Nutritional and inflammatory status dynamics reflect preoperative treatment response and predict prognosis in locally advanced rectal cancer: A retrospective multi-institutional analysis

Background

Systemic inflammation, as an important host property, is the most representative tumor-host interactions in cancer, and the development of malignant neoplasms may contribute to impairment on nutritional status. This study aimed to investigate the potential ability of nutritional and inflammatory index in predicting neoadjuvant chemoradiotherapy efficacy and prognosis in locally advanced rectal cancer (LARC).

Methods

This study was conducted using multi-institutional data. A total of 507 patients (262 in the training and 245 in the validation cohort) with stage IIA-IIIC LARC fit for neoadjuvant chemoradiotherapy were recruited from 2012 to 2014 were included in this study. Advanced lung cancer inflammation index (ALI) reflected nutritional and inflammatory status. The ALI was calculated as body mass index (BMI) × albumin × neutrophil/lymphocyte. Logistic regression model was used to identify predictive factors for preoperative treatment response. Cox multivariate regression models were used to analyze the factors affecting disease-free survival (DFS) and overall survival (OS).

Results

In the training cohort, patients with high pretreatment ALI were observed to be associated with young patients, never smoked, relatively high BMI, and early-stage pathologic TNM staging. The receiver operating characteristic curve indicated that pretreatment ALI and its changing was the single most important factor determining outcomes than other inflammatory indicators. The 10-year DFS and OS rates of the whole group were 63.6% and 74.1% respectively. Patients with low pretreatment ALI and ALI change had significantly poorer 10-year DFS (P < .001 and P = .001) and 10-year OS (P = .002 and P = .025) rates than those with high ALI and ALI change. Similar findings were observed in the validation cohort. Multivariate analysis revealed that pretreatment ALI (P = .047 and P = .006) and ALI change (P = .027 and P = .041) were identified as independent prognostic factors for DFS. Meanwhile, high pretreatment ALI (P = .020 and P = .010), high systemic immune-inflammation index (SII) change (P = .040 and P = .012) and clinical stage T2-T3 were independent protective factors for OS. Furthermore, multivariate logistic regression analyses revealed that pretreatment ALI, ALI change, and SII change could independently predict efficacy of neoadjuvant chemoradiotherapy.

Conclusion

Our results suggest that as a feasible indicator of nutritional and inflammatory status, the ALI shows better efficiency than other inflammatory indicators in predicting efficacy of neoadjuvant chemoradiotherapy and prognosis.