Dataset Information

Prognostic role of aspartate aminotransferase-lymphocyte ratio index in patients with metastatic colorectal cancer: results from the randomized ITACa trial.

ABSTRACT:

Background

The aim of this study was to investigate the role of pre-treatment aspartate aminotransferase-lynphocyte ratio (ALRI) as a predictor of prognosis and treatment efficacy in patients with metastatic colorectal cancer (mCRC) enrolled in the prospective multicenter randomized ITACa (Italian Trial in Advanced Colorectal Cancer) trial to receive first-line chemotherapy (CT) + bevacizumab (B) or CT alone.

Patients and methods

Patients randomly received CT+B or CT alone as first-line therapy. CT consisted of either FOLFOX4 or FOLFIRI at the clinician's discretion.

Results

Out of the 284 patients enrolled, increased ALRI levels were associated with shorter PFS and OS (p<0.0001). At baseline, median PFS was 10.3 months (95% CI 9.4-12.0) and 8.0 months (95 % CI 6.8-8.9), and median OS was 25.2 months (95 % CI 21.3-30.2) and 18.8 months (95 % CI 16.6-21.7) for patients with low (<14) and high (≥14) ALRI levels, respectively (HR 1.43, 95% CI 1.12-1.82, p=0.004; HR=1.51, 95% CI 1.17-1.96, p<0.001). Interaction tests on ALRI levels and treatment efficacy in the CT+B and the CT groups were statistically significant for PFS (p=0.0003), but not for OS (p=0.228).

Conclusion

Our results indicate that ALRI is a good prognostic and predictive marker for mCRC patients candidate for CT+B.

SUBMITTER: Casadei Gardini A

PROVIDER: S-EPMC6120511 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Publications

Prognostic role of aspartate aminotransferase-lymphocyte ratio index in patients with metastatic colorectal cancer: results from the randomized ITACa trial.

Casadei Gardini Andrea A Scarpi Emanuela E Orlandi Elena E Tassinari Davide D Leo Silvana S Bernardini Ilaria I Gelsomino Fabio F Tamberi Stefano S Ruscelli Silvia S Vespignani Roberto R Ronconi Sonia S Frassineti Giovanni Luca GL Amadori Dino D Passardi Alessandro A

OncoTargets and therapy 20180829

<h4>Background</h4>The aim of this study was to investigate the role of pre-treatment aspartate aminotransferase-lynphocyte ratio (ALRI) as a predictor of prognosis and treatment efficacy in patients with metastatic colorectal cancer (mCRC) enrolled in the prospective multicenter randomized ITACa (Italian Trial in Advanced Colorectal Cancer) trial to receive first-line chemotherapy (CT) + bevacizumab (B) or CT alone.<h4>Patients and methods</h4>Patients randomly received CT+B or CT alone as firs ...[more]

PMID: 30214231

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Project description:AimsWe created a new index (Multi Inflammatory Index, MII) composed of an inflammatory index [neutrophil-to lymphocyte-ratio (NLR): MII-1; platelet-to-lymphocyte ratio (PLR): MII-2; or systemic immune-inflammation index (SII): MII-3] and C-reactive protein (CRP). Our aim was to evaluate the prognostic and/or predictive capacity of the MII in the randomized ITACa (Italian Trial in Advanced Colorectal Cancer) study on patients with metastatic colorectal cancer undergoing first-line chemotherapy.MethodsBetween November 2007 and March 2012, baseline NLR, PLR; SII and CRP were available for 131 patients, 66 receiving chemotherapy plus bevacizumab and 65 receiving chemotherapy alone.ResultsPatients with low (<25) MII-1 levels had a better outcome than those with high (⩾25) levels: median progression-free survival (PFS) was 12.4 versus 8.9 months [hazard ratio (HR) = 1.74, 95% confidence interval (CI) 1.21-2.51, p = 0.003] and median overall survival (OS) was 30.9 months versus 15.0 months (HR = 2.05, 95% CI 1.40-3.02, p = 0.0002), respectively. Similar results were obtained for patients with low (<1424) MII-2 levels compared with those with high (⩾1424) levels: median PFS was 12.6 versus 8.9 months (HR = 1.95, 95% CI 1.35-2.82, p = 0.0004) and median OS was 32.4 versus 14.6 months, respectively (HR = 2.42, 95% CI 1.64-3.57, p < 0.0001). Patients with low (<6068) MII-3 levels had a longer median PFS and OS than those with high (⩾6068) levels: 12.6 versus 8.9 months (HR = 1.91, 95% CI 1.33-2.76, p = 0.005) and 30.9 versus15.0 months (HR = 2.10, 95% CI 1.43-3.09, p = 0.0002), respectively. Following adjustment for clinical covariates, multivariate analysis confirmed all MII indexes as independent prognostic factors for predicting PFS and OS.ConclusionAll MII indexes appear to be useful as prognostic markers.Trial registrationClinicalTrials.gov identifier: NCT01878422 (registration date: 07/06/2013) https://clinicaltrials.gov/ct2/show/NCT01878422.

