Predictive Value of the Prognostic Nutritional Index in Neoadjuvant Chemoradiotherapy for Rectal Cancer

Murai, Chika; Matsuhashi, Nobuhisa; Tomita, Hiroyuki; Takahashi, Takehiro; Suetsugu, Tomonari; Tajima, Jesse Yu; Kiyama, Shigeru; Yasufuku, Itaru; Tanaka, Yoshihiro; Okumura, Naoki; Murase, Katsutoshi; Futamura, Manabu; Kawaguchi, Masaya; Ishihara, Takuma; Miyazaki, Tatsuhiko; Hara, Akira; Yoshida, Kazuhiro

doi:10.21873/cdp.10074

Cited by 4 publications

(5 citation statements)

References 47 publications

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“…Likewise, lymphocytes are involved in anti‐tumoral immunity, and lymphocyte dysfunction or imbalance is associated with cancer progression 28 . Previous studies have shown that pretreatment PNI predicted the outcome in patients with CRC, 29,30 and our results further validated the prognostic value of PNI in patients with BM from CRC. Overall, both malnutrition and immune dysfunction represent unfavorable conditions in the prognosis of patients with cancer.…”

Section: Discussionsupporting

confidence: 77%

“…[25][26][27] Likewise, lymphocytes are involved in anti-tumoral immunity, and lymphocyte dysfunction or imbalance is associated with cancer progression. 28 Previous studies have shown that pretreatment PNI predicted the outcome in patients with CRC, 29,30 Besides the comorbidity indices, our analyses also revealed that the control of the primary CRC and the presence of multiple BM were independent factors that predicted survival. The impact of coexisting extracranial metastases (ECM) and the number of BM at the time of the diagnosis of BM have been reported and were…”

Section: Discussionsupporting

confidence: 50%

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Surgical excision and radiotherapy for brain metastasis from colorectal cancer: How frailty and comorbidity indices influence outcome

Wong,

Chang,

Huang

et al. 2024

The Kaohsiung J of Med Scie

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The incidence of brain metastasis (BM) from colorectal cancer (CRC) is increasing. This study aims to identify the clinical prognosticators and evaluate the prognostic validity of common comorbidity indices in patients with BM from CRC. This retrospective single‐center study analyzed 93 patients with BM from CRC who received surgical excision and/or radiotherapy. The clinical characteristics and prognostic indices including the 5‐item modified frailty index (mFI‐5) and prognostic nutritional index (PNI) were calculated from the collected patient data and analyzed. In this study, 66 (71.0%), 10 (10.8%), and 17 (18.3%) patients received whole‐brain radiotherapy (WBRT) alone, surgery alone, and surgery plus WBRT, respectively. The median survival of all patients was 3.98 months (IQR: 1.74–7.99). The 2‐ and 3‐year survival rates were 7.4% and 3.7%, respectively. Controlled primary tumor (p = 0.048), solitary BM (p = 0.001), surgery + radiation (p < 0.001), and greater PNI (p = 0.001) were independent predictors of favorable survival. In surgically treated patients, uncontrolled primary tumor (p = 0.006), presence of multiple BM (p < 0.001), and MFI‐5 ≥ 2 (p = 0.038) were independent prognosticators. For patients who received WBRT, the presence of two (p = 0.004) or multiple (p < 0.001) BM and PNI (p < 0.001) were independent survival predictors MFI‐5, multiple BM, and the status of the primary tumor were independent prognosticators for patients who underwent surgery for CRCBM. For patients who received WBRT, the PNI and the number of BM were independent survival predictors.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionsupporting

confidence: 50%

Surgical excision and radiotherapy for brain metastasis from colorectal cancer: How frailty and comorbidity indices influence outcome

Wong,

Chang,

Huang

et al. 2024

The Kaohsiung J of Med Scie

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“…Currently, several studies have utilized inflammatory indexes or circulating lymphocyte subsets to predict treatment response in rectal cancers. 24 , 25 , 26 , 27 , 28 , 29 To our knowledge, so far, no study has reported the evaluation of the efficacy of NCRT for rectal MACs using the combination of inflammatory indexes and circulating lymphocyte subsets. In this study, we developed an XGB model based on preoperative clinicopathological parameters, inflammatory indexes, and the circulating lymphocyte subsets to predict treatment response to NCRT in rectal MAC patients.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, several studies have utilized inflammatory indexes or circulating lymphocyte subsets to predict treatment response in rectal cancers 24–29 . To our knowledge, so far, no study has reported the evaluation of the efficacy of NCRT for rectal MACs using the combination of inflammatory indexes and circulating lymphocyte subsets.…”

Section: Discussionmentioning

confidence: 99%

Predictive value of circulating lymphocyte subsets and inflammatory indexes for neoadjuvant chemoradiotherapy response in rectal mucinous adenocarcinoma patients: A machine learning approach

