Prognostic Values of Preoperative Inflammatory and Nutritional Markers for Colorectal Cancer

Nannan Zhang; Feilong Ning; Rui Guo; Junpeng Pei; Yun Qiao; Jin Fan; Bo Jiang; Yanlong Liu; Zhaocheng Chi; Zubing Mei; Masanobu Abe; Ji Zhu; Rui Zhang; Chundong Zhang

doi:10.3389/fonc.2020.585083

Prognostic Values of Preoperative Inflammatory and Nutritional Markers for Colorectal Cancer

Front Oncol. 2020 Nov 3:10:585083. doi: 10.3389/fonc.2020.585083. eCollection 2020.

Authors

Nannan Zhang¹, Feilong Ning², Rui Guo³, Junpeng Pei⁴, Yun Qiao³, Jin Fan^{5

6}, Bo Jiang⁷, Yanlong Liu⁸, Zhaocheng Chi⁹, Zubing Mei^{10

11}, Masanobu Abe¹², Ji Zhu^{5

6}, Rui Zhang³, Chundong Zhang^{4

13}

Affiliations

¹ State key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
² Department of General Surgery, Xuzhou Hospital of Traditional Chinese Medicine, Xuzhou, China.
³ Department of Colorectal Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China.
⁴ Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China.
⁵ Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
⁶ Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China.
⁷ Department of Colorectal Anal Surgery, Shanxi Province Cancer Hospital & Institute, Taiyuan, China.
⁸ Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, Harbin, China.
⁹ Second Department of Gastrointestinal Surgery, Jilin Cancer Hospital, Changchun, China.
¹⁰ Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
¹¹ Department of Anorectal Surgery, Anorectal Disease Institute of Shuguang Hospital, Shanghai, China.
¹² Division for Health Service Promotion, University of Tokyo, Tokyo, Japan.
¹³ Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.

Abstract

Background: Increasing evidence indicates that inflammation and nutritional status are associated with survival outcomes in patients with colorectal cancer (CRC). This study aimed to investigate the prognostic values of preoperative inflammatory and nutritional factors and develop a prognostic model individually predicting overall survival (OS) and disease-free survival (DFS) in patients with CRC.

Methods: We retrospectively collected data on patients with CRC who underwent radical surgery. Independent prognostic inflammatory and nutritional markers were identified and novel prognostic models were developed incorporating the identified factors. The discriminative ability and model-fitting performance were evaluated by receiver operating characteristic curves and Akaike information criteria. Clinical usefulness was assessed by decision curve analysis.

Results: A total of 400 eligible patients were identified. Multivariate analysis identified pN stage, tumor differentiation grade, neutrophil count, and body mass index as independent prognostic factors for OS, and pN stage, tumor differentiation grade, neutrophil count, neutrophil-lymphocyte ratio, and serum albumin as prognostic factors for DFS. The combined inflammatory and nutritional prognostic model showed better discriminative ability, model-fitting performance, and net benefits than the inflammatory and nutritional models alone, and the American Joint Committee on Cancer (AJCC) 8th TNM classification for predicting OS and DFS.

Conclusion: Preoperative nutritional and inflammatory factors have significant prognostic value in patients with CRC. A novel prognostic model incorporating preoperative inflammatory and nutritional markers provides better prognostic performance than the AJCC 8th TNM classification. A novel nomogram incorporating preoperative inflammatory and nutritional markers can individually predict OS and DFS in patients with CRC.

Keywords: colorectal cancer; inflammatory status; nutritional status; prognostic model; survival outcome.