Abstract
AimThe Gustave Roussy Immune Score (GRIm-Score) was originally designed to select cancer patients for immunotherapy, and later was reported to be a novel prognostic scoring system in lung cancer and esophageal cancer. This study was aimed to determine the prognostic role and predictive performance of GRIm-Score in colorectal cancer (CRC) CRC patients.MethodsWe conducted a single-institution study of 1,579 adult CRC patients receiving surgical removal, and those patients were divided into low GRIm-Score group (scores 0, 1) and high GRIm-Score group (scores 2, 3). Propensity score matching (PSM) was executed to balance the potential confounding factors between the two groups. Survival and time-dependent receiver operating characteristic (Td-ROC) analyses were applied to depict the prognostic role and predictive significance of GRIm-Score in CRC patients.ResultsThere were 200 cases CRC patients in high GRIm-Score group and 1,379 cases in low GRIm-Score group. CRC patients with high GRIm-Score correspond with higher level of CEA, CA125, and inflammatory indexes, such as NLR, PLR, SII, PNI, and ALRI. Correlation analysis exhibited that GRIm-Score correlated well with the established inflammatory indexes. Survival analysis revealed that CRC patients in high GRIm-Score group showed worse overall survival (OS, P <0.0001) and disease-free survival (DFS, P <0.0001) compared with those in low GRIm-Score group. Results from multivariate Cox regression implicated that high GRIm-Score was not only a potent prognostic index for unfavorable OS (HR = 1.622, 95%CI: 1.118–2.355, P = 0.0109), but also a potent risk factor for worse DFS (HR = 1.743, 95%CI: 1.188–2.558, P = 0.0045). Td-ROC analysis demonstrated that GRIm-Score exhibited the superior discriminatory power in the prediction of OS and DFS when compared to SII, PNI, and ALRI. Such strong associations between high levels of preoperative GRIm-Score and unfavorable survival outcomes remained robust after PSM analysis.ConclusionGRIm-Score, a novel inflammatory and nutritional risk scoring system, is a potent prognostic index in CRC patients receiving surgical removal. GRIm-Score can be used as an effective and simplified risk stratification tool for postoperative survival prediction of CRC patients.
Highlights
Colorectal cancer (CRC) is still one of the most common malignant neoplasms of the digestive tract [1]
Systemic inflammatory indexes based on leukocytes, such as lymphocyte to monocyte ratio (LMR), platelet to lymphocyte ratio (PLR) [6], and neutrophil to lymphocyte ratio (NLR) have been reported in several malignant cancers as prognostic markers
High systemic inflammatory response assessed by other scoring systems, such as systemic immune-inflammation index (SII) [7], prognostic nutritional index (PNI) [7], and aspartate aminotransferase– lymphocyte ratio index (ALRI) [8] have been proven to be associated with unfavorable survival in patients with CRC
Summary
Colorectal cancer (CRC) is still one of the most common malignant neoplasms of the digestive tract [1]. High systemic inflammatory response assessed by other scoring systems, such as systemic immune-inflammation index (SII) [7], prognostic nutritional index (PNI) [7], and aspartate aminotransferase– lymphocyte ratio index (ALRI) [8] have been proven to be associated with unfavorable survival in patients with CRC. These findings attract attention to create a novel risk scoring system that provides clinicians with objective information for the prognostic prediction and risk stratification
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