Abstract
BackgroundInflammation markers have an important effect on tumor proliferation, invasion, and metastasis. Oligometastatic disease (OMD) is an intermediate state between widespread metastases and locally confined disease, where curative strategies may be effective for some patients. We aimed to explore the predictive value of inflammatory markers in patients with oligometastatic colorectal cancer (OMCC) and build a nomogram to predict the prognosis of these patients.MethodsTwo hundred nine patients with OMCC were retrospectively collected in this study. The Kaplan-Meier survival curves and Cox regression analysis were used to estimate overall survival (OS) and progression-free survival (PFS). A multivariate Cox analysis model was utilized to establish the nomogram. The concordance index (C-index), calibration curve, and receiver operating characteristics (ROC) were established to verify the validity and accuracy of the prediction model.ResultsAccording to the multivariate analysis, decreased platelet-to-lymphocyte ratio (PLR) might independently improve OS in patients with OMCC (HR = 2.396, 95% CI 1.391–4.126, P = 0.002). Metastases of extra-regional lymph nodes indicated poor OS (HR = 2.472, 95% CI 1.247–4.903, P = 0.010). While the patients with early N stage had better OS (HR = 4.602, 95% CI 2.055–10.305, P = 0.001) and PFS (HR = 2.100, 95% CI 1.364–3.231, P = 0.007). Primary tumor resection (HR = 0.367, 95% CI 0.148–0.908, P = 0.030) and lower fibrinogen (HR = 2.254, 95% CI 1.246–4.078, P = 0.007) could significantly prolong the OS in patients with OMCC. PLR, metastases of extra-regional lymph nodes, N stage, primary tumor resection, and fibrinogen were used to make up the nomogram. The C-index and area under the curve (AUC) of the ROC in nomogram were 0.721 and 0.772 respectively for OS, showed good consistency between predictive probability of OS and actual survival.ConclusionsDecreased PLR could predict a good prognosis in patients with OMCC. The nomogram including inflammatory factors and clinicopathological markers was credible and accurate to predict survivals in patients with OMCC.
Highlights
Colorectal cancer (CRC) is the third most common cancer [1]
Decreased platelet-to lymphocyte ratio (PLR) could predict a good prognosis in patients with oligometastatic colorectal cancer (OMCC)
The selection criteria for patients were (1) the patient data on laboratory examination, imaging examination, and follow-up data was complete; (2) ultimate diagnosis was confirmed by histopathology; (3) the number of metastatic organs ≤3 and number of total metastatic lesions ≤5 [7]; (4) the metastases identified less 6months after the diagnosis of the primary tumor were defined as synchronous metastases [8]; (5) Eastern Cooperative Oncology Group (ECOG) < 2, patients were required to be > 18 years; (6) patients with other infections, hematologic disease, and other conditions that might affect markers of inflammation were excluded; and (7) patients with brain metastasis and peritoneal metastasis were excluded
Summary
Colorectal cancer (CRC) is the third most common cancer [1]. Metastasis occurs in 21% of patients with the first diagnosis of CRC and distant metastasis would occur in approximately 50% of these patients, resulting in a 5-year OS rate of less than 14% [2]. The OMCC is indolent and moderate compared with the aggressiveness of widespread metastatic cancer, the prognosis of patients with OMCC could be significantly improved with aggressive treatments [9, 10]. These patients could be potentially curable with surgical resection or other local therapies, which is rather promising than the fatal outcome of widespread metastases solid tumors [11]. We aimed to explore the predictive value of inflammatory markers in patients with oligometastatic colorectal cancer (OMCC) and build a nomogram to predict the prognosis of these patients
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