Li Xiunan, Zhang Lei, Xu Biao, Ding Shu, Wang Jing, Jia Yu
Digestive Endoscopy Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Department of Nursing, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Front Med (Lausanne). 2025 May 8;12:1489842. doi: 10.3389/fmed.2025.1489842. eCollection 2025.
Colorectal carcinoma represents one of the common malignant tumors of digestive tract in clinic. Systemic immune inflammation index (SII) has great potential in predicting prognosis of digestive tract tumors. We sought to explore the predictive ability of SII for non-curative resection of early colorectal cancer treated with ESD, and to establish a related predictive model.
A retrospective analysis was performed on data from patients with early-stage colorectal cancer who underwent ESD in our hospital between January 2019 and December 2022. To establish the optimal cut-off value for the SII, Receiver Operating Characteristic (ROC) curves were generated, correlating preoperative SII levels with postoperative resection outcomes. Patients were categorized into high SII and low SII groups, and their clinical characteristics were comparatively analyzed. Furthermore, patients were stratified according to the presence or absence of non-curative resection outcomes post-ESD, to identify independent risk factors associated with non-curative resection. A prognostic nomogram was subsequently developed to enhance predictive accuracy for non-curative resection, integrating identified risk variables.
A total of 215 patients were enrolled in this study, all of whom successfully underwent ESD, achieving an en bloc resection rate of 96.7%. Based on surgical procedures and pathological resection characteristics, 181 cases were classified as curative resections, whereas 34 cases of non-curative resections. Postoperative complications occurred in 10 patients, resulting in a complication rate of 4.7%. The optimal cut-off value of SII was 629.2 × 109/L (area under the curve: 0.762, < 0.001), and the sensitivity and specificity was 64.7 and 85.6%, respectively. An optimal SII cut-off value for predicting non-curative resection was determined to be 1.56 (AUC: 0.571, 95% CI: 0.501-0.641). Multivariate analysis demonstrated that elevated SII ( = 0.002), a positive lifting sign ( = 0.003), increased tumor size ( = 0.034), and poor tumor differentiation ( < 0.001) were independent risk factors significantly associated with non-curative resection.
SII revealed well correlation in predicting non-curable resection in patients with early colorectal cancer treated by ESD. Meanwhile, the higher the patient's NLR, PLR, tumor diameter and infiltration depth, the more likely to occur postoperative non-curative resection.
结直肠癌是临床常见的消化道恶性肿瘤之一。全身免疫炎症指数（SII）在预测消化道肿瘤预后方面具有巨大潜力。我们旨在探讨SII对接受内镜黏膜下剥离术（ESD）治疗的早期结直肠癌非根治性切除的预测能力，并建立相关预测模型。
对2019年1月至-2022年12月在我院接受ESD的早期结直肠癌患者的数据进行回顾性分析。为确定SII的最佳临界值，绘制受试者工作特征（ROC）曲线，将术前SII水平与术后切除结果相关联。将患者分为高SII组和低SII组，并对其临床特征进行比较分析。此外，根据ESD术后是否存在非根治性切除结果对患者进行分层，以确定与非根治性切除相关的独立危险因素。随后开发了一种预后列线图，整合已确定的风险变量，以提高非根治性切除的预测准确性。
本研究共纳入215例患者，均成功接受ESD，整块切除率为96.7%。根据手术操作和病理切除特征，181例被分类为根治性切除，而34例为非根治性切除。10例患者发生术后并发症，并发症发生率为4.7%。SII的最佳临界值为629.2×109/L（曲线下面积：0.762，P<0.001），敏感性和特异性分别为-64.7%和85.6%。预测非根治性切除的最佳SII临界值确定为1.56（AUC：0.571，95%CI：0.501-0.641）。多因素分析表明，SII升高（P=0.002）、抬举征阳性（P=0.003）、肿瘤大小增加（P=0.034）和肿瘤分化差（P<0.001）是与非根治性切除显著相关的独立危险因素。
SII在预测ESD治疗的早期结直肠癌患者的非根治性切除方面显示出良好的相关性。同时，患者的中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、肿瘤直径和浸润深度越高，术后发生非根治性切除的可能性越大。