Project description:Background: Lymphocytes were reported to play a significant part in host anticancer immune responses and influence tumour prognosis. Few studies have focused on the prognostic values of aspartate aminotransferase (AST) to lymphocyte ratio (ALRI), aspartate aminotransferase to platelet count ratio index (APRI) and systemic immune-inflammation index (SII) in hepatocellular carcinoma (HCC) treated with palliative treatments. Methods: Five hundred and ninety-eight HCC patients treated with palliative therapies were retrospectively analysed. We randomly assigned patients into the training cohort (429 patients) and the validation cohort I (169 patients). Receiver operating characteristic (ROC) curves were used to identify the best cut-off values for the ALRI, APRI and SII in the training cohort and the values were further validated in the validation cohort I. Correlations between ALRI and other clinicopathological factors were also analysed. A prognostic nomogram including ALRI was established. We validated the prognostic value of the ALRI, SII and APRI with two independent cohorts, the validation cohort II of 82 HCC patients treated with TACE and the validation cohort III of 150 HCC patients treated with curative resection. In the training cohort and all the validation cohorts, univariate analyses by the method of Kaplan-Meier and multivariate analysis by Cox proportional hazards regression model were carried out to identify the independent prognostic factors. Results: The threshold values of ALRI, APRI and SII were 86.3, 1.37 and 376.4 respectively identified by ROC curve analysis in the training cohort. Correlation analysis showed that ALRI>86.3 was greatly associated with higher rates of Child-Pugh B&C, portal vein tumor thrombosis (PVTT) and ascites (P < 0.05). Correspondingly, ALRI level of HCC patients with Child-Pugh B&C, PVTT and ascites was evidently higher than that of HCC patients with Child-Pugh A, without PVTT and without ascites (P < 0.001). In the training cohort and the validation cohort I, II, III, the OS of patients with ALRI >86.3 was obviously shorter than patients with ALRI ≤86.3 (P <0.001). We identified ALRI as an independent prognostic factor by univariate and multivariate analyses both in training Cohort (HR=1.481, P=0.004), validation cohort I (HR=1.511, P=0.032), validation cohort II (HR=3.166, P=0.005) and validation cohort III (HR=3.921, P=0.010). The SII was identified as an independent prognostic factor in training cohort (HR=1.356, P=0.020) and the validation cohort II (HR=2.678, P=0.002). The prognostic nomogram including ALRI was the best in predicting 3-month, 6-month, 1-year, 2-year survival And OS among TNM, ALRI, ALRI-TNM and nomogram. Conclusions: The ALRI was a novel independent prognostic index for the HCC patients treated with palliative treatments.

Project description:BackgroundThere are no population-based studies on the prognostic value of the preoperative aminotransferase-to-lymphocyte ratio (AALR) in predicting recurrence and survival in patients with colorectal cancer (CRC) who have undergone curative resection.AimThis study explored the relationship between AALR and prognosis of CRC patients, specifically stage III CRC.MethodsRestricted Cubic Splines were used to evaluate the relationship between AALR and outcomes. The survival curve was generated using the Kaplan-Meier method and the log-rank test. COX regression analysis was used to identify the independent prognostic factors of CRC patients. Logistic regression analysis was used to assess the independent risk factors affecting sarcopenia and postoperative complications. Concordance index and calibration curves were used to evaluate the discriminative ability of the prognostic nomograms. Finally, according to a ratio of 7:3, the total population was randomized into two cohorts to validate the practicability of the prognostic nomograms.ResultsIn total, 1304 stage I-III CRC were enrolled in this study. There was a significant positive correlation between AALR and PFS/OS in CRC patients. The PFS/OS ratio of the high AALR group was significantly lower than that of the low AALR group. In the subgroup analysis, we found that the AALR significantly stratified the prognosis of patients with stage III CRC. A high AALR was still independently associated with poor PFS (HR = 1.335, 95% CI =1.075-1.657, p=0.009) and OS (HR = 1.382, 95% CI =1.139-1.677, p=0.001) in CRC patients. Variables with a value ≤ 0.05 in multivariable analysis were incorporated into the construction of prognostic nomograms for predicting 1-5 years PFS/OS of CRC patients. The results of the concordance index and calibration curves confirmed that these prognostic nomograms had a good prediction accuracy. In addition, we demonstrated the good predictive performance of these nomograms in a randomized internal validation cohort.ConclusionAALR is an effective prognostic marker for predicting long-term outcomes and could provide a valuable reference for sarcopenia and postoperative complications in CRC patients. AALR-based nomograms have good predictive accuracy and can help to develop individualized risk stratification, follow-up, and treatment strategies for CRC patients.

Dataset Information

Prognostic role of aspartate aminotransferase-lymphocyte ratio index in patients with metastatic colorectal cancer: results from the randomized ITACa trial.

Background

Patients and methods

Results

Conclusion

Publications

Prognostic role of aspartate aminotransferase-lymphocyte ratio index in patients with metastatic colorectal cancer: results from the randomized ITACa trial.

Similar Datasets

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