Abstract
PurposeThis study aimed to elucidate the prognostic significance of a novel inflammation-joined and nutrition-related clinicopathological marker for colorectal cancer (CRC).MethodsVarious factors from preoperative fasting blood samples from 2471 patients with CRC were retrospectively analyzed. Factors related to prognosis were evaluated using univariate and multivariate analyses. The Kaplan–Meier method was used to generate survival curves, while the log-rank test was used to measure survival differences between groups.ResultsUnivariate analysis revealed that C-reactive protein (CRP)/mean corpuscular volume (MCV) ratio, TNM stage, differentiation, right-sided tumor, age, carcinoembryonic antigen (CEA) level, and CRP level were significantly associated with poor prognosis in CRC. In contrast, adjuvant chemotherapy is regarded as a protective factor. Elevation of CRP/MCV ratio (odds ratio [OR]: 1.535, 95% confidence interval [CI]: 1.121–2.104, P = 0.008), TNM stage (OR: 2.747, 95% CI: 2.175–3.469, P < 0.001), and differentiation (OR, 1.384; 95% CI, 1.150–1.666; P = 0.001) were prognostic risk factors in the multivariate analyses. Subgroup analysis showed that CRP/MCV, TNM staging system, and differentiation also independently affected survival in patients with lymph node-positive CRC. The nomogram based on these three indicators showed that CRP/MCV had a greater prognostic value and clinical significance for lymph node-positive patients with poorly differentiated tumors at the late stage.ConclusionA novel nomogram using the clinicopathologic index of inflammation and nutrition was constructed to predict the prognosis of CRC. Early interventions should be emphasized for advanced-stage patients with severe inflammation and poor nutritional status.
Highlights
Colorectal cancer (CRC) is a major health problem worldwide and the third most common cancer and the second leading cause of cancer-related deaths [1]
Few studies have comprehensively evaluated the prognostic value of C-reactive protein (CRP)/mean corpuscular volume (MCV) in CRC [27]. By combining these two accessible factors, CRP and MCV, we propose an applicable inflammationjoined and nutrition-related clinicopathologic marker for overall survival (OS) prediction in colorectal cancer
Except for the N stage and KRAS status, the increased CRP-MCV was associated with males; older age; presenting advanced T stage, M stage, and later TNM stage; accompanied by microsatellite instability; and right-sided and poorly differentiated colon cancer
Summary
Colorectal cancer (CRC) is a major health problem worldwide and the third most common cancer and the second leading cause of cancer-related deaths [1]. CRC is estimated to be the second most common cancer in China and ranks as the fifth leading cause of cancer-related deaths regardless of age and sex [1]. Colorectal tumors are heterogeneous, and individualized risk stratification helps guide clinical treatment. It is well documented that inflammatory and nutritional status are both important factors affecting tumor development and clinical outcomes [2, 3]. Identification of patients who are in danger of a hyperinflammatory state and malnourishment is vital to reduce the risk of surgical complications and mortality, improve clinical outcomes, and relieve the financial burden [2]
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