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Prognostic role of a new inflammatory index with neutrophil-to-lymphocyte ratio and lactate dehydrogenase (CII: Colon Inflammatory Index) in patients with metastatic colorectal cancer: results from the randomized Italian Trial in Advanced Colorectal Cancer (ITACa) study

Authors Casadei-Gardini A, Scarpi E, Ulivi P, Palladino MA, Accettura C, Bernardini I, Spallanzani A, Gelsomino F, Corbelli J, Marisi G, Ruscelli S, Valgiusti M, Frassineti GL, Passardi A

Received 18 December 2018

Accepted for publication 27 February 2019

Published 10 May 2019 Volume 2019:11 Pages 4357—4369

DOI https://doi.org/10.2147/CMAR.S198651

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Dr Antonella D'Anneo


Andrea Casadei-Gardini,1 Emanuela Scarpi,2 Paola Ulivi,3 Maria Angela Palladino,4 Caterina Accettura,5 Ilaria Bernardini,6 Andrea Spallanzani,7 Fabio Gelsomino,7 Jody Corbelli,8 Giorgia Marisi,8 Silvia Ruscelli,1 Martina Valgiusti,1 Giovanni Luca Frassineti,1 Alessandro Passardi1

1Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; 2Unit of Biostatistics and Clinical Trials, IRST IRCCS, Meldola, Italy; 3Biosciences Laboratory, IRST IRCCS, Meldola, Italy; 4Medical Oncology Department, Piacenza Hospital, Piacenza, Italy; 5Medical Oncology Unit, Vito Fazzi Hospital, Lecce, Italy; 6Medical Oncology Unit, Ramazzini Hospital, Carpi, Italy; 7Department of Oncology and Hematology, Division of Oncology, University Hospital Modena, Modena, Italy; 8Oncolgy Unit, Degli Infermi Hospital, Faenza, Italy

Aim: The aim of this study was to investigate the role of a new inflammatory index (Colon Inflammatory Index [CII]) as a predictor of prognosis and treatment efficacy in patients with metastatic colorectal cancer (mCRC) enrolled in the prospective multicenter randomized ITACa (Italian Trial in Advanced Colorectal Cancer) trial to receive first-line chemotherapy (CT)+ bevacizumab or CT alone.
Patients and methods: Between November 14, 2007 and March 6, 2012, 276 patients diagnosed with CRC were available for baseline neutrophil-to-lymphocyte ratio (NLR) and lactate dehydrogenase (LDH). We divided the population into three groups on basis of the CII index.
Results: At baseline in all populations, median PFS and OS was predictive of clinical outcome (p<0.0001). Following adjustment for clinical covariates, multivariate analysis confirmed CII index as an independent prognostic factor. The CII index was also predictive when we evaluated the two distinct arms with (p=0.0009) or without bevacizumab (p=0.0001). When we divided right side versus left side for treatment regimen (CT plus bevacizumab versus only bevacizumab), we found a benefit of bevacizumab versus only CT in the right side in patients treated with bevacizumab and not in patients treated with only chemotherapy. Conversely, we found no difference the left side, but we found a difference in the poor group of 4 months in favor to only chemotherapy.
Conclusion: Our results indicate that the CII index is a good prognostic marker for mCRC patients in first line treatment with CT with or without bevacizumab.
Trial registration: NCT01878422 ClinicalTrials.gov; date of registration: June 7, 2013.

Keywords: metastatic colorectal cancer, bevacizumab, first-line, prognosis, lactate dehydrogenase, neutrophil-to-lymphocyte ratio

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