Systemic Inflammation Status Relates to Anti-inflammatory Drug Benefit and Survival in Rectal Cancer

Xue Cao; Xiaolin Wang; Heng Wang; Gaopo Xu; Huichuan Yu

doi:10.1016/j.jss.2021.08.028

Systemic Inflammation Status Relates to Anti-inflammatory Drug Benefit and Survival in Rectal Cancer

J Surg Res. 2022 Jan:269:249-259. doi: 10.1016/j.jss.2021.08.028. Epub 2021 Oct 5.

Authors

Xue Cao¹, Xiaolin Wang², Heng Wang², Gaopo Xu², Huichuan Yu³

Affiliations

¹ Department of Oncology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China; Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
² Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
³ Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China; Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China. Electronic address: yuhch5@mail.sysu.edu.cn.

PMID: 34624724
DOI: 10.1016/j.jss.2021.08.028

Abstract

Background: Systemic inflammation status has been recognized as a sensitive marker associated with survival in cancers and anti-inflammatory treatment outcomes in inflammation-derived diseases. This study aimed to investigate the role of systemic inflammation status as a predictive marker for survival and anti-inflammatory treatment benefit in rectal cancer patients.

Methods: A total of 475 patients with stage I-III rectal cancer receiving curative resection were prospectively enrolled. The platelet-neutrophils to lymphocytes ratio (PNLR) that integrates neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios was applied to enable a comprehensive evaluation of systemic inflammation status and investigate its association with survival and nonsteroidal anti-inflammatory drugs (NSAIDs) benefit. Patients were grouped according to baseline PNLR and perioperative use of NSAIDs.

Results: The high-PNLR group had worse 5-y disease-free survival (DFS) compared with the low-PNLR group (61.2% versus 70.9%, P = 0.014). Multivariate analyses confirmed that PNLR was an independent predictor for DFS (hazard ratio [HR] 1.42, 95% CI: 1.03-1.97, P = 0.031). A nomogram including PNLR and other independent prognostic factors was developed and validated to predict DFS. In the high-PNLR subset, NSAIDs group had a 21.3% lower risk of recurrence than non-NSAIDs group (P = 0.009), and multivariate analysis confirmed the independently significant association of perioperative NSAIDs use with better DFS (hazard ratio 0.36, 95% CI 0.16-0.78, P = 0.010). However, this association was not significant in the low-PLR subset.

Conclusions: Baseline PNLR could be used to predict DFS and NSAIDs benefit in rectal cancer patients. This study highlights the potential survival benefit from the anti-inflammatory treatment in the patients with elevated systemic inflammation status in cancer patients.

Keywords: Nonsteroidal anti–inflammatory drugs (NSAIDs); Platelets-neutrophils to lymphocytes ratio (PNLR); Prognostic marker; Rectal cancer; Systemic inflammation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
Blood Platelets
Disease-Free Survival
Humans
Inflammation / drug therapy
Lymphocytes
Neutrophils
Prognosis
Rectal Neoplasms* / drug therapy
Retrospective Studies

Substances

Anti-Inflammatory Agents, Non-Steroidal