Retrospective Cohort Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2025; 17(4): 102862
Published online Apr 27, 2025. doi: 10.4240/wjgs.v17.i4.102862
Early prediction of anastomotic leakage after rectal cancer surgery: Onodera prognostic nutritional index combined with inflammation-related biomarkers
Zi-Yi Zhang, Ke-Jin Li, Xiang-Yue Zeng, Kuan Wang, Subinur Sulayman, Yi Chen, Ze-Liang Zhao
Zi-Yi Zhang, Ke-Jin Li, Xiang-Yue Zeng, Kuan Wang, Subinur Sulayman, Ze-Liang Zhao, Department of Gastrointestinal Surgery, The Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
Yi Chen, Department of Breast and Thyroid Surgery, The Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
Co-corresponding authors: Yi Chen and Ze-Liang Zhao.
Author contributions: Zhang ZY wrote the original draft; Zhang ZY and Li KJ contributed to the data analysis; Zhao ZL led the quality assessments; Wang K, Sulayman S, Chen Y, Zeng XY collected the data. Chen Y and Zhao ZL contributed to the study design and supervision; Chen Y and Zhao ZL contribute equally to this study as co-corresponding authors. All authors have agreed on the manuscript to be submitted. Chen Y, a senior investigator and expert in the field of oncology, played a crucial role in the design and execution of this study. His extensive contributions to both the clinical and experimental aspects of the research were essential in shaping its objectives and ensuring its success. Dr. Chen’s mentorship of junior researchers and his strategic input in data analysis and interpretation further substantiate his leadership role. Additionally, his collaborative efforts in integrating multidisciplinary approaches into the study contributed significantly to its depth and innovation. According to the authorship guidelines and based on his substantial contributions, Chen Y is appropriately listed as a co-corresponding author.
Supported by Natural Science Foundation of Xinjiang Uygur Autonomous Region, No. 2022D01C297.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the Affiliated Cancer Hospital of Xinjiang Medical University (No. K-2024170).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at zlzhao71@163.com. Participants gave informed consent for data sharing.
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: Ze-Liang Zhao, MD, PhD, Director, Doctor, Professor, Research Scientist, Department of Gastrointestinal Surgery, The Affiliated Cancer Hospital of Xinjiang Medical University, No. 789 Suzhou East Street, Xinshi District, Urumqi 830000, Xinjiang Uygur Autonomous Region, China. zlzhao71@163.com
Received: November 1, 2024
Revised: January 29, 2025
Accepted: February 18, 2025
Published online: April 27, 2025
Processing time: 148 Days and 16.7 Hours
Abstract
BACKGROUND

Anastomotic leakage (AL) is a serious complication following rectal cancer surgery and is associated with increased recurrence, mortality, extended hospital stays, and delayed chemotherapy. The Onodera prognostic nutritional index (OPNI) and inflammation-related biomarkers, such as the neutrophil-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), have been studied in the context of cancer prognosis, but their combined efficacy in predicting AL remains unclear.

AIM

To investigate the relationships between AL and these markers and developed a predictive model for AL.

METHODS

A retrospective cohort study analyzed the outcomes of 434 patients who had undergone surgery for rectal cancer at a tertiary cancer center from 2016 to 2023. The patients were divided into two groups on the basis of the occurrence of AL: One group consisted of patients who experienced AL (n = 49), and the other group did not (n = 385). The investigation applied logistic regression to develop a risk prediction model utilizing clinical, pathological, and laboratory data. The efficacy of this model was then evaluated through receiver operating characteristic curve analysis.

RESULTS

In the present study, 11.28% of the participants (49 out of 434 participants) suffered from AL. Multivariate analysis revealed that preoperative levels of the OPNI, NLR, and PLR emerged as independent risk factors for AL, with odds ratios of 0.705 (95%CI: 0.641-0.775, P = 0.012), 1.628 (95%CI: 1.221-2.172, P = 0.024), and 0.994 (95%CI: 0.989-0.999, P = 0.031), respectively. These findings suggest that these biomarkers could effectively predict AL risk. Furthermore, the proposed predictive model has superior discriminative ability, as demonstrated by an area under the curve of 0.910, a sensitivity of 0.898, and a specificity of 0.826, reflecting its high level of accuracy.

CONCLUSION

The risk of AL in rectal cancer surgery patients can be effectively predicted by assessing the preoperative levels of serum nutritional biomarkers and inflammatory indicators, emphasizing their importance in the preoperative evaluation process.

Keywords: Platelet-to-lymphocyte ratio; Neutrophil-to-lymphocyte ratio; Postoperative anastomotic leakage; Ondera prognostic nutritional index; Rectal cancer surgery

Core Tip: This study introduces a novel approach to predict anastomotic leakage (AL) risk in colorectal cancer (CRC) patients. It explored the combined application of the Onodera prognostic nutritional index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio. The results demonstrate that this combination significantly enhances the accuracy of AL prediction, providing a more reliable tool for personalized management of patients with CRC.