Prognostic significance of prognostic nutritional index and hemoglobin to red cell distribution width ratio in metastatic colorectal cancer patients
Abstract
Aims: Malnutrition and systemic inflammation are poor prognostic factors in cancer. Prognostic nutritional index (PNI) and Hemoglobin to red blood cell distribution witdh (HRR) are considered indicators of malnutrition and systemic inflammation. We aimed to investigate the prognostic importance of PNI and HRR on metastatic colorectal cancer survival.
Methods: We retrospectively reviewed all patients diagnosed with metastatic colorectal cancer treated at Kayseri City Training and Research Hospital and Erciyes University Medical School. PNI is calculated as (serum albumin (g/L) +5 x total lymphocyte count (10⁹/L)). And HRR was calculated as the ratio of hemoglobin (g/dl) and RDW (%). PNI was divided into two groups based on the cut off points 46.175 as PNI high and low. And we compared these two groups according to general characteristics and overall survival. We performed another comparision between HRR low and high groups based on the cut off points 0.8675 according to general characteristics and overall survival. Kaplan Meier method was used to analyse overall survival and compared survival rates with the log-rank test.
Results: We reviewed 346 metastatic colorectal cancer patients and we included 145 of them who fit to inclusion criteria to the study. Univariate analysis revealed that presence of initially metastatic disease, right located tumor, low HRR, low PNI were independent prognostic markers of poor overall survival. In multivariate analysis, presence of initially metastatic disease and low PNI remain statistically significant independent prognostic markers of poor survival. The median overall survival was statistically longer in HRR and PNI low groups than high groups.
Conclusion: Both PNI and HRR are associated with poor overall survival in metastatic colorectal cancer.
References
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- Heinemann V, von Weikersthal LF, Decker T, et al. FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3): a randomised, open-label, phase 3 trial. Lancet Oncol. 2014;15(10):1065-1075.
- Koncina E, Haan S, Rauh S, Letellier E. Prognostic and predictive molecular biomarkers for colorectal cancer: updates and challenges. Cancers (Basel). 2020;12(2):319.
- Silva NCD, Prestes IV, Gontijo WA, Pena GDG. High red blood cell distribution width is associated with a risk of short-term mortality in hospitalized surgical, but not clinical patients. Clin Nutr ESPEN. 2020;39:150-156.
- Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer. Cell. 2010;140(6):883-899.
- Zhang K, Qin W, Zheng Y, et al. Malnutrition contributes to low lymphocyte count in early-stage coronavirus disease-2019. Front Nutr. 2022;8:739216.
- Gupta D, Lis CG. Pretreatment serum albumin as a predictor of cancer survival: a systematic review of the epidemiological literature. Nutr J. 2010;9:69.
- Feng Z, Wen H, Ju X, et al. The preoperative prognostic nutritional index is a predictive and prognostic factor of high-grade serous ovarian cancer. BMC Cancer. 2018;18(1):883.
- Kayikcioglu E, Iscan G. A novel prognostic index for metastatic colon cancer: the prognostic immune nutritional index. Cureus. 2023;15(1):e33808.
- Qi Q, Song Q, Cheng Y, Wang N. Prognostic significance of preoperative prognostic nutritional index for overall survival and postoperative complications in esophageal cancer patients. Cancer Manag Res. 2021;13:8585-8597.
- Tuncel ET, Parvizi M, Kut E, Aydın M, Kasap E. Prognostic significance of hemoglobin/prognostic nutritional index and hemoglobin/red blood cell distribution in rectal cancer. Turk J Gastroenterol. 2023;34(2):128-134.
- Hong C, Wei Y, Jiang J, et al. Associations between lifestyles and neutrophil-lymphocyte and platelet-lymphocyte ratios in colorectal cancer. Asia Pac J Clin Oncol. 2014;10(2):168-174.
- Luvián-Morales J, González-Trejo S, Carrillo JF, et al. Association of the prognostic nutritional index and overall survival in patients with colorectal cancer: a STROBE compliant retrospective cohort study. Cancer Med. 2019;8(7):3379-3388.
- Polański J, Chabowski M, Świątoniowska-Lonc N, et al. Relationship between nutritional status and clinical outcome in patients treated for lung cancer. Nutrients. 2021;13(10):3332.
- Fearon KC, Falconer JS, Slater C, McMillan DC, Ross JA, Preston T. Albumin synthesis rates are not decreased in hypoalbuminemic cachectic cancer patients with an ongoing acute-phase protein response. Ann Surg. 1998;227(2):249-254.
- Canna K, McArdle PA, McMillan DC, et al. The relationship between tumour T-lymphocyte infiltration, the systemic inflammatory response and survival in patients undergoing curative resection for colorectal cancer. Br J Cancer. 2005;92(4):651-654.
- Takamizawa Y, Shida D, Boku N, et al. Nutritional and inflammatory measures predict survival of patients with stage IV colorectal cancer. BMC Cancer. 2020;20(1):1092.
- Siddiqui AD, Piperdi B. KRAS mutation in colon cancer: a marker of resistance to EGFR-I therapy. Ann Surg Oncol. 2010;17(4):1168-1176.
