The predictive value of systemic immune inflammation index combined with neutrophil to monocyte ratio for postoperative anastomotic leakage in elderly colon cancer patients_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Jiatai ^1,2 , ZHANG Yuting ^1,2 , BAI Chongyang ^1,2 , LI Runfeng ^1,2 , ZHONG Fupeng ^1,2 , YAN Shaolin ^1,2 , YANG Lei ¹ , HE Zhiyun ¹ , WANG Haiping ³ ,  LI Xun ^1,2,3,4,5,6

1. Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, P. R. China;
2. The First Clinical Medical College of Lanzhou University, Lanzhou 730000, P. R. China;
3. Gansu Province Key Laboratory of Biotherapy and Regenerative Medicine, Lanzhou 730000, P. R. China;
4. Cancer Prevention and Treatment Center of Lanzhou University School of Medicine , Lanzhou 730000, P. R. China;
5. Gansu Provincial Institute of Hepatobiliary Pancreatic Surgery, Lanzhou 730000, P. R. China;
6. Gansu General Surgery Clinical Medical Research Center, Lanzhou 730000, P. R. China;

Corresponding?author：

LI Xun, Email: lxdr21@126.com

Keywords：

systemic immune inflammation index; neutrophil monocyte ratio; colon cancer; anastomotic leakage; risk factor

DOI：

10.7507/1007-9424.202404095

Video：

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Objective To explore the predictive value of systemic immune-inflammation index (SII) combined with neutrophil-monocyte ratio (NMR) on postoperative anastomotic leakage in elderly colon cancer. Methods The clinical data of 493 elderly colon cancer patients who attended the Department of General Surgery of the First Hospital of Lanzhou University from January 2018 to October 2023 were retrospectively analysed, and divided into an anastomotic leakage group (n=29) and a non-anastomotic leakage group (n=464) according to the occurrence of anastomotic leakage or not, and the differences between the two groups in terms of SII and NMR at different time points were compared. Area under the curve (AUC) of receiver operating characteristic (ROC) was used to compare the predictive value of SII, NMR and the combination of the two on the occurrence of anastomotic leakage after surgery in elderly colon cancer patients. Logistic regression was used to analyse the independent risk factors for postoperative anastomotic leakage in elderly colon cancer patients. Results The SII and NMR in the anastomotic leakage group were higher than those in the non-anastomotic leakage group on the 3 rd and 5 th day after operation (P<0.05). ROC curve analysis showed that the AUC values for SII on postoperative day 3, NMR on postoperative day 5, and the combination of the two to predict anastomotic leakage were 0.613, 0.743, and 0.750, respectively. The results of DeLong’s test suggested that the difference between the AUC values of NMR on postoperative day 5 combined with SII on postoperative day 3 and SII on postoperative day 3 was statistically significant (P=0.047). Multifactorial logistic regression analysis showed that age, male, diabetes, preoperative radiotherapy and chemotherapy, tumor located in the left colon, SII on postoperative day 3, and NMR on postoperative day 5 were independent risk factors for postoperative anastomotic leakage in elderly patients with colorectal cancer (all P<0.05). Conclusions Postoperative day 3 SII combined with postoperative day 5 NMR, postoperative day 3 SII, and postoperative day 5 NMR all have predictive value for postoperative anastomotic leakage in elderly patients with colorectal cancer. Both have the potential to serve as important predictors of postoperative anastomotic leakage in elderly patients with colon cancer.

Citation： LI Jiatai, ZHANG Yuting, BAI Chongyang, LI Runfeng, ZHONG Fupeng, YAN Shaolin, YANG Lei, HE Zhiyun, WANG Haiping, LI Xun. The predictive value of systemic immune inflammation index combined with neutrophil to monocyte ratio for postoperative anastomotic leakage in elderly colon cancer patients. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(12): 1491-1498. doi: 10.7507/1007-9424.202404095 Copy

