Sistemik inflamatuar index (SII) ve MELD skoru karaciğer metastatik kolorektal kanserde sağ kalımı öngörebilir mi ?

Öz

Amaç: Bu çalışmada kolorektal kanserlerde (CRC) karaciğer metastazı geliştiği andaki kan nötrofil lenfosit oranı (NLR), platelet lenfosit oranı (PLR) ve model for end-stage liver disease (MELD) skorunun genel sağ kalımı (OS) predikte edip etmediği ve prognositik rollerinin araştırılması amaçlanmıştır. Gereç ve Yöntemler: Onkoloji merkezimizde 2015-2020 yılları arasında takip edilen 1250 kolorektal kanser tanılı hasta retrospektif olarak tarandı ve 203 karaciğer metastatic kolorektal kanserli (LMCRC) hasta çalışmaya dahil edildi. Karaciğer metastazı geliştiği andaki kan NLR, PLR ve MELD skorları retrospektif olarak hesaplandı. Bulgular: NLR oranı 2.5 ve altında olan hastalarda liver specific OS (LSOS) 22 ay (95% C.I: 16.82-27.18) iken, 2.5 üzerinde olanlarda ise 10 ay idi (95% C.I:6.59-13.41) (p=0.004). PLR oranı 150 ve altında olan hastalarda LSOS 19 ay (95% C.I: 14.33-23.36), 150’nin üzerinde olanlarda ise 10 ay idi (95% C.I:5.52-14.47) (p=0.0042). MELD skoru ile LSOS arasında negatif bir korelasyon vardı (r.-0.152, p=0.031). Multivariate regresyon analizinde yüksek NLR oranı LSOS açısından bağımsız prognostic faktör olarak saptandı (HR:95% CI:1.08-1.98). Sonuç: Bu çalışmada yüksek NLR, PLR ve MELD skorunun LMCRC’de daha kötü bir sağ kalımla ilişkili olduğu gösterildi. NLR’nin LSOS için bağımsız prognostik bir faktör olduğu ortaya konuldu. Karaciğer metastazı geliştiği anda bakılan SII ve MELD skoru yüksek olan hastalarda daha yakın bir takip seçenek olabilir.

Anahtar Kelimeler

• NLR
• PLR
• MELD Skoru
• Karaciğer Metastatik Kolorektal Kanser
• Genel Sağ Kalım

Can systemic inflammatory index (SII) and MELD score predict survival in liver metastatic colorectal cancer?

Öz

Aim: In this study, it was aimed to investigate whether the blood neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR) and model for end-stage liver disease (MELD) score at the time of liver metastasis in colorectal cancers (CRC) predict overall survival (OS) and their prognostic roles. Materials and Methods: 1250 colorectal cancer patients followed up in our oncology center between 2015-2020 were retrospectively screened and 203 patients with liver metastatic colorectal cancer (LMCRC) were included in the study. Blood NLR, PLR and MELD scores at the time of liver metastasis were calculated retrospectively . Results: Liver specific OS (LSOS) was 22 months (95% CI: 16.82-27.18) in patients with an NLR ratio of 2.5 or less, while it was 10 months (95% CI: 6.59-13.41) in patients with an NLR rate above 2.5 (p=0.004). LSOS was 19 months (95% CI: 14.33-23.36) in patients with a PLR rate of 150 or less, and 10 months (95% CI: 5.52-14.47) in patients with a PLR rate above 150 (p=0.0042). There was a negative correlation between MELD score and LSOS (r.-0.152, p=0.031). In the multivariate regression analysis, high NLR rate was found to be an independent prognostic factor for LSOS (HR:95% CI:1.08-1.98). Conclusion: In this study, it was shown that higher NLR, PLR and MELD scores are associated with worse survival in LMCRC. NLR was revealed to be an independent prognostic factor for LSOS. Closer follow-up may be an option in patients with high SII and MELD scores when liver metastasis develops.

Anahtar Kelimeler

• NLR
• PLR
• MELD Score
• Liver Metastatic Colorectal Cancer
• Overall Survival

Kaynakça

1. 1. Cummings LC, Payes JD, Cooper GS. Survival after hepatic resection in metastatic colorectal cancer: a population-based study. Cancer. 2007; 109: 718–26
2. 2. de Jong MC, Pulitano C, Ribero D, et al. Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis: an international multi-institutional analysis of 1669 patients. Ann Surg. 2009; 250: 440-8.
3. 3. Tang H, Li B, Zhang A, et al. J. Prognostic Significance of Neutrophil-to-Lymphocyte Ratio in Colorectal Liver Metastasis: A Systematic Review and Meta-Analysis. PLoS One. 2016; 11: 0159447.
4. 4. Erstad DJ, Taylor MS, Qadan M, et al. Platelet and neutrophil to lymphocyte ratios predict survival in patients with resectable colorectal liver metastases. Am J Surg. 2020; 220: 1579-85.
5. 5. Wu Y, Li C, Zhao J, et al. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios predict chemotherapy outcomes and prognosis in patients with colorectal cancer and synchronous liver metastasis. World J Surg Oncol. 2016; 14: 289.
6. 6. Chen DS, Mellman I. Elements of cancer immunity and the cancer-immune set point. Nature. 2017; 541: 321-30.
7. 7. Laviano A, Meguid MM, Inui A, et al. Therapy insight: cancer anorexia-cachexia syndrome–when all you can eat is yourself. Nat Clin Pract Oncol. 2005; 2: 158-65.
8. 8. Lu C, Gao P, Yang Y, et al. Prognostic evaluation of platelet to lymphocyte ratio in patients with colorectal cancer. Oncotarget 2017; 8: 86287–95.

