| Background and aims:Although rectal cancer is predominantly a disease of older patients,current guidelines do not incorporate optimal treatment recommendations for the elderly and address only partially the associated specific challenges encountered in this population.This results in a wide variation and disparity in delivering a standard of care to this subset of patients.As the burden of rectal cancer in the elderly population continues to increase,it is crucial to assess whether current recommendations on treatment strategies for the general population can be adopted for older adults,with the same beneficial oncological and functional outcomes.Systemic nutrition and inflammation are critical factors in cancer initiation,evolution,and progression: Recent studies have shown that systemic inflammation and nutritional indicators are prognostic for a variety of malignancies.However,only limited data have so far demonstrated their usefulness in rectal cancer.This study aimed to evaluate the prognostic value of the Systemic immunoinflammatory Index(SII)and Geriatric Nutrition Risk Index(GNRI)in rectal cancer patients who underwent rectal resection.Materials and methods:We retrospectively analyzed the data of rectal cancer patients who underwent radical surgery in Jiangsu Subei People’s Hospital between2016 to 2018.The area under the receiver operating characteristic curve(AUC)was used to compare several commonly used inflammatory and nutritional indicators.Optimal cut-off values of those indicators in predicting overall survival(OS)were determined.The clinicopathological variables of both indexes were compared using the X2 test.Kaplan-Meier curve and the time-dependent receiver operating characteristic(ROC)curve were used to assess the prognostic values and median survival was compared using the log-rank test.In order to investigate the predictive value of each variable we apply a univariate Cox hazard model,then the significant variables in the univariate were used to do multivariate Cox regression analyses.to identify the accuracy of GNRI and SII prognostic factors that were associated with rectal patient survival and postoperative complications we identify their ROC values.Results:A total of 232 patients who underwent rectal surgery and meet the inclusion criteria were included in this study.The average age of cohort participants was 70.12 years,with 65.0% male and 35.0% female patients.In GNRI analysis,there were statistically significant differences in hypertension(p=0.005),depth of invasion(p=0.006),BMI(p<0.001),and operation duration(p<0.001)between the groups with high and low GNRI.Similarly,SII demonstrates significant differences in hypertension(p= 0.044)and lymph node metastases(p <0.001)between the high and low SII groups.During analysis of postoperative complication variables,we found that in addition to Age(p=0.025),intraoperative bleeding(p<0.001),and operation duration(p=0.015),which were statistically significant factors for postoperative complications,the SII(p=0.001)and GNRI(p=0.012)also were significant.Using KM,patients in the high GNRI group significantly survive more than those in the low GNRI group with log-rank p=0.003 and HR=0.49(95%CI=0.29-0.84),On the other hand,those rectal cancer patients in the low SII group had significantly better survival rate compared to those in high SII group by using Kaplan-Meier analysis with log-rank p<0.001 and HR=0.24(95% CI013-0.45).Interestingly,the combination has the highest survival rate in line with patients in high GNRI and low SII groups(p<0.001).Multivariate analysis revealed that age(HR=1.825,95% CI: 1.103-3.017,p=0.019),depth of invasion(HR=1.68,95% CI:1.015-2.78,p = 0.044),lymph node metastasis(HR=2.48,95% CI: 1.43-4.30,p=0.001),distant metastasis(HR=13.89,95% CI: 4.90-39.3,p < 0.001),GNRI(HR=0.46,95%CI: 0.27-0.786,p=0.004)and SII(HR=0.213,95% CI:0.122-0.372,p<0.001)were independent risk factors.The AUC of GNRI was 0.583,the AUC of SII was 0.747,and the AUC of GNRI-SII was 0.767.Conclusion:1.GNRI is an independent prognostic factor for rectal cancer patients’ survival and postoperative complications in which High GNRI is linked with better survival rate.2.SII is also considered as a prognostic factor in which high SII associated with poor prognosis in patients with rectal cancer.3.Combining both indexes SII and GNRI correlated with high predictive value.4.GNRI and SII can be used as tools to evaluate the prognosis of patients before surgery,helping doctors to better treat high-risk patients. |
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