1.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2.	Tonini V, Zanni M. Impact of anastomotic leakage on long-term prognosis after colorectal cancer surgery. World J Gastrointest Surg, 2023, 15(5): 745-756.
3.	Brito da Silva F, Lopes P, Cavadas D, et al. The impact of anastomotic leakage after curative colon cancer resection on long-term survival: A retrospective cohort study. Cir Esp (Engl Ed), 2024, 102(1): 3-10.
4.	Tsalikidis C, Mitsala A, Mentonis VI, et al. Predictive factors for anastomotic leakage following colorectal cancer surgery: Where are we and where are we going? Curr Oncol, 2023, 30(3): 3111-3137.
5.	中國醫師協會結直腸腫瘤專業委員會. 中國老年結直腸腫瘤患者圍手術期管理專家共識(2020版). 中華結直腸疾病電子雜志, 2020, 9(4): 325-334.
6.	Greijdanus NG, Wienholts K, Ubels S, et al. Stoma-free survival after rectal cancer resection with anastomotic leakage: development and validation of a prediction model in a large international cohort. Ann Surg, 2023, 278(5): 772-780.
7.	Hajjar R, Gonzalez E, Fragoso G, et al. Gut microbiota influence anastomotic healing in colorectal cancer surgery through modulation of mucosal proinflammatory cytokines. Gut, 2023, 72(6): 1143-1154.
8.	Ding P, Guo H, Sun C, et al. Combined systemic immune-inflammatory index (SII) and prognostic nutritional index (PNI) predicts chemotherapy response and prognosis in locally advanced gastric cancer patients receiving neoadjuvant chemotherapy with PD-1 antibody sintilimab and XELOX: a prospective study. BMC Gastroenterol, 2022, 22(1): 121. doi: 10.1186/s12876-022-02199-9.
9.	Portale G, Bartolotta P, Azzolina D, et al. Prognostic role of platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte, and lymphocyte-to-monocyte ratio in operated rectal cancer patients: systematic review and meta-analysis. Langenbecks Arch Surg, 2023, 408(1): 85. doi: 10.1007/s00423-023-02786-8.
10.	Spinelli A, Anania G, Arezzo A, et al. Italian multi-society modified Delphi consensus on the definition and management of anastomotic leakage in colorectal surgery. Updates Surg, 2020, 72(3): 781-792.
11.	Ng SC, McCombie A, Frizelle F, et al. Influence of the type of anatomic resection on anastomotic leak after surgery for colon cancer. ANZ J Surg, 2024, 94(3): 424-428.
12.	Kryzauskas M, Bausys A, Kuliavas J, et al. Short and long-term outcomes of elderly patients undergoing left-sided colorectal resection with primary anastomosis for cancer. BMC Geriatr, 2021, 21(1): 682. doi: 10.1186/s12877-021-02648-2.
13.	He J, He M, Tang JH, et al. Anastomotic leak risk factors following colon cancer resection: a systematic review and meta-analysis. Langenbecks Arch Surg, 2023, 408(1): 252. doi: 10.1007/s00423-023-02989-z.
14.	Penna M, Hompes R, Arnold S, et al. Incidence and risk factors for anastomotic failure in 1 594 patients treated by transanal total mesorectal excision: results from the international TaTME Registry. Ann Surg, 2019, 269(4): 700-711.
15.	Wang J, Li MH. Risk factors for anastomotic fistula development after radical colon cancer surgery and their impact on prognosis. World J Gastrointest Surg, 2023, 15(11): 2470-2481.
16.	Jiang W, Wang H, Zheng J, et al. Post-operative anastomotic leakage and collagen changes in patients with rectal cancer undergoing neoadjuvant chemotherapy vs chemoradiotherapy. Gastroenterol Rep (Oxf), 2022, 10: goac058. doi: 10.1093/gastro/goac058.
17.	Kang J, Kim H, Park H, et al. Risk factors and economic burden of postoperative anastomotic leakage related events in patients who underwent surgeries for colorectal cancer. PLoS One, 2022, 17(5): e0267950. doi: 10.1371/journal.pone.0267950.
18.	Banasiewicz T, Macha?a W, Borejsza Wysocki M, et al. Principles of minimize bleeding and the transfusion of blood and its components in operated patients— surgical aspects. Pol Przegl Chir, 2023, 95(5): 14-39.
19.	王朝樣, 李曉龍, 林浩, 等. 老年結腸癌患者擇期結腸切除術后吻合口漏的影響因素分析及預測模型構建. 中國普外基礎與臨床雜志, 2023, 30(7): 820-826.
20.	康志勇, 姜昌鎬. 結直腸癌術后吻合口漏的相關因素及預防研究進展. 中國普外基礎與臨床雜志, 2020, 27(11): 1450-1456.
21.	Song G, Guo H, Jiang C, et al. Magnetic nanoparticles detection of C-reactive protein combined with neutrophil to lymphocyte ratio to predict the occurrence of anastomotic fistula after rectal cancer surgery. Cell Mol Biol (Noisy-le-grand), 2022, 68(8): 116-122.
22.	Zhang Z, Sun W, Wang J, et al. A nomogram to predict the risk of colorectal anastomotic leakage combining inflammatory-nutritional and abdominal aorta calcium index. Front Surg, 2023, 9: 1008448. doi: 10.3389/fsurg.2022.1008448.
23.	Zhang T, Miao YC. Prognostic evaluation of preoperative systemic immune inflammatory index in patients with colorectal cancer. Front Oncol, 2023, 13: 1260796. doi: 10.3389/fonc.2023.1260796.
24.	Haghi SE, Khanzadeh M, Sarejloo S, et al. Systematic review of the significance of neutrophil to lymphocyte ratio in anastomotic leak after gastrointestinal surgeries. BMC Surg, 2024, 24(1): 15. doi: 10.1186/s12893-023-02292-0.
25.	Gray M, Marland JRK, Murray AF, et al. Predictive and diagnostic biomarkers of anastomotic leakage: A precision medicine approach for colorectal cancer patients. J Pers Med, 2021, 11(6): 471. doi: 10.3390/jpm11060471.
26.	Zhao X, Cai A, Xi H, et al. Predictive factors for lymph node metastasis in early gastric cancer with signet ring cell histology: a meta-analysis. ANZ J Surg, 2017, 87(12): 981-986.
27.	Radulescu D, Baleanu VD, Padureanu V, et al. Neutrophil/lymphocyte ratio as predictor of anastomotic leak after gastric cancer surgery. Diagnostics (Basel), 2020, 10(10): 799. doi: 10.3390/diagnostics10100799.
28.	Chiarelli M, Achilli P, Tagliabue F, et al. Perioperative lymphocytopenia predicts mortality and severe complications after intestinal surgery. Ann Transl Med, 2019, 7(14): 311. doi: 10.21037/atm.2019.06.46.
29.	Qi XY, Tan F, Liu MX, et al. 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. Cancer Rep (Hoboken), 2023, 6(4): e1781. doi: 10.1002/cnr2.1781.
30.	Wang CY, Li XL, Ma XL, et al. Preoperative neutrophil-to-lymphocyte ratio predicts symptomatic anastomotic leakage in elderly colon cancer patients: Multicenter propensity score-matched analysis. World J Gastrointest Surg, 2024, 16(2): 438-450.
31.	劉智龍, 杜曉輝. 中性粒細胞/淋巴細胞比值聯合C反應蛋白/白蛋白比值對直腸癌術后吻合口瘺的預測價值. 海軍軍醫大學學報, 2022, 43(7): 778-783.

