Serum nutritional predictive biomarkers and risk assessment for anastomotic leakage after laparoscopic surgery in rectal cancer patients

BACKGROUND Anastomotic leakage(AL)is one of the severest complications after laparoscopic surgery for middle/low rectal cancer,significantly impacting patient outcomes.Identifying reliable predictive factors for AL remains a clinical challenge.Serum nutritional biomarkers have been implicated in surgical outcomes but are un-derexplored as predictive tools for AL in this setting.Our study hypothesizes that preoperative serum levels of prealbumin(PA),albumin(ALB),and transferrin(TRF),along with surgical factors,can accurately predict AL risk.AIM To determine the predictive value of preoperative serum nutritional biomarkers for rectal cancer AL following laparoscopic surgery.METHODS In the retrospective cohort study carried out at a tertiary cancer center,we examined 560 individuals who underwent laparoscopic procedures for rectal cancer from 2018 to 2022.Preoperative serum levels of PA,ALB,and TRF were measured.We employed multivariate logistic regression to determine the independent risk factors for AL,and a predictive model was constructed and evaluated using receiver operating characteristic curve analysis.RESULTS AL occurred in 11.96%of cases,affecting 67 out of 560 patients.Multivariate analysis identified PA,ALB,and TRF as the independent risk factor,each with an odds ratio of 2.621[95%confidence interval(CI):1.582-3.812,P=0.012],3.982(95%CI:1.927-4.887,P=0.024),and 2.109(95%CI:1.162-2.981,P=0.031),respectively.Tumor location(<7 cm from anal verge)and intraoperative bleeding≥300 mL also increased AL risk.The predictive model demonstrated an excellent accuracy,achieving an area under the receiver operating characteristic curve of 0.942,a sensitivity of 0.844,and a specificity of 0.922,demonstrating an excellent ability to discriminate.CONCLUSION Preoperative serum nutritional biomarkers,combined with surgical factors,reliably predict anastomotic leakage risk after rectal cancer surgery,highlighting their importance in preoperative assessment.

Prognostic value of combined systemic inflammation response index and prognostic nutritional index in colorectal cancer patients

BACKGROUND The prognosis of colorectal cancer(CRC)patients is notably influenced by both inflammation and nutritional status.The prognostic nutritional index(PNI)and systemic inflammatory response index(SIRI)have been reported in prognostic studies of various tumors.However,the efficacy of the combination of the two in predicting the prognosis of CRC patients has not been studied.AIM To evaluate the effectiveness of PNI and SIRI in predicting the prognosis of patients with CRC.METHODS We retrospectively gathered data from 470 CRC patients who underwent feasible radical surgery at Xinjiang Cancer Hospital.The optimal cut-off values for SIRI and PNI,along with their predictive power for survival,were determined through area under the receiver operating characteristic curve using time-dependent receiver operating characteristic analysis.The Kaplan-Meier method and log-rank test were applied to assess prognostic impact,and a multifactorial Cox proportional hazards model was employed for analysis.Additionally,a new model,PSIRI,was developed and assessed for its survival prediction capability.RESULTS The optimal cutoff values for PNI and SIRI were determined to be 47.80 and 1.38,respectively.Based on these values,patients were categorized into high PNI and low PNI groups,as well as high SIRI and low SIRI groups.Significant differences in age,T stage,neutrophil to lymphocyte ratio(NLR),monocyte to lymphocyte ratio(MLR),and platelet-to-lymphocyte ratio(PLR)subgroups were observed between the PNI groups in the baseline profile.In the SIRI group,notable differences were found in gender,T stage,nerve invasion,intravascular tumor emboli,NLR,MLR,and PLR subgroups.Both low PNI and high SIRI were identified as independent risk factors for poor prognosis in CRC patients.When combined into the PSIRI model,it was shown that patients with a PSIRI≤1 had a higher risk of death compared to those with a PSIRI of 2.CONCLUSION We assessed the impact of PNI and SIRI on the prognostic survival of CRC patients and developed a new model,PSIRI.This model demonstrated superior predictive accuracy,with a concordance index of 0.767.

Clinical features and prognosis in colorectal cancer patients with different ethnicities in Northwest China

AIM:To compare the clinical factors and tumor characteristics that predict survival in colorectal cancer(CRC)patients with different ethnicities in Xin Jiang area.METHODS:A total of 1421 histopathologically confirmed sporadic CRC patients who were either Han/Chinese or Uyghur were identified and enrolled from a database of both diagnoses and operative procedures from Xin Jiang Tumor Hospital,which is affiliated to Xin Jiang Medical University between 2000 and 2007.Patients with family histories of CRC,hereditary nonpolyposis CRC,familial adenomatous polyposis,inflammatory bowel disease,carcinoid,squamous carcinoma or melanoma were excluded.The two ethnic groups were compared with regard to clinical features,tumor characteristics,disease stage,overall survival rate,diseasefree survival rate and cancer-specific survival rate.The factors predicting long-term survival were assessed via both univariate and multivariate analysis.RESULTS:Among the 1421 patients with CRC enrolled in this study,1210 patients were Han/Chinese(mean age,62.3±4.5 years;range,19-92 years),while 211patients were Uyghur(mean age,52.4±15.6 years;range,17-87 years).There were significant differences in proportions of gender,age,blood type,occupation and histopathological type between the Han/Chinese and Uyghur patients(P<0.05).The median overall,disease-free and cancer-specific survival time were 45,62and 65 mo for the Han/Chinese patients and 42,49 and61 mo for the Uyghur patients(P=0.000,P=0.005,P=0.007).The cumulative 5-year survival of the Uyghur patients was significantly worse than that of the Han patients(P=0.000).A multivariate analysis showed that age,ethnicity,histopathological type,differentiation,T(Infiltration depth),N(Lymph node metastasis),staging,postoperative metastasis and metastatic site(P<0.05)were found to be the prognostic factors.CONCLUSION:The Uyghur CRC patients are associated with significantly younger age,more aggressive histopathologic characteristics and have significantly worse prognosis than the Han/Chinese patients.

Prognostic significance of preoperative fibrinogen in patients with colon cancer

AIM: To investigate the prognostic significance of preoperative fibrinogen levels in colon cancer patients.