Serum and peritoneal biomarkers for the early prediction of symptomatic anastomotic leakage in patients following laparoscopic low anterior resection: A single‐center prospective cohort study

Qi, Xinyu; Tan, Fei; Liu, Mao‐Xing; Xu, Kai; Gao, Pin; Yao, Zhendan; Zhang, Nan; Yang, Hong; Zhang, Cheng-Hai; Xing, Jiadi; Cui, Ming; Su, Xiangqian

doi:10.1002/cnr2.1781

Cited by 6 publications

(1 citation statement)

References 44 publications

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“…Our study also found that postoperative SII is a strong predictor of DFS in patients after radical resection for rectal cancer, which is consistent with the findings of Zhou et al , who discovered that higher postoperative SII in colorectal cancer patients is associated with shorter survival ( 23 ). In addition, Qi et al found that postoperative SII aids in the early prediction of anastomotic leakage after rectal cancer surgery ( 24 ), which has a negative impact on local recurrence and survival rates after rectal cancer surgery, and early prediction and timely treatment can improve patient outcomes ( 25 ), indicating that postoperative SII has certain predictive value for the prognosis of rectal cancer patients.…”

Section: Discussionmentioning

confidence: 99%

Construction and validation of a nomogram for predicting disease-free survival after radical resection of rectal cancer using perioperative inflammatory indicators

Sun,

Zhong,

Yin

et al. 2024

J Gastrointest Oncol

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Background Colorectal cancer is a common digestive tract malignancy that seriously affects patients’ quality of life and survival time. Surgery is the main treatment modality, but postoperative prognosis varies greatly. This study sought to explore the impact of perioperative inflammatory indicators on disease-free survival (DFS) in patients after radical resection of rectal cancer and to construct a nomogram for clinical reference. Methods A retrospective analysis was performed on 304 primary rectal adenocarcinoma patients who underwent laparoscopic radical resection of rectal cancer at the Affiliated Hospital of Xuzhou Medical University from May 1, 2018 to September 30, 2020. The patients were divided into a training set (n=213) and a validation set (n=91) at a ratio of 7:3. The cut-off values of each inflammatory indicator based on the receiver operating characteristic (ROC) curve were determined and each indicator was divided into high and low groups. The least absolute shrinkage and selection operator (LASSO)-Cox regression model was used to analyze the independent risk factors affecting DFS, and a nomogram was established. The model was internally validated using the validation set, and the discrimination, calibration, and clinical application value of the nomogram were evaluated using ROC curve, calibration curve, and clinical decision curve analysis (DCA). Results Tumor-node-metastasis (TNM) stage III, neural invasion, preoperative neutrophil-to-lymphocyte ratio (NLR) ≥1.995, postoperative systemic immune-inflammation index (SII) ≥451.05, and Δpan-immune-inflammation value (ΔPIV) ≥144.36 (P<0.05) were independent factors for predicting the 3-year DFS of patients after rectal cancer surgery. The area under the ROC curve (AUC) of the nomogram was 0.811 [95% confidence interval (CI): 0.778–0.889] in the training set and 0.808 (95% CI: 0.785–0.942) in the validation set. The nomogram showed good calibration, indicating good consistency between predicted and actual risks. DCA demonstrated the clinical utility of the nomogram. Conclusions The nomogram constructed based on TNM stage III, neural invasion, preoperative NLR ≥1.995, postoperative SII ≥451.05, and ΔPIV ≥144.36 can predict the risk of 3-year DFS in patients undergoing curative surgery for rectal cancer, enabling strict postoperative follow-up and timely adjuvant treatment for high-risk patients.

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Section: Discussionmentioning

confidence: 99%

Construction and validation of a nomogram for predicting disease-free survival after radical resection of rectal cancer using perioperative inflammatory indicators

Sun,

Zhong,

Yin

et al. 2024

J Gastrointest Oncol

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Serum and peritoneal biomarkers for the early prediction of symptomatic anastomotic leakage in patients following laparoscopic low anterior resection: A single‐center prospective cohort study

