Systemic Immune-Inflammation Index Predicts Tumor Recurrence after Radical Resection for Colorectal Cancer

Clinical Significance of the Serum 3'tRF-AlaAGC, Neutrophil to High-Density Lipoprotein Ratio, and Lymphocyte-to-Monocyte Ratio in Breast Cancer with Lymph Node Metastasis

Objective

Breast cancer (BC) is a common malignant tumor among women, the local recurrence, lymph node metastasis (LNM), and distant metastasis are the key factors affecting the prognosis of patients. tRNA-derived small RNAs (tDRs) are non-coding small RNA fragments [16-40 nucleotides (nt) in length] that play an important role in carcinogenesis and can serve as novel biological markers for the diagnosis and prognosis of various tumors. Accumulating evidence suggests that blood-based inflammatory indicators are linked with the pathogenesis of BC. However, the clinical significance of the combination of tDRs and inflammatory indicators in BC patients with LNM is still unclear.

Methods

The serum samples were collected from 175 patients with BC admitted to our hospital during June 2021 and May 2024, and 94 age-matched healthy women, and the clinical data of the research subjects were recorded. Serum 3'tRF-AlaAGC levels were measured using quantitative real-time PCR (qRT-PCR) and the blood-based inflammatory indicators were calculated from peripheral blood samples. Lasso-cox regression and multiple logistic regression were employed for variable selection. Receiver operating characteristic (ROC) was used to calculate the cut-off value of variables. Spearman correlation test was used to examine the correlation between 3'tRF-AlaAGC levels and neutrophil to HDL-C ratio (NHR), lymphocyte-to-monocyte ratio (LMR). A nomogram model for risk assessment of LNM in BC was established by using the rms package of R software.

Results

Serum 3'tRF-AlaAGC levels in BC patients with LNM were significantly higher than that in without LNM [5.17 (1.79, 16.55) vs 11.68 (2.64, 58.74), P=0.009]. The variables screened by Lasso-cox regression including 3'tRF-AlaAGC, NHR and LMR, with optimal cut-off values of 18.78, 2.94 and 5.41, respectively. NHR levels were significantly negatively associated with LMR in low 3'tRF-AlaAGC expression groups (r=-0.209, P=0.021). Multivariate logistic regression analysis confirmed that 3'tRF-AlaAGC (OR: 3.242, 95% CI: 1.583-6.641, P=0.001), NHR (OR: 3.305, 95% CI: 1.543-7.079, P=0.002), and LMR (OR: 0.329, 95% CI: 0.150-0.723, P=0.006) were independent risk factors of BC with LNM. The C-statistic of the nomograms model was 0.704, with a sensitivity of 57.14% and a specificity of 77.14%.

Conclusion

3'tRF-AlaAGC >18.78, NHR > 2.94, and LMR ≤ 5.41 were the independent risk factors of BC with LNM. The nomogram model incorporating 3'tRF-AlaAGC, NHR and LMR can effectively predict the risk of LNM of BC patients.

Association of serum carotenoids and SII among general people, based on NHANES 2001-2006

As a novel inflammatory marker, Systemic Immune-Inflammation Index (SII) has recently been recognized as a prognostic indicator for a variety of diseases including malignant cancers, coronary artery disease, hyperlipidemia, and hepatic steatosis. Carotenoids are a group of abundant lipid-soluble phytochemicals, and studies have suggested that they have antioxidant, antiapoptotic, and anti-inflammatory properties. However, a systematic analysis of the association between serum carotenoids and SII is still lacking. The purpose of this investigation was to explore the association between serum carotenoid concentration and SII. The cross-sectional investigation included general people (age ≥ 20) with complete information on SII and five different serum carotenoids (Trans-lycopene, β-carotene, α-carotene, lutein/zeaxanthin, and β-cryptoxanthin). Multivariate linear regression analyses were used to evaluate the association between serum carotenoids and SII among general people. The potential non-linear relationship was determined using threshold effect analysis and fitted smoothing curves. Subgroup analysis was performed to explore the potential stratified factors. 15903 participants were enrolled in our investigation. Based on multivariate linear regressions, the highest quartiles of serum carotenoids were found significantly associated with SII compared with the lowest quartiles. The results showed the negative association between SII and the concentration of five different serum carotenoids. According to the non-linear analysis, we found that there are non-linear relationships between β-carotene and trans-lycopene and SII in general people with an inflection point of 6.90 (log2-transformed, ug/dL) and 4.01 (log2-transformed, ug/dL), respectively. The results from subgroup analysis provide several potential moderating effects, such as race, current drinker, and age. This study revealed the relationship between the concentration of several serum carotenoids and SII across the general American population. Further prospective and longitude investigations are needed.

