Correlation Of Preoperative Inflammatory And Nutritional Indicators With Clinical Characteristics And Prognostic Predictive Value In Patients Undergoing Radical Colorectal Cancer Surgery

Objective: To explore the differences in clinical and pathological characteristics of preoperative systemic immune inflammatory index(SII),nutritional risk index(NRI),platelet lymphocytic ratio(PLR),and neutrophil lymphocytic ratio(NLR)in patients with colorectal cancer(CRC)undergoing radical surgery,To further explore the predictive value of combined indicators SII and NRI(co SII NRI)in the prognosis of patients undergoing radical CRC surgery.Methods: A total of 257 CRC patients treated in the gastrointestinal and hernia Department of the First Affiliated Hospital of Kunming Medical University from December 2015 to December 2020 were analyzed as research objects.All patients underwent radical surgery,and perioperative basic data were collected:gender,age,height,weight,diabetes history,hypertension history,length of stay,hospitalization expenses,and weight changes in half a year;The latest blood routine and biochemical indicators before surgery: absolute value of neutrophils,absolute value of lymphocytes,absolute value of platelets,serum albumin,hemoglobin,tumor markers CEA and CA199;Information on intraoperative and postoperative pathology,including tumor length,tumor location,lymph node metastasis,pTNM staging,gross classification,WHO histological classification,histological grade 2,postoperative chemotherapy,neurological involvement,vascular involvement,N stage,T stage,recent complications,surgical time,postoperative normal dietary interval,and follow-up survival time.It is divided into quantitative data processing and classified data processing.The preoperative SII,NRI,PLR,and NLR values were calculated,and the data in the study were statistically analyzed using statistical software SPSS25.0.The subject working curve(ROC curve)was used to find the maximum Youden index to obtain the optimal cutoff values for SII,NRI,PLR,and NLR.The values were divided into high and low SII groups,high and low NRI groups,high and low PLR groups,and high and low NLR groups.Chi-square test or rank sum test were used to compare the statistical differences between groups;Single factor and multivariate binary logistic regression models were used to analyze the independent risk factors for postoperative complications and prognosis,and the OR value was calculated.Kaplan-Meier survival analysis was used to describe the survival process and draw survival curves.Log Rank test was used to compare the differences in the distribution of survival time between groups;Factors with statistically significant Cox univariate analysis results were included in a multivariate Cox proportional risk model to explore factors affecting survival time,predict survival rate,and calculate risk ratio(HR)and 95% confidence interval(CI)to assess risk.The above statistical analysis is based on a two-sided hypothesis test to α= 0.05 is the test level,and P<0.05 is the statistically significant difference.Results:1.According to the inclusion and exclusion criteria,a total of 257 patients were included.Statistical analysis was conducted based on their data.The age distribution of patients ranged from 21 to 87 years old,with an average of(61.8 ±12.7)years old.Among them,106 patients(41.2%)< 60 years old,and 151 patients(58.8%)≥ 60 years old;147 males(57.2%)and 110 females(42.8%);BMI<18.5 in 17cases(6.6%),18.5 ≤ BMI<24 in 147 cases(57.2%),and BMI ≥ 24 in 93 cases(36.2%);63 cases(24.5%)were complicated with hypertension before operation;21cases(8.2%)were complicated with diabetes before operation;The median length of hospitalization is 15(12,20)days,and the hospitalization cost is 56.6(49.9,63.2)Thousand yuan.The median tumor length in all patients was 4(3,5)cm;Lymph node metastasis was positive in 72 cases(28%);The tumors were located in the rectum in118 cases(45.9%),in the left colon in 71 cases(27.6%),and in the right colon in 68cases(26.4%);The general classification of tumors: 153 cases(59.5%)of ulcer type,104 cases(40.5%)of other types;WHO histological classification: 222 cases(86.4%)of non specific type adenocarcinoma,35 cases(13.6%)of special type adenocarcinoma;Tumor histology grading method: 208 cases(80.9%)were low grade,49 cases(19.1%)were high grade;168 cases(65.4%)underwent postoperative chemotherapy;Tumor nerve invasion occurred in 47 cases(18.3%),and tumor vessel invasion in 52 cases(20.2%);N stage: 166 