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Open Access 01-12-2023 | Colorectal Cancer | Research

High preoperative CEA and systemic inflammation response index (C-SIRI) predict unfavorable survival of resectable colorectal cancer

Authors: Hao Cai, Yu Chen, Qiao Zhang, Yang Liu, HouJun Jia

Published in: World Journal of Surgical Oncology | Issue 1/2023

Abstract

Background

CEA and systemic inflammation were reported to correlate with proliferation, invasion, and metastasis of colorectal cancer. This study investigated the prognostic significance of the preoperative CEA and systemic inflammation response index (C-SIRI) in patients with resectable colorectal cancer.

Methods

Two hundred seventeen CRC patients were recruited from Chongqing Medical University, the first affiliated hospital, between January 2015 and December 2017. Baseline characteristics, preoperative CEA level, and peripheral monocyte, neutrophil, and lymphocyte counts were retrospectively reviewed. The optimal cutoff value for SIRI was defined as 1.1, and for CEA, the best cutoff values were 4.1 ng/l and 13.0 ng/l. Patients with low levels of CEA (< 4.1 ng/l) and SIRI (< 1.1) were assigned a value of 0, those with high levels of CEA (≥ 13.0 ng/l) and SIRI (≥ 1.1) were assigned a value of 3, and those with CEA (4.1–13.0 ng/l) and SIRI (≥ 1.1), CEA (≥ 13.0 ng/l), and SIRI (< 1.1) were assigned a value of 2. Those with CEA (< 4.1 ng/l) and SIRI (≥ 1.1) and CEA (4.1–13.0 ng/l) and SIRI (< 1.1) were assigned a value of 1. The prognostic value was assessed based on univariate and multivariate survival analysis.

Results

Preoperative C-SIRI was statistically correlated with gender, site, stage, CEA, OPNI, NLR, PLR, and MLR. However, no difference was observed between C-SIRI and age, BMI, family history of cancer, adjuvant therapy, and AGR groups. Among these indicators, the correlation between PLR and NLR is the strongest. In addition, high preoperative C-SIRI was significantly correlated with poorer overall survival (OS) (HR: 2.782, 95% CI: 1.630–4.746, P < 0.001) based on univariate survival analysis. Moreover, it remained an independent predictor for OS (HR: 2.563, 95% CI: 1.419–4.628, p = 0.002) in multivariate Cox regression analysis.

Conclusion

Our study showed that preoperative C-SIRI could serve as a significant prognostic biomarker in patients with resectable colorectal cancer.

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209–49. https://doi.org/10.3322/caac.21660.CrossRefPubMed

Dekker E, Tanis PJ, Vleugels J, Kasi PM, Wallace MB. Colorectal cancer. Lancet. 2019;394:1467–80. https://doi.org/10.1016/s0140-6736(19)32319-0.CrossRefPubMed

Aggarwal BB, Shishodia S, Sandur SK, Pandey MK, Sethi G. Inflammation and cancer: how hot is the link? Biochem Pharmacol. 2006;72:1605–21. https://doi.org/10.1016/j.bcp.2006.06.029.CrossRefPubMed

Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002;420:860–7. https://doi.org/10.1038/nature01322.CrossRefPubMedPubMedCentral

Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer. Cell. 2010;140:883–99. https://doi.org/10.1016/j.cell.2010.01.025.CrossRefPubMedPubMedCentral

Hussain P, Harris CC. Inflammation and cancer: an ancient link with novel potentials. Int J Cancer. 2007;121:2373–80. https://doi.org/10.1002/ijc.23173.CrossRefPubMed

DeNardo DG, Andreu P, Coussens LM. Interactions between lymphocytes and myeloid cells regulate pro- versus anti-tumor immunity. Cancer Metastasis Rev. 2010;29:309–16. https://doi.org/10.1007/s10555-010-9223-6.CrossRefPubMedPubMedCentral

Qian B-Z, Pollard JW. Macrophage diversity enhances tumor progression and metastasis. Cell. 2010;141:39–51. https://doi.org/10.1016/j.cell.2010.03.014.CrossRefPubMedPubMedCentral

Landskron G, De la Fuente M, Thuwajit P, Thuwajit C, Hermoso MA. Chronic inflammation and cytokines in the tumor microenvironment. J Immunol Res. 2014;2014:1–19 Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4036716/.CrossRef

10.