Clinical value of systemic immunoinflammatory index in predicting recurrence and metastasis in patients with primary liver cancer

BACKGROUND

Primary liver cancer is a highly aggressive neoplasm with high incidence and mortality. Due to the high ability to metastasis, the 5-year survival rate of patients with primary liver cancer is poor.

AIM

To investigate the clinical value of systemic immunoinflammatory index (SII) in predicting recurrence and metastasis after interventional therapy in patients with primary liver cancer.

METHODS

Total 186 patients with primary liver cancer were included and underwent Transcatheter arterial chemoembolization (TACE), and followed up for 3 years. Then, patients were divided into 110 cases in the recurrent metastasis group and 76 cases in the non-recurrent metastasis group according to presence or absence of recurrence and metastasis. Baseline data, SII and alpha-fetoprotein (AFP) levels were compared. Cox proportional hazards regression analysis was used to analyze factors affecting recurrence and metastasis. ROC curve was used to analyze SII and AFP levels in predicting recurrence and metastasis after interventional therapy in patients. Kaplan-Meier survival curves were used to evaluate the survival of patients.

RESULTS

The SII index and AFP levels in the recurrence and metastasis group were higher than those in the non-recurrence and metastasis group (P < 0.001). Cox proportional hazards regression analysis confirmed tumor size ≥ 5 cm, presence of vascular tumor thrombus, presence of vascular invasion, no tumor capsule, SII index, AFP Levels were closely related to the recurrence and metastasis of patients with primary liver cancer (P < 0.05). ROC curve analysis showed that AUC of SII and AFP predicted recurrence and metastasis after intervention were 0.797 and 0.839, respectively, and the jointed AUC was 0.910. After a 3-years of follow-up, the overall survival rate of the 186 patients was 45.70% (85/186). Kaplan-Meier survival curve analysis showed that patients with high SII levels had shorter survival time than that of patients with low SII levels (P < 0.05).

CONCLUSION

Preoperative SII was closely associated with early recurrence and metastasis, and combined with AFP may have higher value in predicting recurrence and metastasis after interventional therapy in patients with primary liver cancer.

Association of systemic immune-inflammatory index with all-cause and cancer mortality in Americans aged 60 years and older

Background

This research delved into the association between the systemic immune-inflammatory index (SII) and both all-cause and cancer-specific mortality among individuals aged 60 years and above in the United States during the period from 1999 to 2018, with follow-up extending until 31 December 2019. The data utilized was sourced from 4295 population-based participants in the National Health and Nutrition Examination Survey (NHANES).

Methods

To analyze the relationship between SII and mortality, the study employed Cox proportional-risk models, restricted cubic spline curves, survival curves, and subgroup analyses.

Results

The average age of the participants was 70.7 (±7.6) years, the median follow-up duration was 131.7 (±59.8) months, and the all-cause mortality rate stood at 50.5%. Findings from the Cox regression model indicated that, after adjusting for covariates, SII was significantly and linearly related to all-cause mortality (hazard ratio HR = 1.31, 95% confidence interval CI = 1.15-1.48). Moreover, the relationship between SII and cancer mortality exhibited a U-shaped pattern. Results from the survival curves suggested that a higher SII was associated with an augmented risk of both all-cause mortality and cancer mortality.

Conclusion

There is a significant association between higher SII levels and increased risk of all-cause and cancer-specific mortality in the US population aged 60 years and older.

AGR, LMR and SIRI are the optimal combinations for risk stratification in advanced patients with non-small cell lung cancer following immune checkpoint blockers

Due to drug resistance, a majority of patients with non-small cell lung cancer (NSCLC) experience disease progression following immunotherapy. Therefore, there is an urgent need to develop novel biomarkers to predict the prognosis of NSCLC patients. Clinical data from 544 patients with advanced NSCLC who underwent immune checkpoint blockers (ICBs) at our clinical center were collected in this study. The results indicated that low Albumin-Globulin Ratio (AGR) and Lymphocyte-Monocyte Ratio (LMR) and high Systemic Immune-Inflammation Index (SIRI) were significantly correlated with both poor overall survival (OS) and progression-free survival (PFS) in NSCLC patients (P < 0.01). These three indicators collectively formed the most effective combined model for predicting the prognosis of NSCLC. Importantly, risk stratification based on AGR, LMR and SIRI was better than that based on the TNM stage, and served as an independent predictor of OS and PFS. Notably, the nomogram model developed by risk stratification, sex, age, smoking history, and pathological type demonstrated a good ability to predict the 1 to 5-year OS rates for NSCLC patients. In summary, AGR, LMR, and SIRI represented the optimal combined models for forecasting the prognosis of patients with advanced NSCLC who underwent ICBs, offering promising potential as biomarkers to direct personalized clinical interventions.

