Inflammatory indices as prognostic markers in metastatic colorectal cancer patients treated with chemotherapy plus Bevacizumab

Abstract

Background: Validated predictors of sensitivity or resistance to Bevacizumab (Bev) are not available, and Inflammatory Indexes (IIs) has been reported to be useful prognostic factors in various malignant solid tumours, including metastatic colorectal cancer (mCRC). Objectives: To explore the prognostic value of IIs in mCRC patients treated with first-line chemotherapy plus Bev. Design: One hundred and eighty-two patients diagnosed with mCRC and treated with first line chemotherapy plus Bev were considered for this prospective non-pharmacological study. Neutrophil, lymphocyte, platelet, aspartate transaminase (AST) and lactate dehydrogenase (LDH) tests were carried out at baseline and before each treatment cycle, according to clinical practice. Methods: Pre-treatment Systemic Immune-inflammation Index (SII), Colon Inflammatory Index (CII) and Aspartate aminotransferase-Lymphocyte Ratio Index (ALRI) were evaluated to assess a correlation with progression-free survival (PFS) and overall survival (OS). Results: In the overall population, PFS and OS were lower in patients with high SII (HR 1.64, p = 0.006 and HR 1.75, p = 0.004, respectively) and high ALRI (HR 2.13, p = 0.001 and HR 1.76, p = 0.02, respectively), but no difference was detected according to CII value. The multivariate analysis confirmed both SII and ALRI as independent prognostic factors for PFS (HR 1.64 and 2.82, respectively) and OS (HR 1.65 and 2.12, respectively). Conclusion: Our results demonstrate and confirm that IIs, and in particular SII and ALRI, are easy to measure prognostic markers for patient candidates to first line chemotherapy plus Bev for mCRC.

A Clinical Analysis of Anti-Programmed Death-Ligand 1 (PD-L1) Immune Checkpoint Inhibitor Treatments Combined with Chemotherapy in Untreated Extensive-Stage Small-Cell Lung Cancer

“…The Warburg effect refers to the ability of cancer cells to derive energy through glycolysis even under aerobic conditions. Therefore, elevated serum LDH levels may reflect increased cancer cell activation and are associated with poor prognosis in cancer patients [34]. The results of our study are compatible with those of previous studies [19,23,24,[32][33][34][35], and LDH was identified as a factor associated with unfavorable outcomes in extensive-stage SCLC patients who received first-line anti-PD-L1 ICIs combined with chemotherapy.…”

“…Therefore, elevated serum LDH levels may reflect increased cancer cell activation and are associated with poor prognosis in cancer patients [34]. The results of our study are compatible with those of previous studies [19,23,24,[32][33][34][35], and LDH was identified as a factor associated with unfavorable outcomes in extensive-stage SCLC patients who received first-line anti-PD-L1 ICIs combined with chemotherapy. The three female patients in this study had significantly shorter OS than the male patients.…”

“…LDH is an essential enzyme in glycolysis and functions through catalyzing the conversion of pyruvate to lactate. Elevated serum LDH levels have been used as an inflammatory index [34]. The Warburg effect refers to the ability of cancer cells to derive energy through glycolysis even under aerobic conditions.…”

Association of the systemic immune-inflammation index with all-cause and cardiovascular mortality in individuals with rheumatoid arthritis

“…Furthermore, research has shown that SII is associated with a heightened risk of mortality in adults with asthma 33 . Within oncology, studies established SII as an independent prognostic factor for overall mortality, underscoring its potential utility as a prognostic marker 34 , 35 . In cardiac surgery, a meta-analysis involving over 3245 patients revealed that a high preoperative SII significantly predicts an increased risk of postoperative atrial fibrillation, suggesting its value as a predictive biomarker 36 .…”

“…It is derived from a formula incorporating levels of specific immune system markers obtained from complete blood counts, specifically, (platelets × neutrophils) / lymphocytes 7 . Traditionally, SII has been utilized as a mortality predictor for patients with various tumors 6 , 7 , 34 , 36 , cerebrovascular diseases 8 , 9 , 11 , and cardiovascular conditions 9 , 10 , 12 . The scope of SII's application has been broadening, with recent research indicating its potential in forecasting disease severity and monitoring the efficacy of treatments 13 – 17 .…”