| Objective:1.To assess the predictive value of systemic inflammation response index(SIRI)and its dynamics on the near-term efficacy and long-term prognosis of first-line therapy in patients with metastasis colorectal cancer(mCRC);2.To compare SIRI and neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),monocyte to lymphocyte ratio(MLR)on the prognosis of mCRC patients.Methods:Retrospective analysis of 109 patients with pathologically or imaging confirmed diagnosis of mCRC attending the First Hospital of Shanxi Medical University from April2016 to September 2020.Blood counts,including neutrophil count,platelet count,lymphocyte count,and monocyte count,were collected before first-line treatment and before the first efficacy evaluation in patients with the first confirmed distant metastasis.The NLR,MLR,PLR,and SIRI values of the patients were calculated according to the formula.The subject operating characteristic(ROC)curve was used to derive the best cut-off values for NLR,MLR,PLR and SIRI,and the area under the curve(AUC)was calculated to show the ability to assess each index.Patients were divided into a high SIRI group and a low SIRI group based on the best cut-off value of SIRI.Patients were further divided into high-high,high-low,low-high,and low-low groups based on the dynamic changes before and after SIRI treatment.Comparisons between groups were made using the chi-square test or the Fishier exact probability method.Survival curves were plotted for different groups using the Kaplan-Meier method and survival rates were compared using the Log-rank method.Factors that may affect prognosis were analyzed using Cox proportional risk regression models.Results:The AUC values of SIRI,NLR,MLR,and PLR were 0.728,0.716,0.690,and 0.609,respectively,based on the ROC curves,and the optimal cutoff value of SIRI was determined to be 1.34 based on the Jorden index maximum principle,according to which it was divided into SIRI <1.34(low group)and SIRI ≥1.34(high group).The low SIRI group before first-line treatment was more likely to achieve PR than the high SIRI group,with higher ORR(23.2% and 2.5%,respectively)and DCR(89.9% and 67.5%,respectively),and the differences were statistically significant(all P values < 0.05);ORR and DCR in the group with high or low SIRI before treatment were higher after treatment than in the group with elevated SIRI after treatment(all P values < 0.05);ORR in the chemotherapy combined with targeted therapy group was higher than that in the chemotherapy alone group(P < 0.05).PFS in the low-SIRI group was significantly higher than that in the high-SIRI group,and the difference was statistically significant(P< 0.05);compared with the post-treatment elevated group,PFS in the pre-treatment high or low-SIRI lowered by treatment group was high,and the PFS of patients in the low-low group was significantly longer than that in all other groups(all P values < 0.05);compared with the chemotherapy alone group,PFS in the chemotherapy combined with targeted therapy group was longer,and the difference was statistically significant(P <0.05).Univariate and multifactorial analyses confirmed that changes in pre-treatment SIRI and dynamic SIRI were independently associated with PFS.Conclusion:1.Pretreatment SIRI and its dynamics are predictive of the near-term outcome and prognosis of mCRC patients receiving first-line therapy,and SIRI can be used as an independent prognostic factor.2.mCRC patients may have better near-term outcomes and long-term prognosis when combined with molecularly targeted therapy.3.SIRI has a higher prognostic value compared to NLR,MLR and PLR in determining the prognosis of mCRC patients. |
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