An Applicable Inflammation-Joined And Nutrition-Related Prognostic Indicator In Patients With Colorectal Cancer

Object:The aim of this study was to elucidate the prognostic significance of a novel inflammation-joined and nutrition-related clinicopathological marker C-reactive protein/mean corpuscular volume ratio（CRP/MCV）for colorectal cancer（CRC）,and to stratify clinical risk based on this marker to construct a prognostic risk model to guide clinical decision-making.Methods:Various factors from the basic medical records,preoperative fasting blood samples,instrument examinations and postoperative pathologies of 2471patients with CRC were retrospectively analyzed.Factors related to prognosis were evaluated using univariate and multivariate analyses.The Kaplan–Meier method was used to generate survival curves,while the log-rank test was used to measure survival differences between groups.Independent prognostic factors in multivariate analysis were used to construct predictable nomograms,ROC and AUC curves were used to evaluate the predictive value of the model,and validity curves were drawn to evaluate the clinical applicability of the model.Results:Univariate analysis revealed that C-reactive protein（CRP）/mean corpuscular volume（MCV）ratio,TNM stage,differentiation,right sided tumor,age,carcinoembryonic antigen（CEA）level,and CRP level were significantly associated with poor prognosis in CRCs.Contrariwise,adjuvant chemotherapy was regarded as a protective factor.Elevation of CRP/MCV ratio（odds ratio[OR]:1.535,95%confidence interval[CI]:1.121–2.104,P=0.008）,TNM stage（OR:2.747,95%CI:2.175–3.469,P<0.001）,and differentiation（OR:1.384,95%CI:1.150–1.666,P=0.001）were prognostic risk factors in multivariate analyses.The increased CRP-MCV was associated with males,older age（older than 60 years）,higher CEA value,presenting advanced T,M stage,and later TNM stage,accompanying microsatellite instability,right-sided,and poorly differentiated colon cancer.Risk stratification based on CRP/MCV values could significantly distinguish the prognosis of patients with different stages.Subgroup analysis showed that CRP/MCV,TNM staging system,and differentiation also affected survival independently in lymph node-positive CRC patients.The nomogram based on these three indicators showed that CRP/MCV had a greater prognostic value and clinical significance for lymph node-positive patients with poorly differentiated tumors at the late stage.The AUC value of the model（0.694）was better than that of the TNM staging system alone（0.642）,and the time-dependent AUC value of the model was always greater than that of the TNM staging system over time.Conclusion:1.CRP/MCV,TNM stage and degree of differentiation were independent prognostic factors of CRCs;In terms of prognosis,overall survival was worse in patients with CRP/MCV>0.06(×10^-15mg/L²).2.Elevated CRP/MCV can effectively predict the biological behavior of tumor;Advanced patients are more likely to have high CRP/MCV values,while severe inflammatory response and malnutrition suggest poor early prognosis.And appropriate intervention measures should be taken early to improve prognosis and quality of life of patients.3.Compared with TNM staging system and CEA,CRP/MCV is a clinically friendly marker.4.CRP/MCV value is a novel and practical prognostic indicator of inflammation-related nutritional combination in CRC,which effectively stratifies risk,provides guidance for early clinical intervention,and emphasizes individualized treatment.