Diagnostic value of peripheral blood inflammatory indices for clinicopathological profile of colorectal cancer: a retrospective observational study

BACKGROUND

Colorectal cancer (CRC) ranks as the third most prevalent cancer globally and the second leading cause of cancer-related mortality. This study investigates the diagnostic value of peripheral blood inflammatory indices, including the Cancer-Inflammation Prognostic Index (CIPI), Systemic Inflammation Response Index (SIRI), Hemoglobin-Albumin-Lymphocyte-Platelet (HALP) index, Neutrophil-to-Lymphocyte Ratio (NLR), and Platelet-to-Lymphocyte Ratio (PLR), in the early diagnosis of clinicopathological characteristics of CRC.

METHOD

This retrospective observational study involved 224 patients with CRC aged over 45, admitted to Rasoul-Akram Hospital from September 2019 to 2023, undergoing elective CRC surgery. Key demographic and clinicopathological data were collected alongside blood samples to derive inflammatory indices. Univariate and multivariate analyses were applied to determine metastasis and stage predictors. A receiver operating characteristic (ROC) analysis was performed to evaluate the SIRI diagnostic value in differentiating tumors with and without metastasis and the CIPI diagnostic value in differentiating tumors with high and low stage.

RESULTS

The study identified a significant association between elevated SIRI levels and metastasis in univariate analysis (OR = 2.79, CI = 1.12-6.94). Multivariate analysis shows CIPI is associated with advanced tumor stages (OR = 1.97, CI = 1.14-3.38). According to the ROC curve, the optimal cut-off value of SIRI and CIPI was 1.376 (sensitivity 52.6%, specificity 60.8%, AUC = 61.5%) for diagnosing the metastasis and 7.114 (sensitivity 59.8%, specificity 57%, AUC = 57.9%) for diagnosing the tumor stage, respectively.

DISCUSSION

The findings show that a higher SIRI value is associated with a higher chance of metastasis and a higher CIPI value is associated with a higher chance of advanced stages. Furthermore, the study advocates for the integration of these inflammatory indices into clinical practice to facilitate personalized treatment strategies and early diagnosis, enhancing the prognosis and survival in CRC.

Changes in systemic immune-inflammation index (SII) predict the prognosis of patients with hepatitis B-related hepatocellular carcinoma treated with lenvatinib plus PD-1 inhibitors

PURPOSE

This study aimed to evaluate the prognostic significance of changes in inflammatory markers in patients with Hepatitis B virus-related hepatocellular carcinoma (HBV-HCC) treated with first-line lenvatinib plus a programmed cell death protein 1 (PD-1) inhibitor.

METHODS

This study retrospectively included 117 HBV-HCC patients treated with first-line lenvatinib in combination with a PD-1 inhibitor. Independent factors affecting progression-free survival (PFS) and overall survival (OS) were explored based on baseline indicators and inflammatory markers changes after one treatment cycle.

RESULTS

Multivariate analysis revealed that an alpha-fetoprotein (AFP) level ⩾ 400 ng/mL [hazard ratio (HR), 1.69; 95% confidence interval (CI), 1.11-2.58; P = 0.01] was identified as an independent risk factor, platelet-to-neutrophil ratio (PNR) ⩽ 65.43 (HR 0.50; 95% CI 0.30-0.84; P < 0.01 ) and SII ⩽ 539.47 (HR 0.54; 95% CI 0.30-0.96; P = 0.03) were identified as independent protective factors for PFS. Additionally, multivariate analysis demonstrated that AFP ⩾ 400 ng/mL, HBV-HCC patients with diabetes mellitus (DM), and SII > 303.66 were independent risk factors of OS. The patients whose SII had increased after one cycle of treatment showed a poorer PFS (HR 1.61; 95 %CI 1.10-2.37; P = 0.015) and OS (HR 1.76; 95 % CI 1.15-2.70; P = 0.009) than patients whose SII had decreased. The objective response rate (ORR) was higher in the SII-decreased patients (47.5% vs 32.5%, P = 0.11). Mann-Whitney test found a significant difference in therapeutic response between the SII-increased patients and the SII-decreased patients (P = 0.04).

CONCLUSION

SII can be associated with outcomes in patients with HBV-HCC treated with first-line lenvatinib plus PD-1 inhibitors.