Lin,

Sun,

Jiang

et al. 2024

Cancer Medicine

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IntroductionIn this study, we aimed to evaluate the predictive value of circulating lymphocyte subsets and inflammatory indexes in response to neoadjuvant chemoradiotherapy (NCRT) in patients with rectal mucinous adenocarcinomas (MACs).MethodsRectal MAC patients who underwent NCRT and curative resection at Fujian Medical University Union Hospital's Department of Colorectal Surgery between 2016 and 2020 were included in the study. Patients were categorized into good and poor response groups based on their pathological response to NCRT. An independent risk factor‐based nomogram model was constructed by utilizing multivariate logistic regression analysis. Additionally, the extreme gradient boosting (XGB) algorithm was applied to build a machine learning (ML)‐based predictive model. Feature importance was quantified using the Shapley additive explanations method.ResultsOut of the 283 participants involved in this research, 190 (67.1%) experienced an unfavorable outcome. To identify the independent risk factors, logistic regression analysis was performed, considering variables such as tumor length, pretreatment clinical T stage, PNI, and Th/Tc ratio. Subsequently, a nomogram model was constructed, achieving a C‐index of 0.756. The ML model exhibited higher prediction accuracy than the nomogram model, achieving an AUROC of 0.824 in the training set and 0.762 in the tuning set. The top five important parameters of the ML model were identified as the Th/Tc ratio, neutrophil to lymphocyte, Th lymphocytes, Gross type, and T lymphocytes.ConclusionRadiochemotherapy sensitivity is markedly influenced by systemic inflammation and lymphocyte‐mediated immune responses in rectal MAC patients. Our ML model integrating clinical characteristics, circulating lymphocyte subsets, and inflammatory indexes is a potential assessment tool that can provide a reference for individualized treatment for rectal MAC patients.

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“…Similar to our study, other studies have shown a decrease in PNI levels post-CRT compared with pre-CRT in patients with rectal cancer. They also mentioned that the pre-CRT PNI had an impact on overall survival and disease-free survival [ 15 ]. Okugawa et al [ 16 ] did not find a significant correlation between the pre-CRT PNI and adverse CRT effects, but a low pre-CRT PNI was an independent risk factor for the ineffectiveness of CRT.…”

Section: Discussionmentioning

confidence: 99%

Clinical influence of neoadjuvant chemoradiotherapy on immunonutritional status in locally advanced rectal cancer

Lee¹,

Kang²,

Ahn³

et al. 2023

Korean J Clin Oncol

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Purpose: Cancer patients receiving various anti-cancer treatments commonly experience malnutrition, and many studies have reported that nutritional status is associated with survival and prognosis. Although standard neoadjuvant chemoradiotherapy (CRT) is commonly used in patients with locally advanced rectal cancer owing to its tumor-downsizing and downstaging effects, there is a lack of research on the impact of patients’ nutritional status on the efficacy of neoadjuvant CRT.Methods: We investigated the immunonutritional markers before and after long-course neoadjuvant CRT in 131 patients diagnosed with locally advanced rectal cancer from March 2013 to March 2022.Results: We divided the patients into two groups: a low prognostic nutritional index (PNI) with a cutoff value of 50.92, and a high PNI. In both groups, significant decreases in lymphocyte count and PNI and an increase in neutrophil-to-lymphocyte ratio (NLR) were observed before and after CRT (P<0.001). Furthermore, a higher proportion of patients experienced adverse effects in the low PNI group than in the high PNI group (76.6% in low PNI vs. 54.8% in high PNI, P=0.013). The most commonly reported CRT-induced adverse effect was lower gastrointestinal tract toxicity.Conclusion: By measuring the PNI and NLR without additional tests prior to starting neoadjuvant CRT in patients with locally advanced rectal cancer, it is possible to predict the risk of acute adverse effects caused by CRT. Additionally, providing external nutritional support to reduce the immunonutritional changes that occur during CRT can decrease side effects and potentially increase treatment compliance.

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Predictive Value of the Prognostic Nutritional Index in Neoadjuvant Chemoradiotherapy for Rectal Cancer

Cited by 4 publications

References 47 publications

Surgical excision and radiotherapy for brain metastasis from colorectal cancer: How frailty and comorbidity indices influence outcome

Surgical excision and radiotherapy for brain metastasis from colorectal cancer: How frailty and comorbidity indices influence outcome

Predictive value of circulating lymphocyte subsets and inflammatory indexes for neoadjuvant chemoradiotherapy response in rectal mucinous adenocarcinoma patients: A machine learning approach

Clinical influence of neoadjuvant chemoradiotherapy on immunonutritional status in locally advanced rectal cancer

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