Alorda-Clara M, Torrens-Mas M, Hernández-López R, de la Ibarra Rosa JM, Falcó E, Fernández T. Inflammation- and metastasis-related proteins expression changes in early stages in tumor and non-tumor adjacent tissues of colorectal cancer samples. Cancers. 2022;14:4487.CrossRefPubMedPubMedCentral

11.

Vlodavsky I, Beckhove P, Lerner I, Pisano C, Meirovitz A, Ilan N, et al. Significance of heparanase in cancer and inflammation. Cancer Microenvironment. 2011;5:115–32 Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3399068/. [Cited 2022 May 17].CrossRefPubMedPubMedCentral

12.

Masola V, Zaza G, Gambaro G, Franchi M, Onisto M. Role of heparanase in tumor progression: molecular aspects and therapeutic options. Seminars in Cancer Biol-ogy. 2020;62:86–98.CrossRef

13.

Wang S, Liu Z, Wang L, Zhang X. NF-κB signaling pathway, inflammation and colorectal cancer. Cell Mol Immunol. 2009;6:327–34.CrossRefPubMedPubMedCentral

14.

Desai SJ, Prickril B, Rasooly A. Mechanisms of phytonutrient modulation of Cy-clooxygenase-2 (COX-2) and inflammation related to cancer. Nutr Cancer. 2018;70:350–75.CrossRefPubMedPubMedCentral

15.

Sheng J, Sun H, Yu FB, Li B, Zhang Y, Zhu YT. The role of cyclooxygenase-2 in colorectal cancer. Int J Med Sci. 2020;17:1095–101.CrossRefPubMedPubMedCentral

16.

Zou ZY, Liu HL, Ning N, Li SY, Du XH, Li R. Clinical significance of pre-operative neutrophil lymphocyte ratio and platelet lymphocyte ratio as prognostic factors for patients with colorectal cancer. Oncol Lett. 2016;11:2241–8.CrossRefPubMedPubMedCentral

17.

Xiao W-W, Zhang L-N, You K-Y, Huang R, Yu X, Ding P-R, et al. A low lymphocyte-to-monocyte ratio predicts unfavorable prognosis in pathological T3N0 rectal cancer patients following total mesorectal excision. J Cancer. 2015;6:616–22.CrossRefPubMedPubMedCentral

18.

Zhou J, Wei W, Hou H, Ning S, Li J, Huang B, et al. Prognostic value of C-reactive protein, glasgow prognostic score, and C-reactive protein-to-albumin ratio in colorectal cancer. Front Cell Dev Biol. 2021;9:1–12.CrossRef

19.

Huang H, Liu Q, Zhu L, Zhang Y, Lu X, Wu Y, Liu L. Prognostic value of pre-operative systemic immune-inflammation index in patients with cervical cancer. Sci Rep. 2019;9:3284. https://doi.org/10.1038/s41598-019-39150-0.CrossRefPubMedPubMedCentral

20.

Qi Q, Zhuang L, Shen Y, Geng Y, Yu S, Chen H, Liu L, Meng Z, Wang P, Chen Z. A novel systemic inflammation response index (SIRI) for predicting the survival of patients with pancreatic cancer after chemotherapy. Cancer. 2016;122:2158–67. https://doi.org/10.1002/cncr.30057.CrossRefPubMed

21.

Li S, Lan X, Gao H, Li Z, Chen L, Wang W, Song S, Wang Y, Li C, Zhang H, et al. Systemic Inflammation Response Index (SIRI), cancer stem cells and survival of localised gastric adenocarcinoma after curative resection. J Cancer Res Clin Oncol. 2017;143:2455–68. https://doi.org/10.1007/s00432-017-2506-3.CrossRefPubMed

22.

Cao Y, Zheng X, Hu Y, Li J, Huang B, Zhao N, Liu T, Cai K, Tian S. Levels of systemic inflammation response index are correlated with tumor-associated bacteria in colorectal cancer. Cell Death Dis. 2023;14: https://doi.org/10.1038/s41419-023-05602-9.

23.

Tarantino I, Warschkow R, Worni M, Merati-Kashani K, Köberle D, M SB, A MS, Steffen T, Cerny T, Güller U. Elevated preoperative CEA is associated with worse survival in stage I–III rectal cancer patients. Br J Cancer. 2012;107:266–274. https://doi.org/10.1038/bjc.2012.267.

24.

Forones NM, Tanaka M, Falcão JB. CEA as a prognostic index in colorectal cancer. Sao Paulo Med J. 1997;115:1589–92. https://doi.org/10.1590/s1516-31801997000600006.CrossRefPubMed

25.

