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Prognostic role of aspartate aminotransferase-lymphocyte ratio index in patients with metastatic colorectal cancer: results from the randomized ITACa trial

Authors Casadei Gardini A, Scarpi E, Orlandi E, Tassinari D, Leo S, Bernardini I, Gelsomino F, Tamberi S, Ruscelli S, Vespignani R, Ronconi S, Frassineti GL, Amadori D, Passardi A

Received 26 February 2018

Accepted for publication 12 May 2018

Published 29 August 2018 Volume 2018:11 Pages 5261—5268


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Yao Dai

Andrea Casadei Gardini,1,* Emanuela Scarpi,2,* Elena Orlandi,3 Davide Tassinari,4 Silvana Leo,5 Ilaria Bernardini,6 Fabio Gelsomino,7 Stefano Tamberi,8 Silvia Ruscelli,1 Roberto Vespignani,9 Sonia Ronconi,10 Giovanni Luca Frassineti,1 Dino Amadori,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; 3Medical Oncology Department, Piacenza Hospital, Piacenza, Italy; 4Department of Oncology, City Hospital, Rimini, 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, Italy; 8Oncolgy Unit, Degli Infermi Hospital, Faenza, Italy; 9IT Service, IRST IRCCS, Meldola, Italy; 10Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy

*These authors contributed equally to this work

Background: The aim of this study was to investigate the role of pre-treatment aspartate aminotransferase-lynphocyte ratio (ALRI) 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 (B) or CT alone.
Patients and methods: Patients randomly received CT+B or CT alone as first-line therapy. CT consisted of either FOLFOX4 or FOLFIRI at the clinician’s discretion.
Results: Out of the 284 patients enrolled, increased ALRI levels were associated with shorter PFS and OS (p<0.0001). At baseline, median PFS was 10.3 months (95% CI 9.4–12.0) and 8.0 months (95 % CI 6.8–8.9), and median OS was 25.2 months (95 % CI 21.3–30.2) and 18.8 months (95 % CI 16.6–21.7) for patients with low (<14) and high (≥14) ALRI levels, respectively (HR 1.43, 95% CI 1.12–1.82, p=0.004; HR=1.51, 95% CI 1.17–1.96, p<0.001). Interaction tests on ALRI levels and treatment efficacy in the CT+B and the CT groups were statistically significant for PFS (p=0.0003), but not for OS (p=0.228).
Conclusion: Our results indicate that ALRI is a good prognostic and predictive marker for mCRC patients candidate for CT+B.

Keywords: metastatic colorectal cancer, bevacizumab, first line, prognosis, aspartate aminotransferase-lymphocyte ratio index, clinical outcome, rectal cancer

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