- Wang PF, Song SY, Guo H, Wang TJ, Liu N, Yan CX. Prognostic role of pretreatment red blood cell distribution width in patients with cancer: a meta-analysis of 49 studies. J Cancer. 2019;10(18):4305-4317.
- Wang PF, Song SY, Guo H, Wang TJ, Liu N, Yan CX. Prognostic role of pretreatment red blood cell distribution width in patients with cancer: A meta-analysis of 49 studies. J Cancer. 2019;10(18):4305-4317.
- Rahamim E, Zwas DR, Keren A, et al. The ratio of hemoglobin to red cell distribution width: a strong predictor of clinical outcome in patients with heart failure. J Clin Med. 2022;11(3):886.
Abstract
References
- Xia C, Dong X, Li H, et al. Cancer statistics in China and United States, 2022: profiles, trends, and determinants. Chin Med J (Engl). 2022;135(5):584-590.
- Heinemann V, von Weikersthal LF, Decker T, et al. FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3): a randomised, open-label, phase 3 trial. Lancet Oncol. 2014;15(10):1065-1075.
- Koncina E, Haan S, Rauh S, Letellier E. Prognostic and predictive molecular biomarkers for colorectal cancer: updates and challenges. Cancers (Basel). 2020;12(2):319.
- Silva NCD, Prestes IV, Gontijo WA, Pena GDG. High red blood cell distribution width is associated with a risk of short-term mortality in hospitalized surgical, but not clinical patients. Clin Nutr ESPEN. 2020;39:150-156.
- Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer. Cell. 2010;140(6):883-899.
- Zhang K, Qin W, Zheng Y, et al. Malnutrition contributes to low lymphocyte count in early-stage coronavirus disease-2019. Front Nutr. 2022;8:739216.
- Gupta D, Lis CG. Pretreatment serum albumin as a predictor of cancer survival: a systematic review of the epidemiological literature. Nutr J. 2010;9:69.
- Feng Z, Wen H, Ju X, et al. The preoperative prognostic nutritional index is a predictive and prognostic factor of high-grade serous ovarian cancer. BMC Cancer. 2018;18(1):883.
- Kayikcioglu E, Iscan G. A novel prognostic index for metastatic colon cancer: the prognostic immune nutritional index. Cureus. 2023;15(1):e33808.
- Qi Q, Song Q, Cheng Y, Wang N. Prognostic significance of preoperative prognostic nutritional index for overall survival and postoperative complications in esophageal cancer patients. Cancer Manag Res. 2021;13:8585-8597.
- Tuncel ET, Parvizi M, Kut E, Aydın M, Kasap E. Prognostic significance of hemoglobin/prognostic nutritional index and hemoglobin/red blood cell distribution in rectal cancer. Turk J Gastroenterol. 2023;34(2):128-134.
- Hong C, Wei Y, Jiang J, et al. Associations between lifestyles and neutrophil-lymphocyte and platelet-lymphocyte ratios in colorectal cancer. Asia Pac J Clin Oncol. 2014;10(2):168-174.
- Luvián-Morales J, González-Trejo S, Carrillo JF, et al. Association of the prognostic nutritional index and overall survival in patients with colorectal cancer: a STROBE compliant retrospective cohort study. Cancer Med. 2019;8(7):3379-3388.
- Polański J, Chabowski M, Świątoniowska-Lonc N, et al. Relationship between nutritional status and clinical outcome in patients treated for lung cancer. Nutrients. 2021;13(10):3332.
- Fearon KC, Falconer JS, Slater C, McMillan DC, Ross JA, Preston T. Albumin synthesis rates are not decreased in hypoalbuminemic cachectic cancer patients with an ongoing acute-phase protein response. Ann Surg. 1998;227(2):249-254.
- Canna K, McArdle PA, McMillan DC, et al. The relationship between tumour T-lymphocyte infiltration, the systemic inflammatory response and survival in patients undergoing curative resection for colorectal cancer. Br J Cancer. 2005;92(4):651-654.
- Takamizawa Y, Shida D, Boku N, et al. Nutritional and inflammatory measures predict survival of patients with stage IV colorectal cancer. BMC Cancer. 2020;20(1):1092.
- Siddiqui AD, Piperdi B. KRAS mutation in colon cancer: a marker of resistance to EGFR-I therapy. Ann Surg Oncol. 2010;17(4):1168-1176.
- Wang PF, Song SY, Guo H, Wang TJ, Liu N, Yan CX. Prognostic role of pretreatment red blood cell distribution width in patients with cancer: a meta-analysis of 49 studies. J Cancer. 2019;10(18):4305-4317.
- Wang PF, Song SY, Guo H, Wang TJ, Liu N, Yan CX. Prognostic role of pretreatment red blood cell distribution width in patients with cancer: A meta-analysis of 49 studies. J Cancer. 2019;10(18):4305-4317.
- Rahamim E, Zwas DR, Keren A, et al. The ratio of hemoglobin to red cell distribution width: a strong predictor of clinical outcome in patients with heart failure. J Clin Med. 2022;11(3):886.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Oncology |
| Journal Section | Research Articles |
| Authors | |
| Early Pub Date | October 26, 2023 |
| Publication Date | October 27, 2023 |
| Published in Issue | Year 2023 Volume: 5 Issue: 4 |
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