Prognostic role of a new index (multi inflammatory index) in patients with metastatic colorectal cancer: results from the randomized ITACa trial

Andrea Casadei Gardini, Emanuela Scarpi, Martina Valgiusti, Manlio Monti, Silvia Ruscelli, Laura Matteucci, Giulia Bartolini, Bernadette Vertogen, Flavia Pagan, Giulia Rovesti, Giovanni Luca Frassineti, Alessandro Passardi, Andrea Casadei Gardini, Emanuela Scarpi, Martina Valgiusti, Manlio Monti, Silvia Ruscelli, Laura Matteucci, Giulia Bartolini, Bernadette Vertogen, Flavia Pagan, Giulia Rovesti, Giovanni Luca Frassineti, Alessandro Passardi

Abstract

Aims: We created a new index (Multi Inflammatory Index, MII) composed of an inflammatory index [neutrophil-to lymphocyte-ratio (NLR): MII-1; platelet-to-lymphocyte ratio (PLR): MII-2; or systemic immune-inflammation index (SII): MII-3] and C-reactive protein (CRP). Our aim was to evaluate the prognostic and/or predictive capacity of the MII in the randomized ITACa (Italian Trial in Advanced Colorectal Cancer) study on patients with metastatic colorectal cancer undergoing first-line chemotherapy.

Methods: Between November 2007 and March 2012, baseline NLR, PLR; SII and CRP were available for 131 patients, 66 receiving chemotherapy plus bevacizumab and 65 receiving chemotherapy alone.

Results: Patients with low (<25) MII-1 levels had a better outcome than those with high (⩾25) levels: median progression-free survival (PFS) was 12.4 versus 8.9 months [hazard ratio (HR) = 1.74, 95% confidence interval (CI) 1.21-2.51, p = 0.003] and median overall survival (OS) was 30.9 months versus 15.0 months (HR = 2.05, 95% CI 1.40-3.02, p = 0.0002), respectively. Similar results were obtained for patients with low (<1424) MII-2 levels compared with those with high (⩾1424) levels: median PFS was 12.6 versus 8.9 months (HR = 1.95, 95% CI 1.35-2.82, p = 0.0004) and median OS was 32.4 versus 14.6 months, respectively (HR = 2.42, 95% CI 1.64-3.57, p < 0.0001). Patients with low (<6068) MII-3 levels had a longer median PFS and OS than those with high (⩾6068) levels: 12.6 versus 8.9 months (HR = 1.91, 95% CI 1.33-2.76, p = 0.005) and 30.9 versus15.0 months (HR = 2.10, 95% CI 1.43-3.09, p = 0.0002), respectively. Following adjustment for clinical covariates, multivariate analysis confirmed all MII indexes as independent prognostic factors for predicting PFS and OS.

Conclusion: All MII indexes appear to be useful as prognostic markers.

Trial registration: ClinicalTrials.gov identifier: NCT01878422 (registration date: 07/06/2013) https://ichgcp.net/clinical-trials-registry/NCT01878422.

Keywords: bevacizumab; first-line; inflammation; metastatic colorectal cancer; neutrophil-to-lymphocyte ratio; prognosis.

Conflict of interest statement

Conflict of interest statement: The authors declare that there is no conflict of interest.

© The Author(s), 2020.

Figures

Figure 1.
Figure 1.
Flow chart of the study. B, bevacizumab; CT, chemotherapy.
Figure 2.
Figure 2.
Kaplan–Meier curves of progression-free survival (PFS) (A) and overall survival (OS) (B) according to neutrophil-to-lymphocyte ratio (NLR) and high-sensitivity C-reactive protein (hs-CRP); PFS (C) and OS (D) according to platelet-to-lymphocyte ratio (PLR) and hs-CRP; and PFS (E) and OS (F) according to systemic inflammatory index (SII) and hs-CRP.

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Source: PubMed

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