Prognostic and Predictive Value of Pan-Immune Inflammation Value in Rectal Cancer Patients Treated With Neoadjuvant Therapy.

IntroductionPredicting prognosis before treatment in rectal cancer patients undergoing neoadjuvant therapy is essential for effective treatment strategy selection. This study evaluates the prognostic impact of the pretreatment pan-immune-inflammation value (PIV) on pathological response, local control, and overall survival.MethodsWe included 126 patients who received neoadjuvant treatment for rectal cancer from November 2020 to May 2024. This study was conducted retrospectively. PIV was calculated as (neutrophil count × platelet count × monocyte count)/lymphocyte count, with an optimal threshold identified at 475. Patients were categorized into low (PIV < 475) and high (PIV ≥ 475) groups. Pathological responses were analyzed using the chi-square test, while survival rates were assessed with the Kaplan-Meier method and log-rank tests. Cox regression analysis examined the influence of variables on outcomes.ResultsThe high PIV group had a significantly higher prevalence of N2 disease (33.3% vs 13.7%, = .02) and a greater incidence of abdominoperineal resection (35.9% vs 17.2%, = .02). Pathological response was notably higher in the low PIV group (75% vs 33.3%, < .001). Overall survival and local recurrence-free survival rates were significantly better in the low PIV group ( = .006 and = .004, respectively). In multivariate analysis, PIV was the only significant factor affecting overall and local recurrence-free survival.ConclusionHigher pretreatment PIV values correlate with poorer pathological response and reduced overall and local recurrence-free survival in rectal cancer patients. These findings support the use of PIV for risk stratification and treatment personalization.