1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2. Tonini V, Zanni M. Impact of anastomotic leakage on long-term prognosis after colorectal cancer surgery. World J Gastrointest Surg, 2023, 15(5): 745-756.
3. Brito da Silva F, Lopes P, Cavadas D, et al. The impact of anastomotic leakage after curative colon cancer resection on long-term survival: A retrospective cohort study. Cir Esp (Engl Ed), 2024, 102(1): 3-10.
4. Tsalikidis C, Mitsala A, Mentonis VI, et al. Predictive factors for anastomotic leakage following colorectal cancer surgery: Where are we and where are we going? Curr Oncol, 2023, 30(3): 3111-3137.
5. 中國醫師協會結直腸腫瘤專業委員會. 中國老年結直腸腫瘤患者圍手術期管理專家共識(2020版). 中華結直腸疾病電子雜志, 2020, 9(4): 325-334.
6. Greijdanus NG, Wienholts K, Ubels S, et al. Stoma-free survival after rectal cancer resection with anastomotic leakage: development and validation of a prediction model in a large international cohort. Ann Surg, 2023, 278(5): 772-780.
7. Hajjar R, Gonzalez E, Fragoso G, et al. Gut microbiota influence anastomotic healing in colorectal cancer surgery through modulation of mucosal proinflammatory cytokines. Gut, 2023, 72(6): 1143-1154.
8. Ding P, Guo H, Sun C, et al. Combined systemic immune-inflammatory index (SII) and prognostic nutritional index (PNI) predicts chemotherapy response and prognosis in locally advanced gastric cancer patients receiving neoadjuvant chemotherapy with PD-1 antibody sintilimab and XELOX: a prospective study. BMC Gastroenterol, 2022, 22(1): 121. doi: 10.1186/s12876-022-02199-9.
9. Portale G, Bartolotta P, Azzolina D, et al. Prognostic role of platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte, and lymphocyte-to-monocyte ratio in operated rectal cancer patients: systematic review and meta-analysis. Langenbecks Arch Surg, 2023, 408(1): 85. doi: 10.1007/s00423-023-02786-8.
10. Spinelli A, Anania G, Arezzo A, et al. Italian multi-society modified Delphi consensus on the definition and management of anastomotic leakage in colorectal surgery. Updates Surg, 2020, 72(3): 781-792.
11. Ng SC, McCombie A, Frizelle F, et al. Influence of the type of anatomic resection on anastomotic leak after surgery for colon cancer. ANZ J Surg, 2024, 94(3): 424-428.
12. Kryzauskas M, Bausys A, Kuliavas J, et al. Short and long-term outcomes of elderly patients undergoing left-sided colorectal resection with primary anastomosis for cancer. BMC Geriatr, 2021, 21(1): 682. doi: 10.1186/s12877-021-02648-2.
13. He J, He M, Tang JH, et al. Anastomotic leak risk factors following colon cancer resection: a systematic review and meta-analysis. Langenbecks Arch Surg, 2023, 408(1): 252. doi: 10.1007/s00423-023-02989-z.
14. Penna M, Hompes R, Arnold S, et al. Incidence and risk factors for anastomotic failure in 1 594 patients treated by transanal total mesorectal excision: results from the international TaTME Registry. Ann Surg, 2019, 269(4): 700-711.
15. Wang J, Li MH. Risk factors for anastomotic fistula development after radical colon cancer surgery and their impact on prognosis. World J Gastrointest Surg, 2023, 15(11): 2470-2481.
16. Jiang W, Wang H, Zheng J, et al. Post-operative anastomotic leakage and collagen changes in patients with rectal cancer undergoing neoadjuvant chemotherapy vs chemoradiotherapy. Gastroenterol Rep (Oxf), 2022, 10: goac058. doi: 10.1093/gastro/goac058.
