ONCOmmunity

Prognostic Significance of Systemic Inflammation Indices by KRAS Status in Patients with Metastatic Colorectal Cancer.

By: Yuji Miyamoto, Takahiko Akiyama, Rikako Kato, Hiroshi Sawayama, Katsuhiro Ogawa, Naoya Yoshida, Hideo Baba

Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan Department of Gastrointestinal Cancer Biology, International Research Centre for Medical Sciences, Kumamoto University, Kumamoto, Japan Division of Translational Research and Advanced Treatment Against Gastrointestinal Cancer, Kumamoto University, Kumamoto, Japan.
2022-2-23; doi: 10.1097/DCR.0000000000002392

Abstract

Background

Systemic inflammation markers are useful prognostic indicators for metastatic colorectal cancer. However, the influence of KRAS genotypes on these markers in metastatic colorectal cancer patients is unclear.

Objective

We evaluated the associations between systems of evaluating pretreatment systemic inflammation and outcomes according to KRAS genotypes in patients with metastatic colorectal cancer.

Setting

This study was conducted at a university hospital.

Design

This was a retrospective study.

Patients

A total of 272 patients (KRAS wildtype [KRASwt]:mutant [KRASMut] = 169:103) who received first-line systemic chemotherapy for metastatic colorectal cancer.

Main

We retrospectively calculated 8 systemic inflammation indices: neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, lymphocyte/monocyte ratio, prognostic nutritional index, Glasgow prognostic score, Naples prognostic score, systemic inflammation score, and systemic immune-inflammation index. Patients were categorized into high or low groups for each index. The prognostic relevance of these indices for overall survival was evaluated according to KRAS genotype.

Results

Kaplan-Meier survival analyses showed that median overall survival significantly differed between the high and low groups for all indices in the KRASwt group but not in the KRASMut group, except for Glasgow prognostic score and lymphocyte/monocyte ratio. Multivariate Cox regression analyses identified all indices as independent prognostic factors. In the KRASwt group, all indices except platelet/lymphocyte ratio had strong prognostic effects, but not in the KRASMut group. Interaction tests indicated that KRAS genotype significantly influenced the prognostic impacts of neutrophil/lymphocyte ratio (p = 0.042), prognostic nutritional index (p = 0.048), Naples prognostic score (p < 0.001), and systemic immune-inflammation index (p = 0.004).

Limitation

A major limitation of this study is the lack of external validation.

Conclusion

The prognostic significance of systemic inflammation indices is more useful in patients with KRASwt metastatic colorectal cancer. See Video Abstract at http://links.lww.com/DCR/B921.