Relationship between preoperative inflammatory status and survival in patients undergoing curative surgery for colorectal cancer

IF 2.1 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford Pub Date : 2026-02-01 Epub Date: 2025-11-19 DOI:10.1016/j.suronc.2025.102332

Valerio Argiolas , Simona Deidda , Mirko Armas, Luigi Zorcolo, Angelo Restivo

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引用次数: 0

Abstract

Introduction

Colorectal cancer (CRC) is a leading cause of cancer-related morbidity and mortality worldwide. While TNM staging remains the cornerstone for prognostic stratification, growing evidence highlights the role of systemic inflammation and nutritional status in influencing oncologic outcomes. This study aimed to evaluate the prognostic significance of preoperative immunonutritional indices in patients undergoing curative resection for stage I–III CRC.

Methods

This retrospective cohort study included 616 patients treated between January 2013 and December 2021 at a single tertiary center. Preoperative indices—neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), prognostic nutritional index (PNI), and systemic inflammation score (SIS)—were calculated from routine blood tests performed within four weeks prior to surgery. Overall survival (OS) and disease-free survival (DFS) were estimated using Kaplan-Meier curves and Cox proportional hazard models.

Results

After a median follow-up of 61.3 months, 185 deaths (30.0 %) and 74 recurrences (12.0 %) were recorded. All indices demonstrated significant associations with five-year OS and DFS in univariate analysis. In multivariate analysis, PLR>176.9 (HR 1.43; 95 % CI 1.06–1.94; p = 0.02) and LMR≤3 (HR 1.46; 95 % CI 1.8–1.99; p = 0.01) were independently associated with worse OS. For DFS, significant independent predictors of adverse outcomes included NLR>2.95 (HR 1.58; 95 % CI 1.15–2.15; p = 0.004), PLR>176.9 (HR 1.65; 95 % CI 1.20–2.26; p = 0.002), LMR≤3 (HR 1.57; 95 % CI 1.14–2.15; p = 0.006), SII>529.6 (HR 1.46, 95 % CI 1.07–1.99; p = 0.02), and SIS 1–2 (HR 1.43, 95 % CI 1.03–2.06; p = 0.04).

Conclusion

Preoperative immunonutritional indices are independent prognostic markers in nonmetastatic colorectal cancer. Their integration with standard staging system could enhance risk stratification and guide personalized treatment.

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结直肠癌根治性手术患者术前炎症状态与生存的关系

结直肠癌（CRC）是世界范围内癌症相关发病率和死亡率的主要原因。虽然TNM分期仍然是预后分层的基础，但越来越多的证据强调了全身性炎症和营养状况在影响肿瘤预后方面的作用。本研究旨在评估术前免疫营养指标对I-III期结直肠癌根治性切除术患者预后的意义。方法本回顾性队列研究纳入了2013年1月至2021年12月在单一三级中心接受治疗的616例患者。术前指标-中性粒细胞与淋巴细胞比率（NLR），血小板与淋巴细胞比率（PLR），淋巴细胞与单核细胞比率（LMR），全身免疫炎症指数（SII），预后营养指数（PNI）和全身炎症评分(SIS) -通过术前四周内进行的常规血液检查计算。使用Kaplan-Meier曲线和Cox比例风险模型估计总生存期（OS）和无病生存期（DFS）。结果中位随访61.3个月，死亡185例（30.0%），复发率74例（12.0%）。在单变量分析中，所有指标均与5年OS和DFS有显著相关性。在多因素分析中，PLR> = 176.9 （HR 1.43; 95% CI 1.06-1.94; p = 0.02）和LMR≤3 （HR 1.46; 95% CI 1.8-1.99; p = 0.01）与OS较差独立相关。对于DFS，不良结局的重要独立预测因子包括NLR>；2.95 （HR 1.58; 95% CI 1.15-2.15; p = 0.004）、PLR>176.9 （HR 1.65; 95% CI 1.20-2.26; p = 0.002）、LMR≤3 （HR 1.57; 95% CI 1.14-2.15; p = 0.006）、SII>529.6 （HR 1.46, 95% CI 1.07-1.99; p = 0.02）和SIS 1-2 （HR 1.43, 95% CI 1.03-2.06; p = 0.04）。结论术前免疫营养指标是判断非转移性结直肠癌预后的独立指标。与标准分期系统相结合，可加强风险分层，指导个体化治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgical Oncology-Oxford 医学-外科

CiteScore

4.50

自引率

0.00%

发文量

169

审稿时长

38 days

期刊介绍： Surgical Oncology is a peer reviewed journal publishing review articles that contribute to the advancement of knowledge in surgical oncology and related fields of interest. Articles represent a spectrum of current technology in oncology research as well as those concerning clinical trials, surgical technique, methods of investigation and patient evaluation. Surgical Oncology publishes comprehensive Reviews that examine individual topics in considerable detail, in addition to editorials and commentaries which focus on selected papers. The journal also publishes special issues which explore topics of interest to surgical oncologists in great detail - outlining recent advancements and providing readers with the most up to date information.