Lu Ying, Ye Qiu-Ying, Mei Ou, Li Ya-Nan, Peng Yue, Ying Hou-Qun, Cheng Xue-Xin
Department of Clinical Laboratory, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, People's Republic of China.
Department of Medical Technology, Jiangxi Medical College, Shangrao, 334000, People's Republic of China.
J Inflamm Res. 2025 May 26;18:6767-6781. doi: 10.2147/JIR.S517378. eCollection 2025.
This study aimed to develop and validate an integrated inflammatory prognostic index and to investigate associations between primary tumor location, chronic inflammatory status, adjuvant chemotherapy response, and survival outcomes in stage II-III colorectal cancer (CRC).
A total of 1413 stage II-III CRC patients who underwent radical resection were enrolled and divided into discovery and validation cohorts. Preoperative systemic inflammatory biomarkers were quantified, and patients were followed for 3 years to establish an optimal chronic inflammatory index (CII) and evaluate its association with survival and chemotherapy efficacy across primary tumor locations.
The comprehensive CII was the top-performing prognostic biomarker, with time-dependent AUCs of 0.71(95% CI: 0.68-0.74) for 36-month RFS and 0.74(95% CI: 0.70-0.77) for OS. Furthermore, the 3C (CII, CEA and CA19-9) combined score demonstrated prognostic predictive AUCs of 0.74(95% CI: 0.71-0.77) for RFS and 0.76(95% CI: 0.72-0.79) for OS in the overall population. The splenic flexure and ascending colon showed significantly elevated CII levels versus other subsites, and the disease was divided into the proximal colon, transverse colon, distal colon and rectum. A significant CII gradient emerged across subsites (proximal > transverse > distal > rectal), with corresponding survival decrements (log-rank < 0.001). Proximal CRC exhibited marked worse survival outcomes ( = 0.002 for RFS and = 0.001 for OS) and inferior chemotherapy efficacy ( < 0.001 for RFS and OS) versus rectal cancer, with no significant differences between adjacent subsites (all > 0.05).
The validated CII represents a biologically relevant, subsite-specific prognostic biomarker in CRC. The chronic inflammation-based tumor subsite classification correlated with chemotherapy efficacy and clinical outcomes, highlighting its potential for personalized treatment strategies.
本研究旨在开发并验证一种综合炎症预后指数，并探讨II-III期结直肠癌（CRC）的原发肿瘤部位、慢性炎症状态、辅助化疗反应和生存结果之间的关联。
共纳入1413例行根治性切除术的II-III期CRC患者，并分为发现队列和验证队列。对术前全身炎症生物标志物进行定量分析，并对患者进行3年随访，以建立最佳慢性炎症指数（CII），并评估其与不同原发肿瘤部位的生存及化疗疗效的关联。
综合CII是表现最佳的预后生物标志物，36个月无复发生存期（RFS）的时间依赖性曲线下面积（AUC）为0.71（95%CI：0.68-0.74），总生存期（OS）的为0.74（95%CI：0.70-0.77）。此外，在总体人群中，3C（CII、癌胚抗原和糖类抗原19-9）联合评分显示RFS的预后预测AUC为0.74（95%CI：0.71-0.77），OS的为0.76（95%CI：0.72-0.79）。脾曲和升结肠的CII水平显著高于其他亚部位，并将疾病分为近端结肠、横结肠、远端结肠和直肠。各亚部位出现显著的CII梯度（近端>横结肠>远端>直肠），并伴有相应的生存下降（对数秩<0.001）。与直肠癌相比，近端CRC的生存结果明显更差（RFS为P = 0.002，OS为P = 0.001），化疗疗效更差（RFS和OS均为P<0.001），相邻亚部位之间无显著差异（均为P>0.05）。
经验证的CII是CRC中一种具有生物学相关性、亚部位特异性的预后生物标志物。基于慢性炎症的肿瘤亚部位分类与化疗疗效和临床结果相关，突出了其在个性化治疗策略中的潜力。