17. Kang J, Kim H, Park H, et al. Risk factors and economic burden of postoperative anastomotic leakage related events in patients who underwent surgeries for colorectal cancer. PLoS One, 2022, 17(5): e0267950. doi: 10.1371/journal.pone.0267950.
18. Banasiewicz T, Macha?a W, Borejsza Wysocki M, et al. Principles of minimize bleeding and the transfusion of blood and its components in operated patients— surgical aspects. Pol Przegl Chir, 2023, 95(5): 14-39.
19. 王朝樣, 李曉龍, 林浩, 等. 老年結腸癌患者擇期結腸切除術后吻合口漏的影響因素分析及預測模型構建. 中國普外基礎與臨床雜志, 2023, 30(7): 820-826.
20. 康志勇, 姜昌鎬. 結直腸癌術后吻合口漏的相關因素及預防研究進展. 中國普外基礎與臨床雜志, 2020, 27(11): 1450-1456.
21. Song G, Guo H, Jiang C, et al. Magnetic nanoparticles detection of C-reactive protein combined with neutrophil to lymphocyte ratio to predict the occurrence of anastomotic fistula after rectal cancer surgery. Cell Mol Biol (Noisy-le-grand), 2022, 68(8): 116-122.
22. Zhang Z, Sun W, Wang J, et al. A nomogram to predict the risk of colorectal anastomotic leakage combining inflammatory-nutritional and abdominal aorta calcium index. Front Surg, 2023, 9: 1008448. doi: 10.3389/fsurg.2022.1008448.
23. Zhang T, Miao YC. Prognostic evaluation of preoperative systemic immune inflammatory index in patients with colorectal cancer. Front Oncol, 2023, 13: 1260796. doi: 10.3389/fonc.2023.1260796.
24. Haghi SE, Khanzadeh M, Sarejloo S, et al. Systematic review of the significance of neutrophil to lymphocyte ratio in anastomotic leak after gastrointestinal surgeries. BMC Surg, 2024, 24(1): 15. doi: 10.1186/s12893-023-02292-0.
25. Gray M, Marland JRK, Murray AF, et al. Predictive and diagnostic biomarkers of anastomotic leakage: A precision medicine approach for colorectal cancer patients. J Pers Med, 2021, 11(6): 471. doi: 10.3390/jpm11060471.
26. Zhao X, Cai A, Xi H, et al. Predictive factors for lymph node metastasis in early gastric cancer with signet ring cell histology: a meta-analysis. ANZ J Surg, 2017, 87(12): 981-986.
27. Radulescu D, Baleanu VD, Padureanu V, et al. Neutrophil/lymphocyte ratio as predictor of anastomotic leak after gastric cancer surgery. Diagnostics (Basel), 2020, 10(10): 799. doi: 10.3390/diagnostics10100799.
28. Chiarelli M, Achilli P, Tagliabue F, et al. Perioperative lymphocytopenia predicts mortality and severe complications after intestinal surgery. Ann Transl Med, 2019, 7(14): 311. doi: 10.21037/atm.2019.06.46.
29. Qi XY, Tan F, Liu MX, et al. 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. Cancer Rep (Hoboken), 2023, 6(4): e1781. doi: 10.1002/cnr2.1781.
30. Wang CY, Li XL, Ma XL, et al. Preoperative neutrophil-to-lymphocyte ratio predicts symptomatic anastomotic leakage in elderly colon cancer patients: Multicenter propensity score-matched analysis. World J Gastrointest Surg, 2024, 16(2): 438-450.
31. 劉智龍, 杜曉輝. 中性粒細胞/淋巴細胞比值聯合C反應蛋白/白蛋白比值對直腸癌術后吻合口瘺的預測價值. 海軍軍醫大學學報, 2022, 43(7): 778-783.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The predictive value of systemic immune inflammation index combined with neutrophil to monocyte ratio for postoperative anastomotic leakage in elderly colon cancer patients

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