Schiefer S, Wirsik, Naita Maren, Kalkum E, Seide SE, Nienhüser H, Müller B, Billeter A, Büchler MW, Schmidt T, Probst P. Systematic review of prognostic role of blood cell ratios in patients with gastric cancer undergoing surgery. Diagnostics. 2022;12:593. https://doi.org/10.3390/diagnostics12030593.

26.

Zhu ZF, Zhuang LP, Zhang CY, Ning ZY, Wang D, Sheng J, Hua YQ, Xie J, Xu LT, Meng ZQ. Predictive role of the monocyte-to-lymphocyte ratio in advanced hepatocellular carcinoma patients receiving anti-PD-1 therapy. Transl Cancer Res. 2022;11:160–70. https://doi.org/10.21037/tcr-21-1760.CrossRefPubMedPubMedCentral

27.

Zhou Q, Su S, You W, Wang T, Ren T, Zhu L. Systemic inflammation response index as a prognostic marker in cancer patients: a systematic review and meta-analysis of 38 cohorts. Dose-Response. 2021;19:155932582110647. https://doi.org/10.1177/15593258211064744.CrossRef

28.

Zhu M, Chen L, Kong X, Wang X, Fang Y, Li X, Wang J. The systemic inflammation response index as an independent predictor of survival in breast cancer patients: a retrospective study. Front Mol Biosci. 2022;9. https://doi.org/10.3389/fmolb.2022.856064.

29.

Zeng X, Liu G, Pan Y, Li Y. Development and validation of immune inflammation–based index for predicting the clinical outcome in patients with nasopharyngeal carcinoma. J Cell Mol Med. 2020;24:8326–49. https://doi.org/10.1111/jcmm.15097.CrossRefPubMedPubMedCentral

30.

Gold P, Freedman SO. Demonstration of tumor-specific antigens in human colonic carcinomata by immunological tolerance and absorption techniques. J Exp Med. 1965;121:439–62. https://doi.org/10.1084/jem.121.3.439.CrossRefPubMedPubMedCentral

31.

Thomson DM, Krupey J, Freedman SO, Gold P. The radioimmunoassay of circulating carcinoembryonic antigen of the human digestive system. Proc Natl Acad Sci. 1969;64:161–7. https://doi.org/10.1073/pnas.64.1.161.CrossRefPubMedPubMedCentral

32.

George PK, Loewenstein MS, O’Brien MJ, Bronstein B, Koff RS, Zamcheck N. Circulating CEA levels in patients with fulminant hepatitis. Dig Dis Sci. 1982;27:139–42. https://doi.org/10.1007/bf01311707.CrossRefPubMed

33.

Becerra AZ, Probst CP, Tejani MA, Aquina CT, González MG, Hensley BJ, Noyes K, Monson JR, Fleming FJ. Evaluating the prognostic role of elevated preoperative carcinoembryonic antigen levels in colon cancer patients: results from the national cancer database. Ann Surg Oncol. 2016;23:1554–61. https://doi.org/10.1245/s10434-015-5014-1.CrossRefPubMed

34.

Spindler BA, Bergquist JR, Thiels CA, Habermann EB, Kelley SR, Larson DW, Mathis KL. Incorporation of CEA improves risk stratification in stage II colon cancer. J Gastrointest Surg. 2017;21:770–7. https://doi.org/10.1007/s11605-017-3391-4.CrossRefPubMed

35.

Kim JY, Kim NK, Sohn SK, Kim YW, Kim K, Hur H, Min BS, Cho CH. Prognostic value of postoperative CEA clearance in rectal cancer patients with high preoperative CEA levels. Ann Surg Oncol. 2009;16:2771–8. https://doi.org/10.1245/s10434-009-0651-x.CrossRefPubMedPubMedCentral

Title: High preoperative CEA and systemic inflammation response index (C-SIRI) predict unfavorable survival of resectable colorectal cancer
Authors: Hao Cai
Yu Chen
Qiao Zhang
Yang Liu
HouJun Jia
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Colorectal Cancer
Colorectal Cancer
Published in: World Journal of Surgical Oncology / Issue 1/2023
Electronic ISSN: 1477-7819
DOI: https://doi.org/10.1186/s12957-023-03056-z

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High preoperative CEA and systemic inflammation response index (C-SIRI) predict unfavorable survival of resectable colorectal cancer

Abstract

Background

Methods

Results

Conclusion

Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions

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Abstract

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