Association Between Systemic Immunity-Inflammation Index (SII) and Fatigue, Cancer, and Cancer-Related Fatigue: Insights From NHANES (2005-2018)

OBJECTIVE

To investigate the association between the systemic immunity-inflammation index (SII) and fatigue, cancer, and cancer-related fatigue (CRF) populations.

METHODS

The National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018 provided data for this retrospective cross-sectional study. By dividing the platelet count by the neutrophil count and the lymphocyte count, SII was calculated. Participants were categorized into four groups: normal, fatigue, cancer, and cancer-related fatigue (CRF), with the normal group serving as the reference. Binary logistic regression was applied to assess the correlations. The dose-response relationship between SII and outcomes in the four groups was evaluated using restricted cubic splines. Use threshold effect analysis to determine the optimal SII value for each of the three groups. Stratified and subgroup analyses were performed based on sociodemographic factors and confounders, with specific attention to fatigue severity levels (mild, moderate, severe) in the fatigue and CRF groups.

RESULTS

Data analysis included a total of 32,491 participants, including 14,846 in the normal group, 14,581 in the fatigue group, 1520 in the cancer group, and 1544 in the CRF group. The results of binary logistic regression showed that SII was positively correlated with the fatigue group (1.43[1.33, 1.55]), cancer group (1.67 [1.43, 1.95]) and CRF group (1.93 [1.66, 2.25]). Restricted cubic spline analysis revealed a linear relationship between SII and outcomes. The threshold values (k) for each of these groups were identified as 464.78 × 103 cells/μL, 448.97 × 103 cells/μL, and 454.65 × 103 cells/μL, respectively. Stratified analysis indicates that most groups exhibit significant differences. The subgroup analysis indicated that fatigue severity increased with higher SII levels, with the CRF group exhibiting the highest rate of severe fatigue (171% increase).

CONCLUSION

SII is positively correlated with fatigue, cancer, and CRF in a linear way. Higher SII values are associated with greater fatigue, particularly in the CRF population.

Predictive value of the systemic immune inflammation index in recurrence of atrial fibrillation after radiofrequency catheter ablation

The recurrence of atrial fibrillation (AF) in patients after successful radiofrequency catheter ablation (RFCA) appears to be an unresolved clinical issue and needs to be clearly elucidated. There are many factors associated with AF recurrence, such as duration of AF, male sex, concomitant heart failure, hemodynamic parameters, chronic obstructive pulmonary disease, hypertension, obstructive sleep apnea, hyperthyroidism, smoking and obesity. However, the inflammatory changes are strongly associated with electrical and structural cardiac remodeling, cardiac damage, myocardial fibrotic changes, microvascular dysfunction and altered reparative response. In this context, biomarkers reflecting the different stages of AF pathogenesis deserve thorough investigation. The authors of the retrospective study revealed that one-year recurrence rate of non-valvular AF in the high systemic immune inflammation (SII) index group was significantly increased compared to that of the low SII index group and provided additional predictive value to the APPLE. Furthermore, the authors suggest that this biomarker may help physicians to optimize the selection of AF patients and to develop a personalized treatment approach. In conclusion, the SII index may serve as a valuable indicator of recurrent AF in patients after RFCA and may be a biomarker with plausible predictive value for poor clinical outcomes.

The Clinical Value of the Combined Detection of Systemic Immune-Inflammation Index (SII), Systemic Inflammation Response Index (SIRI), and Prognostic Nutritional Index (PNI) in Early Diagnosis of Gastric Cancer

Objective

Gastric cancer (GC) is a common malignant tumor of the digestive tract. Accumulating studies suggest that inflammation is linked with the pathogenesis of GC. The study delves into novel hematological inflammatory markers, such as systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and prognostic nutritional index (PNI), to explore their potential applications in early diagnosis of GC.

Methods

From October 2020 and August 2024, 1339 GC patients admitted to our hospital were enrolled in this study. The pre-treatment SII, SIRI, and PNI was calculated from peripheral blood samples. Univariate and multivariate logistic regression analyses were utilized to verify independent risk factors for patients, and constructed the nomograms. The correlation between hematological indicators and tumor-node-metastasis (TNM) stage was assessed through Spearman's analysis.

Results

Eligible patients and healthy controls were grouped by gender. The diagnostic ability of PNI was significantly superior to other indicators to diagnose male GC (area under the curve [AUC]=0.908, 95% CI: 0.892-0.925) and female GC (AUC=0.890, 95% CI: 0.865-0.914). Besides, the combination of hematological indicators is more effective in diagnosing GC patients, especially for male patients (AUC=0.916, 95% CI: 0.901-0.932, sensitivity: 84.98%, specificity: 84.29%). The C-statistic of Nomogram model was 0.917 for males and 0.875 for females. In both male and female cohorts, CEA, SII, and SIRI were positively correlated with TNM stage, while PNI was negatively correlated. The AUC of CEA, SII, SIRI, and PNI combined for the diagnosis in the early stage of male GC patients was 0.897 (95% CI: 0.875-0.918, sensitivity: 86.57%, specificity: 80.30%) is higher than that of in the advanced stage (AUC: 0.745, 95% CI: 0.710-0.780, sensitivity: 56.53%, specificity: 82.86%).

