The Study Of Preoperative Systemic Inflammatory Response Index In Predicting The Prognosis Of Patients With Colorectal Cancer After Radical Resection

Objective:The systemic lnflammation Response Index(SIRI)recently was regarded as a useful prognostic marker for certain types of malignant tumors,based on peripheral lymphocyte,monocyte,neutrophil counts.The purpose of this study is to verify the relationship between SIRI and survival with colorectal caner after curative resection and whether the prognostic value of SIRI was more powerful than other inflammatory response indexes.Methods:A single-center database was used to retrospectively analyze the clinicopatholog-ical data of 690 patients who underwent radical resection for colorectal cancer at the First Affiliated Hospital of Nanchang University between May 2009 and September2016.The data collected included general demographic information(gender,age,etc.),laboratory tests 7 days before surgery(blood routine,tumor markers,etc.),pathological information(general tumor staging,degree of differentiation,postoperat-ive pathological staging,etc.),and postoperative survival time.The 690 patients were divided into two groups: the training cohort(452 patients)and the validation cohort(238 patients).In the training cohort,the best cut-off values of SIRI,NLR,PLR,and MLR were obtained using the Youden index of ROC curves(Youden index).In the training cohort,survival analysis and COX regression model were used to determine the prognostic value of inflammatory markers and establish prediction models,and the models were further validated in the validation cohort.Results:A total of 690 patients were included in the study.In the training cohort,237(52.43%)were male and the mean age at diagnosis was(60.0 ± 3.6)years.The number of patients with stage I,II and III according to the American Joint Committee on Cancer(AJCC)8th edition was 34,54 and 364,respectively;median OS was 81.0months and median follow-up period was 66 months(1-100 months).In the validation cohort,119(50.0%)patients were male and 119(50.0%)female patients with a mean age at diagnosis of 59.5 ± 3.5 years;median OS was 83.0 months and median follow-up period was 70 months(1-100 months).The difference in overall survival time(OS)for colorectal cancer was not statistically significant between the training and validation groups(p=0.83).Patients were divided into high SIRI(>0.76)and low SIRI(<0.76)groups in both cohorts.The overall survival(OS)of patients in the high SIRI group was significantly lower than that in the low SIRI group(p<0.005),and the prognostic predictive power of SIRI was higher than that of NLR,PLR,MLR.Kaplan-Meier curve and COX multifactor analysis yielded TNM stage,degree of tumor differenti-ation,CA19-9,CEA,CA125,SIRI,and gross tumor staging as independent risk factors for overall survival time of colorectal cancer patients.The results from C-index,clinical decision curve analysis,and calibration curve plots showed that our prediction model had better discriminative power and clinical utility than the conventional TNM staging system.Columnar line graphs consisting of clinicopatholo-gical factors and SIRI could effectively predict the prognosis of colorectal cancer patients.Conclusion:1.SIRI is a useful,novel,independent,reliable prognostic marker for the colorectal cancer after radical resection and has the potential to be a superior prognostic index than PLR,MLR,and NLR.2.The nomogram based on SIRI,and conventional clinicopathological indicators showed good performance in predicting the overall survival probability of patients and might serve clinicians to develop individualized treatment strategies.