Yunlin Li, Yuwen Zeng

Department of Gastrointestinal Surgery, Meizhou People’s Hospital, Meizhou, People’s Republic of China

Correspondence: Yuwen Zeng, Department of Gastrointestinal Surgery, Meizhou People’s Hospital, Meizhou, People’s Republic of China, Email 14754938521@163.com

Background: Pan-immune-inflammation value (PIV) and prognostic nutritional index (PNI) have values in the prognosis assessment of tumors. However, their relationship with the distant metastasis risk of colorectal cancer (CRC) remains unclear. The aim of our study was to explore the relationship between PIV and PNI and the risk of distant metastasis in CRC patients with and without KRAS mutation.
Methods: The clinical data (age, gender, body mass index (BMI), cigarette smoking, alcoholism, and diabetes mellitus, family history of tumor, tumor stage, and KRAS/NRAS mutation status) of 2408 CRC patients were retrospectively collected and analyzed. The optimal thresholds of PIV and PNI were evaluated by receiver operating characteristic (ROC) curve analysis. Logistic regression analysis was used to reveal the relationship of PIV and PNI and distant metastasis in CRC with and without KRAS mutation, respectively.
Results: The average levels of PIV and PNI was 327.62 (183.19, 590.36) and 46.70 (43.10, 50.90). There were 825 (34.3%) patients with distant metastasis and 1583 (65.7%) without. The optimal threshold of PIV and PNI was 339.50 and 45.53 by ROC analysis. Logistic regression analysis showed that stage T3-T4 (odds ratio (OR): 2.967, 95% confidence interval (CI): 1.804– 4.880, p< 0.001), and stage N2-N3 (OR: 5.109, 95% CI: 3.886– 6.717, p< 0.001) were associated with distant metastasis in CRC with KRAS wild-type; while stage T3-T4 (OR: 5.963, 95% CI: 2.897– 12.273, p< 0.001), and stage N2-N3 (OR: 7.094, 95% CI: 5.070– 9.926, p< 0.001), high PIV (OR: 2.867, 95% CI: 2.119– 3.879, p< 0.001), and low PNI (OR: 1.620, 95% CI: 1.184– 2.215, p=0.003) were associated with distant metastasis in CRC with KRAS mutation.
Conclusion: Stages T3-T4 and N2-N3 were associated with distant metastasis in CRC with and without KRAS mutation. High PIV and low PNI were associated with distant metastasis in CRC patients with KRAS mutation, but not in patients without KRAS mutation.

Keywords: colorectal cancer, distant metastasis, KRAS, pan-immune-inflammation value, prognostic nutritional index