cases(64.6%)of stage N0,54 cases(21%)of stage N1,and 37 cases(14.4%)of stage N2;T stage: 66 cases(25.7%)in Tis,T1,T2,191 cases(74.3%)in T3,T4;PTNM staging: 46 cases(17.9%)in stage I,115cases(44.7%)in stage II,and 96 cases(37.4%)in stage III;The median surgical time was 3(3,3.5)hours;The median postoperative time interval for normal diet was 8(7,10)days,with 52(20.2%)recent complications;78 patients(30.4%)died within 5years;The median CEA of tumor markers was 4.03(2.66,8.245)ng/ml and the median CA199 was 11.9(6.86,20.84)U/ml;The median hemoglobin is 140(123.5154)g/L;The median serum albumin was 42.5(39.25,45.6)g/L.The median values for SII,NRI,PLR,and NLR were 506(339.2,795.9),103(99,108.7),147.7(106.4,200.9),and 2(1.5,2.83).2.Draw a ROC curve to determine the optimal cutoff values for predicting survival for SII,NRI,PLR,and NLR using the maximum Youden index(sensitivity+specificity-1),with the optimal values being 730.6,99.9,180.7,and2.39,respectively;Area Under Curve(AUC)is 0.676,0.803,0.656,and 0.666,respectively.The maximum values of the Youden index are 0.345,0.507,0.326,and0.296,respectively(Figure 1).According to the optimal cutoff value,they were divided into high SII and low SII groups,high NRI and low NRI groups,high PLR and low PLR groups,and high NLR and low NLR groups.SII ≥ 730.6 in 70 cases(27.2%),NRI ≥ 99.9 in 183 cases(71.2%),PLR ≥ 180.7 in 80 cases(31.1%),and NLR ≥ 2.39 in 92 cases(35.8%).3.The high SII,PLR,and NLR groups were significantly associated with colon site tumors,recent complications,higher mortality,lower serum albumin content,and low NRI groups;The high SII and PLR groups were significantly correlated with the type of ulcerative tumor,longer hospital stay,and low hemoglobin content;High SII and NLR groups were associated with larger tumor length and diameter;In addition,the high SII group was associated with postoperative chemotherapy and longer surgical time;The high PLR group was associated with lower BMI levels;The high NLR group was significantly associated with men and late T staging.The above differences were statistically significant(P<0.05).The low NRI group was significantly associated with older age,lower BMI,recent complications,late T staging,late pTNM staging,higher mortality,larger tumor length,longer hospitalization days,more hospitalization costs,low serum albumin content,low hemoglobin content,and high SII groups,with significant differences(P<0.05).4.pTNM stage(OR=1.821,95% CI 1.015-3.266,P=0.044),tumor length and diameter(cm)(OR=1.221,95% CI 1.018-1.464,P=0.031),surgical time(OR=1.674,95% CI 1.080-2.595,P=0.021),serum albumin content(g/L)(OR=0.855,95% CI 0.758-0.964,P=0.010),and high NLR group(OR=2.609,95% CI1.078-6.315,P=0.033)can be independent predictors of short-term complications in patients undergoing radical surgery for CRC.Age(OR=2.290,95% CI 1.011-5.184,P=0.047),pTNM stage(OR=2.761,95% CI 1.301-5.861,P=0.008),postoperative normal dietary interval(day)(OR=1.130,95% CI 1.038-1.231,P=0.005),and low NRI group(OR=0.251,95% CI 0.082-0.763,P=0.015)can be independent predictors of mortality risk in patients undergoing radical surgery for CRC.5.Vascular invasion(HR=1.972,95% CI 1.077-3.611,P=0.028),postoperative normal dietary interval(days)(HR=1.109,95% CI 1.053-1.169,P<0.001),serum albumin content(HR=0.918,95% CI 0.868-0.971,P=0.003),and co SII-NRI(HR=1.671,95% CI 1.188-2.351,P=0.003)can be considered as independent risk factors affecting the overall 5-year survival of patients undergoing radical surgery for CRC.Conclusions:1.Preoperative SII,NRI,PLR,and NLR are simple,practical,accurate,reliable,low-cost,and repeatable indicators that can reveal the clinical and pathological characteristics of colorectal cancer patients to a certain extent;NRI has the greatest ability to predict the survival rate of CRC patients undergoing radical surgery,followed by SII,and PLR and NLR are similar.2.Late pTNM staging,long tumor length,long surgical time,low serum albumin,and high NLR groups are independent risk factors for short-term postoperative complications in patients undergoing CRC radical surgery.3.The elderly(≥ 60 years old),late pTNM staging,long postoperative normal diet interval,and low NRI group are independent risk factors for mortality in patients undergoing CRC radical surgery.4.Combined indicators SII and NRI(coSII NRI),vascular invasion,preoperative serum albumin levels,and postoperative normal dietary interval are important predictors of prognosis in patients undergoing radical surgery for CRC.