High preoperative CEA and Systemic Inflammation Response Index(C-SIRI) Predict Unfavorable Survival of Resectable Colorectal Cancer

Abstract

Background: CEA and systemic inflammation were reported to correlate with proliferation, invasion and metastasis of colorectal cancer. This study investigated the prognostic significance of the pre-operative CEA and systemic inflammation response index (C-SIRI) in patients with resectable colorectal cancer. Methods: 217 CRC patients were recruited from Chongqing Medical University, the first affiliated hospital, between January 2015 and December 2017. Baseline characteristics, preoperative CEA level and peripheral monocyte, neutrophil and lymphocyte counts were retrospectively reviewed. The optimal cutoff value for SIRI was defined as 1.1, and for CEA, the best cutoff values were 4.1 ng/l and 13.0 ng/l. Patients with low levels of CEA (＜4.1 ng/l) and SIRI (＜1.1) were assigned a value of 0, those with high levels of CEA (≥13.0 ng/l) and SIRI (≥1.1) were assigned a value of 3, Those with CEA in the (4.1-13.0 ng/l) and SIRI (≥1.1), CEA (≥13.0 ng/l) and SIRI (＜1.1) were assigned a value of 2. Those with CEA (＜4.1 ng/l) and SIRI (≥1.1), CEA in the (4.1-13.0 ng/l) and SIRI (＜1.1) were assigned a value of 1. The prognostic value was assessed based on univariate and multivariate survival analysis. Results: Preoperative C-SIRI was significantly correlated with gender, site, stage, CEA, OPNI, NLR, PLR, and MLR. However, no difference was observed between C-SIRI and age, BMI, family history of cancer, adjuvant therapy, and AGR groups. Among these indicators, the correlation between PLR and NLR is the strongest. In addition, high preoperative C-SIRI was significantly correlated with poorer overall survival (OS) (HR: 2.782, 95%CI: 1.630-4.746, P<0.001) based on univariate survival analysis. Moreover, it remained an independent predictor for OS (HR: 2.563, 95%CI: 1.419-4.628, p=0.002) in multivariate Cox regression analysis. Conclusion: Our study showed that preoperative C-SIRI could serve as a significant prognostic biomarker in patients with resectable colorectal cancer.