Tan

Liu

et al. 2023

Cancer Reports

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Background Anastomotic leakage (AL) is one of the common complications after rectal cancer surgery. This study aimed to evaluate the combination of biomarkers for the early prediction of symptomatic AL after surgery. Methods A prospective cohort study evaluated the serum and peritoneal biomarkers of patients who underwent laparoscopic low anterior resection (Lap LAR) from November 1, 2021, to May 1, 2022. Multivariate‐penalized logistic regression was performed to explore the independent biomarker with a P‐value <.1, and receiver operating characteristic (ROC) curve was used to analyze the area under the curve (AUC), sensitivity, and specificity of the independent biomarkers. A predictive model for symptomatic AL was built based on the independent biomarkers and was visualized with a nomogram. The calibration curve with the concordance index (c‐index) was further applied to evaluate the efficacy of the predictive model. Results A total of 157 patients were included in this study, and 7 (4.5%) were diagnosed with symptomatic AL. C‐reactive protein/album ratio (CAR) on postoperative day 1 and systemic immune‐inflammation index (SII) and peritoneal interleukin‐6 (IL‐6) on postoperative day 3 were proven to be independent predictors for the early prediction of symptomatic AL. The optimal cutoff values of CAR, SII, and peritoneal IL‐6 were 1.04, 916.99, and 26430.09 pg/ml, respectively. Finally, the nomogram, including these predictors, was established, and the c‐index of this nomogram was 0.812, indicating that the nomogram could be used for potential clinical reference. Conclusion The combination of CAR, SII, and peritoneal IL‐6 might contribute to the early prediction of symptomatic AL in patients following Lap LAR. Given the limitations of this study and the emergence of other novel biomarkers, multicenter prospective studies are worthy of further exploration.

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Laboratory Predictors for Diagnosing Colorectal Anastomotic Leakage

GORDIICHUK,

MYASOYEDOV

2024

Exp. oncol.

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Background. An important concern in oncological coloproctology is colorectal anastomotic leakage (AL), which occurs in 3.5%–21% of patients. Predicting the occurrence of failure based on the results of laboratory markers can be decisive for the treatment of this complication. Aim. To improve the early diagnosis of AL by establishing combinations and threshold values of laboratory markers — predictors of the inflammatory process. Materials and Methods. The prospective study, conducted from 2020 to 2023, included 213 rectal cancer patients who underwent low anterior resection after neoadjuvant chemoradiotherapy. The inflammatory biomarkers were assessed before surgery and on the 3rd, 5th, and 7th days of the postoperative period. Results. AL diagnosed in 25 (11.74%) patients by the grade of severity was as follows: A (radiological) in 7 (3.29%) patients; B (clinical) — 4 (1.88%); C (clinically expressed, peritonitis) — 11 (5.16%), and P (late) — 3 (1.41%) patients. The changes in the laboratory indicators of the inflammatory response such as С-reactive protein (CRP), procalcitonin (PCT), the counts of neutrophils (NEU), lymphocytes (LYM), platelets (PLT), and neutrophil/lymphocyte ratio (NLR) were significant only in B or C AL grades. Among them, only three indicators were identified as significant for predicting AL when assessed 24 h before the onset of this complication, namely LYM (threshold value ≤ 0.97 × 103/mm3, sensitivity 66.7% and specificity 81.3%, p < 0.001); PLT (threshold value > > 257 103/mm3, sensitivity 58.6%, and specificity 86.7%, p < 0.001); and NLR (threshold value > 4.42, sensitivity 58.1%, and specificity 86.7%, p < 0.001). The three-factor model based on these selected indicators was set up, and the prognosis index (Prog) was proposed with the decision threshold Progcrit = 2.23. The sensitivity of the model was 80% (95% CI 51.9%—95.7%), and the specificity — 74.2% (67.6%—80.2%). Conclusion. Based on the routine laboratory predictors used in the complex diagnosis of AL, B or C AL grades may be predicted allowing for the timely effective early diagnosis, medication, and surgical intervention..

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Serum and peritoneal biomarkers for the early prediction of symptomatic anastomotic leakage in patients following laparoscopic low anterior resection: A single‐center prospective cohort study

Cited by 6 publications

References 44 publications

Construction and validation of a nomogram for predicting disease-free survival after radical resection of rectal cancer using perioperative inflammatory indicators

Construction and validation of a nomogram for predicting disease-free survival after radical resection of rectal cancer using perioperative inflammatory indicators

Serum and peritoneal biomarkers for the early prediction of symptomatic anastomotic leakage in patients following laparoscopic low anterior resection: A single‐center prospective cohort study

Laboratory Predictors for Diagnosing Colorectal Anastomotic Leakage

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