9. 9. Kim IY, You SH, Kim YW. Neutrophil-lymphocyte ratio predicts pathologic tumor response and survival after preoperative chemoradiation for rectal cancer. BMC Surg. 2014; 14: 94.
10. 10. Salerno F, Merli M, Cazzaniga M, et al. MELD score is better than Childe Pugh score in predicting 3-month survival of patients undergoing transjugular intrahepatic portosystemic shunt. J Hepatol 2002; 36: 494–500.
11. 11. Fromer MW, Aloia TA, Gaughan JP, et al. The utility of the MELD score in predicting mortality following liver resection for metastasis. Eur J Surg Oncol. 2016 ; 42: 1568-75.
12. 12. Lau T, Ahmad J. Clinical applications of the model for end-stage liver disease (MELD) in hepatic medicine. Hepat Med 2013; 5: 1–10.
13. 13. Cescon M, Cucchetti A, Grazi GL, et al. Indication of the extent of hepatectomy for hepatocellular carcinoma on cirrhosis by a simple algorithm based on preoperative variables. Arch Surg 2009; 144: 57–63.
14. 14. Simons JP, Hill JS, Ng SC, et al. Perioperative mortality for management of hepatic neoplasm: a simple risk score. Ann Surg 2009; 250: 929–34.
15. 15. Huang XZ, Chen WJ, Zhang X, et al. An elevated platelet-to-lymphocyte ratio predicts poor prognosis and clinicopathological characteristics in patients with colorectal cancer: a meta-analysis. Dis Markers. 2017; 2017: 1053125.
16. 16. Sucandy I, Giovannetti A, Spence J, Ross S, Rosemurgy A. Does preoperative MELD score affect outcomes following robotic hepatectomy for liver tumors? J Robot Surg. 2020; 14: 725-31.
17. 17. Kim YW, Kim SK, Kim CS, et al. Association of serum and intratumoral cytokine profiles with tumor stage and neutrophil lymphocyte ratio in colorectal cancer. Anticancer Res. 2014; 34: 3481–7.
18. 18. Chen ZY, Raghav K, Lieu CH, et al. Cytokine profile and prognostic significance of high neutrophil-lymphocyte ratio in colorectal cancer. Br J Cancer. 2015; 112: 1088–97.
19. 19. Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer. Cell. 2010; 140: 883–99.
20. 20. L. Liang, J. Zhu, H. Jia et al., “Predictive value of pretreatment lymphocyte count in stage II colorectal cancer and in high-risk patients treated with adjuvant chemotherapy,” Oncotarget, 2016; 1014–28
21. 21. G. P. Dunn, L. J. Old, and R. D. Schreiber, “The immunobiology of cancer immunosurveillance and immunoediting,” Immunity, 2004; 137–48.
22. 22. Baranyai Z, Krzystanek M, Jósa V, et al. The comparison of thrombocytosis and platelet-lymphocyte ratio as potential prognostic markers in colorectal cancer. Thromb Haemost. 2014; 111: 483-90.
23. 23. Ikeda M, Furukawa H, Imamura H, et al. Poor prognosis associated with thrombocytosis in patients with gastric cancer. Ann Surg Oncol 2002; 9: 287-91.
24. 24. Verheul HM, Hoekman K, Lupu F, et al. Platelet and coagulation activation with vascular endothelial growth factor generation in soft tissue sarcomas. Clin Cancer Res 2000; 6: 166-71.
25. 25. Tsuruo T, Fujita N. Platelet aggregation in the formation of tumour metastasis. Proc Jpn Acad Ser B Phys Biol Sci 2008; 84: 189-98.
26. 26. Huo TI, Hsia CY, Huang YH et al. Selecting a short-term prognostic model for hepatocellular carcinoma: comparison between the model for end-stage liver disease (MELD), MELD-sodium, and five cancer staging systems. J Clin Gastroenterol. 2009; 43: 773-81.
27. 27. Kondo T, Okabayashi K, Hasegawa H, Tsuruta M, Shigeta K, Kitagawa Y. The impact of hepatic fibrosis on the incidence of liver metastasis from colorectal cancer. Br J Cancer. 2016; 115: 34-9.
28. 28. Matsusue R, Kubo H, Hisamori S, et al. Hepatic stellate cells promote liver metastasis of colon cancer cells by the action of SDF-1/CXCR4 axis. Ann Surg Oncol 2009; 16: 2645–53.
29. 29. Shen A, Chen H, Chen Y, et al. Pien Tze Huang overcomes multidrug resistance and epithelial mesenchymal transition in human colorectal carcinoma cells via suppression of TGF-beta pathway. Evid Based Complement Alternat Med 2014: 679436.