Conclusion

The combined CEA, SII, PNI, and SIRI could be used as screening biomarkers in diagnosing GC, especially in the early stage of male GC patients.

Prognostic value and clinicopathological significance of pre-and post-treatment systemic immune-inflammation index in colorectal cancer patients: a meta-analysis

BACKGROUND

In recent years, the association between systemic immune-inflammation index (SII) and the prognosis of patients with colorectal cancer (CRC) has remained a topic of considerable debate. To address this, the present study was carried out to investigate the prognostic significance of SII in CRC.

METHODS

Databases including PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science were scrutinized up to March 27, 2024. The relationship between pre- and post-treatment SII levels and the prognosis of CRC was evaluated. Following literature screening, quality assessment, and extraction of outcome measures, a meta-analysis was conducted using Stata. Publication bias was assessed by funnel plots and Egger's test.

RESULTS

A total of 27 studies were included in the analysis. Pooled results demonstrated that a high SII level was associated with poor overall survival (OS, HR = 1.78, 95% CI = 1.40-2.26), progression-free survival (PFS, HR = 1.80, 95% CI = 1.26-2.56), disease-free survival (DFS, HR = 1.91, 95% CI = 1.43-2.56), and recurrence-free survival (RFS, HR = 3.29, 95% CI = 1.58-6.88). Notably, the association between pre-treatment SII and OS, PFS, and DFS was stronger than that observed for post-treatment SII, indicating that treatment may attenuate the predictive valueof SII for survival outcomes. Additionally, elevated SII was correlated with poor tumor differentiation, tumor location in the rectum, and larger tumor size ≥ 5 cm.

CONCLUSION

Our meta-analysis suggested that a high SII is a predictor of poor prognosis in CRC patients. High SII levels were strongly correlated with inferior OS, PFS, DFS, and RFS. The relationship between SII and survival outcomes was attenuated post-treatment compared to pre-treatment. Additionally, elevated SII was correlated with clinicopathological factors in CRC patients. These findings suggest that SII can serve as an independent prognostic indicator for CRC.

Differential effects of systemic immune inflammation indices on hepatic steatosis and hepatic fibrosis: evidence from NHANES 1999-2018

BACKGROUND

Several studies have demonstrated that systemic immune inflammation index (SII) has a positive relationship with hepatic steatosis. However, it is lack of system evidence for the correlation between SII and hepatic fibrosis. The objective of this study was to evaluate the relationships between SII and hepatic steatosis or hepatic fibrosis.

METHODS

A cross-sectional analysis was performed from the National Health and Nutrition Examination Survey (NHANES). Fibrosis-4 index (FIB-4), NAFLD fibrosis score (NFS) and hepamet fibrosis score (HFS) were the indicators for hepatic fibrosis; fatty liver index (FLI), NAFLD liver fat score (LFS) and Framingham steatosis index (FSI) were the indicators for hepatic steatosis. Pearson's test, generalized linear model (GLM) and restricted cubic splines (RCS) were used to analyze associations of SII with hepatic fibrosis and hepatic steatosis.

RESULTS

A total of 21,833 participants were enrolled in the study. Pearson's test and GLM revealed that there were negative relationships between SII and hepatic fibrosis (FIB-4, NFS and HFS), while positive relationships between SII and hepatic steatosis (FLI, LFS and FSI). The corresponding β (95%CI) of SII and hepatic fibrosis were - 0.35(-0.46, -0.24), -0.67(-0.71, -0.63) and - 0.10(-0.12, -0.09), respectively. The corresponding β (95%CI) of SII and hepatic steatosis were 6.12(4.75, 7.50), 0.22(0.12, 0.31) and 0.27(0.20, 0.34), respectively. Statistically significant non-linear association were found in SII with hepatic fibrosis and hepatic steatosis in RCS model (all P < 0.001).

CONCLUSION

There was a negative significant association between SII and hepatic fibrosis, while a positive significant association between SII and hepatic steatosis.

