Inflammation-Immunity-Nutrition Score: A Novel Prognostic Score for Patients with Resectable Colorectal Cancer

Abstract

Purpose

This study was designed to investigate the prognostic value of the combination of high-sensitivity C-reactive protein, lymphocyte, and albumin in patients with resectable colorectal cancer.

Patients and Methods

Seven-hundred-and-nineteen patients who underwent colorectal cancer resection in Hubei Cancer Hospital were included. Inflammation-Immunity-Nutrition score (0–6) was constructed based on preoperative high-sensitivity C-reactive protein, lymphocyte, and albumin. Time-dependent receiver operating characteristic curve, decision curve, Kaplan-Meier survival curve, Cox regression, and C-index were conducted to detect the prognostic values of inflammation-immunity-nutrition score. The prognostic values of inflammation-immunity-nutrition score in different subgroups by sex, location of tumor, pathologic stage, and KRAS mutation were also explored. The prognostic performance of inflammation-immunity-nutrition score was further compared with that of other traditional prognostic indicators.

Results

The median follow-up time was 40 months. High inflammation-immunity-nutrition score (>2 scores) presented worse survival, with the adjusted hazard ratios (95% confidence intervals) of 3.106 (2.202–4.380) for overall survival and 2.105 (1.604–2.764) for disease-free survival. Besides, the associations of high inflammation-immunity-nutrition score with overall survival were even stronger in cases with wild type KRAS, with the adjusted hazard ratios (95% confidence intervals) of 4.018 (2.355–6.854). Considering the AUCs, C-indices, and hazard ratios estimates, inflammation-immunity-nutrition score presented better prognostic performance than high-sensitivity modified Glasgow prognostic score, high-sensitivity C-reactive protein to albumin ratio, prognostic nutrition index, carcinoembryonic antigen, and carbohydrate antigen 19-9 for overall survival.

Conclusion

Inflammation-immunity-nutrition score might serve as a powerful prognostic score in patients with colorectal cancer for overall survival, particularly in patients with wild type KRAS.

Keywords:

• high-sensitivity C-reactive protein
• survival
• colorectal cancer
• inflammation

Data Sharing Statement

The data sets generated and analyzed during the current study are available from the corresponding author on reasonable request.

Acknowledgments

We express our appreciations to the participants who contributed to our study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China to Shao-Fa Nie (Grant No. 81974491), the National Natural Science Foundation of China to Li Liu (Grant No. 81302491 and No. 82173602), the Health commission of Hubei Province scientific research project to Li Liu (Grant No. WJ2019Q027), the Applied Basic Research Program of Wuhan Science and Technology Bureau to Xin-Jun Liang (Grant No. 2020020601012250), the Foundation of Chinese Society of Clinical Oncology to Xin-Jun Liang (Grant No. CSCO: Y-HS2019-39 and No. CSCO: Y-QL2019-0351), the Health commission of Hubei Province scientific research project to Xin-Jun Liang (Grant No. WJ2021Z001), the National Key R&D Program of China to Shao-Zhong Wei (Grant No. 2017YFC0908200), the Health commission of Hubei Province scientific research project to Shao-Zhong Wei (Grant No. WJ2019H121), and the Hubei Provincial Natural Science Foundation to Shao-Zhong Wei (Grant No. 2019ACA135).