Tian Shan, Cao Yinghao, Duan Yanran, Liu Qi, Peng Pailan
Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Colorectal Surgery and Gastroenterology, Wuhan Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.
Front Oncol. 2021 Nov 30;11:737283. doi: 10.3389/fonc.2021.737283. eCollection 2021.
The Gustave Roussy Immune Score (GRIm-Score) was originally designed to select cancer patients for immunotherapy, and later was reported to be a novel prognostic scoring system in lung cancer and esophageal cancer. This study was aimed to determine the prognostic role and predictive performance of GRIm-Score in colorectal cancer (CRC) CRC patients.
We conducted a single-institution study of 1,579 adult CRC patients receiving surgical removal, and those patients were divided into low GRIm-Score group (scores 0, 1) and high GRIm-Score group (scores 2, 3). Propensity score matching (PSM) was executed to balance the potential confounding factors between the two groups. Survival and time-dependent receiver operating characteristic (Td-ROC) analyses were applied to depict the prognostic role and predictive significance of GRIm-Score in CRC patients.
There were 200 cases CRC patients in high GRIm-Score group and 1,379 cases in low GRIm-Score group. CRC patients with high GRIm-Score correspond with higher level of CEA, CA125, and inflammatory indexes, such as NLR, PLR, SII, PNI, and ALRI. Correlation analysis exhibited that GRIm-Score correlated well with the established inflammatory indexes. Survival analysis revealed that CRC patients in high GRIm-Score group showed worse overall survival (OS, P <0.0001) and disease-free survival (DFS, P <0.0001) compared with those in low GRIm-Score group. Results from multivariate Cox regression implicated that high GRIm-Score was not only a potent prognostic index for unfavorable OS (HR = 1.622, 95%CI: 1.118-2.355, P = 0.0109), but also a potent risk factor for worse DFS (HR = 1.743, 95%CI: 1.188-2.558, P = 0.0045). Td-ROC analysis demonstrated that GRIm-Score exhibited the superior discriminatory power in the prediction of OS and DFS when compared to SII, PNI, and ALRI. Such strong associations between high levels of preoperative GRIm-Score and unfavorable survival outcomes remained robust after PSM analysis.
GRIm-Score, a novel inflammatory and nutritional risk scoring system, is a potent prognostic index in CRC patients receiving surgical removal. GRIm-Score can be used as an effective and simplified risk stratification tool for postoperative survival prediction of CRC patients.
古斯塔夫·鲁西免疫评分（GRIm-Score）最初旨在为癌症患者选择免疫治疗方案，后来据报道它是肺癌和食管癌中的一种新型预后评分系统。本研究旨在确定GRIm-Score在结直肠癌（CRC）患者中的预后作用和预测性能。
我们对1579例接受手术切除的成年CRC患者进行了单机构研究，并将这些患者分为低GRIm-Score组（评分0、1）和高GRIm-Score组（评分2、3）。进行倾向评分匹配（PSM）以平衡两组之间的潜在混杂因素。应用生存分析和时间依赖性受试者工作特征（Td-ROC）分析来描述GRIm-Score在CRC患者中的预后作用和预测意义。
高GRIm-Score组有200例CRC患者，低GRIm-Score组有1379例。高GRIm-Score的CRC患者对应较高水平的癌胚抗原（CEA）、糖类抗原125（CA125）以及炎症指标，如中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、全身炎症反应指数（SII）、预后营养指数（PNI）和急性淋巴细胞白血病相关抑制指数（ALRI）。相关性分析表明GRIm-Score与已确立的炎症指标相关性良好。生存分析显示，与低GRIm-Score组相比，高GRIm-Score组的CRC患者总生存期（OS，P<0.0001）和无病生存期（DFS，P<0.0001）更差。多变量Cox回归结果表明，高GRIm-Score不仅是不良OS的有力预后指标（风险比[HR]=1.622，95%置信区间[CI]：1.118-2.355，P=0.0109），也是DFS更差的有力危险因素（HR=1.743，95%CI：1.188-2.558，P=0.0045）。Td-ROC分析表明，与SII、PNI和ALRI相比，GRIm-Score在预测OS和DFS方面具有更好的辨别能力。在PSM分析后，术前GRIm-Score高水平与不良生存结果之间的这种强关联仍然很显著。
GRIm-Score是一种新型的炎症和营养风险评分系统，是接受手术切除的CRC患者的有力预后指标。GRIm-Score可作为CRC患者术后生存预测的有效且简化的风险分层工具。