Prognostic Nutritional Index is Related to All-Cause Mortality in Patients With Stage IV Colorectal Cancer Treated With Capecitabine: Single-Center 24-Month Observational Study in Vietnam

AIM

To determine the mortality rate and the predictive value of the prognostic nutritional index (PNI) for all-cause mortality during the 24 months in patients with stage IV colorectal cancer treated with capecitabine.

METHODS

We conducted a study on 87 stage IV colorectal cancer patients treated with capecitabine. Before the day of treatment, all patients were measured CEA and CRP-hs levels and calculated neutrophil/lympho ratio (NLR) and PNI. Patients were monitored and collected drug side effects and mortality for 24 months.

RESULTS

The mortality rate of study subjects was 60.9%. CRP-hs, NLR, and PNI were independent factors associated with 24-month mortality in patients with stage IV colorectal cancer (p < 0.05 to p < 0.01). At a cut-off value of 38.51, PNI was a predictor for mortality, with the area under the curve (AUC) of 0.88 and p < 0.001.

CONCLUSIONS

PNI was a good predictor of all-cause mortality in patients with stage IV colorectal cancer treated with capecitabine for 24 months.

KRAS Gene Mutation Associated with Grade of Tumor Budding and Peripheral Immunoinflammatory Indices in Patients with Colorectal Cancer

Background

The efficacy of targeted therapy for colorectal cancer (CRC) is affected by hub genes of epidermal growth factor receptor (EGFR) signaling pathways, such as KRAS. Immune cell infiltration may lead to gene mutation, but the relationship between KRAS status and peripheral immune-inflammatory indices has not been clarified in CRC.

Methods

Clinical records of CRC patients were collected. The relationship between KRAS status and clinicopathological characteristics, peripheral immune-inflammatory indices (pan-immune inflammation value (PIV) (monocyte×neutrophil×platelet/lymphocyte), systemic immune inflammation index (SII) (platelet×neutrophil/lymphocyte), and system inflammation response index (SIRI) (monocyte×neutrophil/lymphocyte)) were analyzed.

Results

1033 CRC patients were collected, there were 514 (49.8%) patients with KRAS wild-type and 519 (50.2%) with KRAS mutation. Patients with KRAS mutation had higher proportions of female, III-IV stage, and lymph node metastasis and lower proportion of low grade of tumor budding (the presence of single tumor cells or small clusters of up to 5 cells in mesenchyma at the front of tumor invasion) than those with KRAS wild-type. The PIV, SII, and SIRI levels in KRAS mutation patients were significantly higher than those in KRAS wild-type patients. The proportion of aged ≥65 years old, dMMR, distant metastasis, and KRAS mutation were high in patients with high PIV, SII, and SIRI levels. Logistic regression analysis showed that non-low grade of tumor budding (odds ratio (OR): 1.970, 95% confidence interval (CI): 1.287-3.016, p=0.002), and high SII level (≥807.81 vs <807.81, OR: 1.915, 95% CI: 1.120-3.272, p=0.018) were independently associated with KRAS mutation.

Conclusion

Non-low grade of tumor budding, and high SII level were independently associated with KRAS mutation in CRC. It provides additional references for diagnosis and treatment options for patients with CRC.

The early biomarker of immature granulocyte count in predicting right-side colonic complicated acute diverticulitis: a retrospective cohort study

OBJECTIVE

Early identification of complicated acute diverticulitis(cAD) is especially significant for clinical physician and surgeon to reduce the antibiotic usage and the risk of emergency surgery. This study was aimed to investigate the significance of immature granulocyte(IG) count in early prediction for right-side(Rt-side) cAD.

METHODS

The patients with Rt-side colonic acute diverticulitis was enrolled between January, 2019 and March, 2024, and divided into complicated and simple acute diverticulitis group(cAD and sAD). The data about demographic, clinical and laboratory parameters were collected and compared. Logistic regression analysis and receiver operator characteristic(ROC) curves were used to assess the predictive values of these parameters for Rt-side complicated diverticulitis.

RESULTS

289 participants who met the inclusion criteria were followed as 31 patients in cAD group and 258 in sAD group. Compared to sAD group, cAD group had the higher body mass index(BMI) and peripheral blood routine parameters, especially IG count, systemic immune inflammation index(SII) and neutrophil-to-lymphocyte ratio(NLR), with the statistically significant differences(P<0.001). Moreover, logistic regression analysis indicated that IG count was a significant and independent predictors for cAD(OR 4.92, 95%CI 3.86-8.39). In the ROC analysis, area under the ROC curves (AUC) was found for IG count(0.93(95%CI 0.88-0.99) ) and SII(0.88(95%CI 0.820-0.95)). The optimal cut-off value of IG count was 0.10 with the largest sensitivity of 80.60% and specificity of 100.00% for identifying Rt-side colonic complicated diverticulitis.

