DETERMINATION OF PREDICTORS OF COLORECTAL CANCER RECURRENCE IN RADICALLY OPERATED PATIENTS

Vitaliia  Kostiuchenko

doi:10.21272/eumj.2024;12(4):996-1006

Vitaliia Kostiuchenko Municipal Non-Profit Enterprise of Sumy Regional Council "Sumy Regional Clinical Oncology Center"; Department of Oncology and Radiology, Medical Institute of Sumy State University, Sumy, Ukraine https://orcid.org/0000-0001-7301-0945

DOI: https://doi.org/10.21272/eumj.2024;12(4):996-1006

Keywords: colorectal cancer, inflammatory markers, recurrence, radical surgery

Abstract

Introduction. The high risk of recurrence of colorectal cancer (CRC) in radically operated patients has become the reason for discussions about the issue of intensification of the observation period and the search for reliable predictors of the course of the disease. Inflammatory markers (IM) have shown promise in this aspect. The main goal of this study was to evaluate IM as predictors of CRC recurrence in radically operated patients. Of secondary importance was to determine which of the patient's and tumor's basic characteristics influence the recurrence-free survival (RFS) and overall survival (OS) in the same cohort of patients.

Materials and Methods. The data of 138 patients from the Municipal Non-Profit Enterprise of Sumy Regional Council "Sumy Regional Clinical Oncology Center" was used for the research. Patients with CRC who underwent radical surgery for stage I–III colon or rectal tumors between December 2019 and December 2020 were included. Gender, age, body mass index (BMI), tumor location, stage, T, N, neoadjuvant and adjuvant therapy, degree of tumor differentiation, and IM were evaluated as potential predictors of disease recurrence. IM were calculated based on data from clinical and biochemical blood tests performed no more than a week before the surgery. The studied IM were: neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), prognostic nutritional index (PNI), advanced lung cancer inflammation index (ALI) and level of lymphocytes x albumin (LA). ROC analysis (AUC≥0.7), Kaplan-Meier method, Log-rank test (p < 0.05) and multivariate Cox regression analysis with the Breslow method (confidence interval (CI) – 95%, p < 0.05) were used for the statistical data processing.

Results. According to the results of the ROC analysis, LA was the only statistically significant IM (AUC=0.7592). LA demonstrated a significant effect on RFS (Log-rank p=0.0000) and OS (Log-rank p=0.0023). Patients with LA<37.5 had a higher risk of relapse and death. According to the result of the multivariate Cox regression analysis with the Breslow method, age (p=0.032), BMI (p=0.048) and LA (p=0.031) were independent factors influencing the RFS and LA (р=0.008) was the only factor influencing the OS.

Conclusions. According to the results of this study, LA was determined as an independent predictor of the course of CRC after radical surgery. Patients with a low LA level had worse RFS and OS. In addition, age and BMI have been identified as basic characteristics of the patient that reliably influence RFS. Patients older than 65 years and overweight patients had a higher risk of disease recurrence.

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