, 2024 Revised: January 3, 2025 Accepted: January 8, 2025 Published online: April 15, 2025 Processing time: 105 Days and 22.2 Hours
Abstract
The study by Wu et al analyzed the correlation between nutritional and inflammatory markers and prognosis in patients with colorectal cancer peritoneal metastasis. The authors propose the neutrophil-to-lymphocyte ratio (NLR) as a predictor of overall survival (OS) and developed a nomogram incorporating NLR, hemoglobin (Hb), and peritoneal cancer index (PCI) to estimate 1- and 2-year survival. Although the nomogram shows high accuracy, the group of patients analyzed is heterogeneous with respect to the surgical treatment received, and no clear definitions are given for normal Hb and there is no reason for choosing a very high PCI (≥ 20). Patient selection for cytoreductive surgery with hyperthermic intraperitoneal chemotherapy requires a multidisciplinary approach. Over-simplification of the selection pathway may deny access to curative treatments to patients who could benefit. While methodologically sound, the study does not consider the effect of treatment received on OS, thus introducing a potential bias.
Core Tip: In this study, Wu conducted a single-center retrospective analysis on patients with colorectal cancer and peritoneal metastasis. Findings indicate that a high neutrophil-to-lymphocyte ratio and low hemoglobin levels are independent risk factors for poor prognosis in this population. The developed nomogram accurately predicted overall survival for this patient group, demonstrating its potential as a valuable prognostic tool for this population. Over-simplification of the selection pathway may deny access to curative treatments to patients who could benefit.