CONCLUSION

IG count was a more comparable and independent predictor for Rt-side colonic complicated diverticulitis with a largest AUC than other markers in complete blood count (CBC). Given its early arise, easy accessibility and no-radiation, it can largely convince physicians' decision-making of antibiotic abuse and surgeons' early intervention in Rt-side colonic cAD.

Evaluation of peripheral blood inflammation indexes as prognostic markers for colorectal cancer metastasis

The aim of this study was to evaluate the prognostic value of peripheral blood inflammation indexes in patients with metastatic Colorectal Cancer (CRC) and to establish a predictive scoring system. A total of 324 CRC patients diagnosed through pathological examination from January 2017 to July 2022 at the Third Affiliated Hospital of Kunming Medical University were included. The prognosis of patients with metastatic CRC was examined, and the correlation between IL-10 expression in pathological tissues and IL-10 expression in serum was analyzed. The results showed that the prognosis of CRC was poorer when metastasis occurred (P < 0.001). Additionally, IL-10 was highly expressed in the metastatic CRC group (P = 0.018), and the expression of IL-10 in pathological tissues of patients with metastatic CRC was positively correlated with the expression of IL-10 in serum (P = 0.037). The neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-white blood cell ratio (LWR), aggregate index of systemic inflammation (AISI), monocyte-to-lymphocyte ratio (MLR), systemic inflammatory response index (SIRI), prognostic nutritional index (PNI), advanced lung cancer inflammation index (ALI), and interleukin-10 (IL-10) were calculated and determined by ROC curve. The critical values were 2.135, 3.735, 353.745, 0.265, 1.025, 52.975, 353.635, and 11.25, respectively. Inflammatory indexes with an AUC of more than 0.6 were selected, and each colorectal cancer patient with any of these risk factors was assigned a score of one. The 324 patients were then divided into two groups: 0-4 for the low-risk group and 4-8 for the high-risk group. The occurrence of distant metastases in the two groups was statistically analyzed. The results showed that the OS and PFS of the low-risk group were significantly superior to those of the high-risk group (P < 0.05). These findings indicate that NLR, LWR, AISI, MLR, SIRI, PNI, ALI, and IL-10 are risk factors for distant metastasis in CRC patients. Therefore, the prediction scores of these indexes can be used to effectively evaluate the prognosis of patients with metastatic CRC.

Correlation between Neurotransmitters (Dopamine, Epinephrine, Norepinephrine, Serotonin), Prognostic Nutritional Index, Glasgow Prognostic Score, Systemic Inflammatory Response Markers, and TNM Staging in a Cohort of Colorectal Neuroendocrine Tumor Patients

Neuroendocrine tumors are uncommon in the gastrointestinal system but can develop in the majority of the body's epithelial organs. Our goal was to examine the presence and clinical application of serum dopamine (DA), serotonin (ST), norepinephrine (NE), and epinephrine (EPI), in addition to determining the significance of the Prognostic Nutritional Index (PNI), Glasgow Prognostic Score (GPS), and systemic inflammatory response (SIR) markers as a prognostic factor for patients with colorectal neuroendocrine tumors (CR-NETs), in various tumor-node-metastasis (TNM) stages. We also wanted to identify the possible connection between them. This study included 25 consecutive patients who were diagnosed with CR-NETs and a control group consisting of 60 patients with newly diagnosed colorectal cancer (CRC). We used the Enzyme-Linked Immunosorbent Assay (ELISA) technique. This study revealed that CR-NET patients showed significantly higher serum levels of DA compared to CRC patients. We showed that serum DA was present in the early stages of CR-NETs, with increasing levels as we advanced through the TNM stages. Moreover, we found a close relationship between the levels of DA and the inflammation and nutritional status of the CR-NET patients in this study. CR-NET patients from the PNI < 47.00 subgroup had a higher level of DA than those from the PNI ≥ 47.00 subgroup. Pearson's correlation analysis revealed correlations between DA, PNI, and the neutrophil/lymphocyte ratio (NLR) and the platelet/lymphocyte ratio (PLR). Both hematological indices were negatively correlated with albumin (ALB). Our investigation's findings relating to the PNI, GPS, SIR, and DA indicate that these tools can be markers of nutritional and systemic inflammatory status, are simple to use, and are repeatable. Further research on this topic could provide valuable insights into which biomarkers to incorporate into clinical practice for the management of CR-NET patients.

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

OBJECTIVE

Using the preoperative pan-immune-inflammation value (PIV) and the monocyte to high-density lipoprotein ratio (MHR) to reflect inflammation, immunity, and cholesterol metabolism, we aim to develop and visualize a novel nomogram model for predicting the survival outcomes in patients with colorectal cancer (CRC).

METHODS

A total of 172 patients with CRC who underwent radical resection were retrospectively analyzed. Survival analysis was conducted after patients were grouped according to the optimal cut-off values of PIV and MHR. Univariate and multivariate analyses were performed using Cox proportional hazards regression to screen the independent prognostic factors. Based on these factors, a nomogram was constructed and validated.

RESULTS

The PIV was significantly associated with tumor location (P < 0.001), tumor maximum diameter (P = 0.008), and T stage (P = 0.019). The MHR was closely related to gender (P = 0.016), tumor maximum diameter (P = 0.002), and T stage (P = 0.038). Multivariate analysis results showed that PIV (Hazard Ratio (HR) = 2.476, 95% Confidence Interval (CI) = 1.410-4.348, P = 0.002), MHR (HR = 3.803, 95%CI = 1.609-8.989, P = 0.002), CEA (HR = 1.977, 95%CI = 1.121-3.485, P = 0.019), and TNM stage (HR = 1.759, 95%CI = 1.010-3.063, P = 0.046) were independent prognostic indicators for overall survival (OS). A nomogram incorporating these variables was developed, demonstrating robust predictive accuracy for OS. The area under the curve (AUC) values of the predictive model for 1-, 2-, and 3- year are 0.791,0.768,0.811, respectively. The calibration curves for the probability of survival at 1-, 2-, and 3- year presented a high degree of credibility. Furthermore, Decision curve analysis (DCA) for the probability of survival at 1-, 2-, and 3- year demonstrate the significant clinical utility in predicting survival outcomes.

CONCLUSION

Preoperative PIV and MHR are independent risk factors for CRC prognosis. The novel developed nomogram demonstrates a robust predictive ability, offering substantial utility in facilitating the clinical decision-making process.

Platelet-lymphocyte ratio as a predictor of lymph node metastasis in small bowel cancer

The purpose of this research was to investigate the potential predictive value of preoperative systemic inflammatory indexes in identifying lymph node metastasis among patients diagnosed with small bowel cancer. A retrospective analysis of clinical data was conducted on small bowel cancer patients who underwent surgical treatment at the gastrointestinal surgery department of our hospital between January 2010 and June 2021. Patients were divided into groups based on the presence or absence of lymph node metastasis as confirmed by postoperative pathological results. The study compared the differences in preoperative inflammatory indexes and clinical data between the two groups using single factor analysis and multifactorial Logistic regression analysis. Furthermore, a nomogram model for predicting lymph node metastasis in colorectal cancer was constructed using R software and internally validated. The study sample consisted of 140 small bowel cancer patients,postoperative pathology confirmed lymph node metastasis in 72 cases. Univariate analysis results indicated associations between preoperative inflammatory indexes and clinical data with lymph node metastasis in small bowel cancer. Multifactorial logistic regression analysis revealed that gender, PLR, number of lymph node dissection, and lymphovascular invasion independently influenced lymph node metastasis in small bowel cancer patients. The developed nomogram model demonstrated a C-index of 0.855 (95% CI 0.792-0.917), with a calibrated prediction curve closely resembling the ideal curve. An elevated PLR is an independent risk factor for LNM in patients with small bowel cancer.

Exploratory Evaluation of Pre-Treatment Inflammation Profiles in Patients with Colorectal Cancer

In light of the elevated incidence and consequential prognostic implications associated with colorectal cancer, a comprehensive investigation into the impact exerted by inflammatory status on patient management becomes imperative. A retrospective study spanning 7 years was conducted, involving the retrospective collection of data on colorectal cancer patients undergoing surgical intervention. We evaluated six inflammation ratios derived from complete peripheral blood counts. A thorough analysis of these markers' prognostic capacity was conducted, revealing that patients who died postoperatively displayed significantly higher preoperative Aggregate Index of Systemic Inflammation-AISI (p = 0.014) and Systemic Inflammation Response Index-SII (p = 0.0197) levels compared to those with successful discharge. Noteworthy variations in neutrophil-to-lymphocyte ratio (p = 0.0103), platelet-to-lymphocyte ratio (p = 0.0041), AISI (p < 0.001), and SII (p = 0.0045) were observed in patients necessitating postoperative Intensive Care Unit (ICU) monitoring. Furthermore, patients with complications, such as an intestinal fistula, exhibited significantly elevated AISI (p = 0.0489). Inflammatory biomarkers stand out as valuable prognostic tools for colorectal cancer patients, offering potential assistance in predicting their prognosis.