Wu ZJ, Lan B, Luo J, Ameti A, Wang H, Hu QY. Impact of preoperative inflammatory and nutritional markers on the prognosis of patients with peritoneal metastasis of colorectal cancer. World J Gastrointest Oncol 2024; 16(9): 3865-3874 [PMID: 39350999 DOI: 10.4251/wjgo.v16.i9.3865]
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08228836
Submitted on:
September 13, 2024, 11:21
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Reader Comments:
The authors' proposed study aims to investigate the association between nutritional and inflammatory markers and the prognosis of patients with CRC-PM.
The article argues for the predictive role of NLR with respect to patients' OS, based on blood sampling performed one week before surgery regardless of the treatment the patient receives. It also constructs a nomogram on NLR, Hb and PCI (dividing patients into only two groups PCI > or <20).
As highlighted by the authors in the introduction, treatment impacts the OS of patients: the OS of chemo-treated-only patients is 13 months while for those who received a CRS/HIPEC it is up to 41.7 months.
In the literature, the following are documented as prognostic factors affecting OS: extent of peritoneal disease in accordance with PCI (there are more than two subgroups, commonly: PCI<7-11; PCI between 11 and 15 ,PCI>15 also, some studies consider a PCI>20 to be outside the chances of benefiting from any treatment), achievement of optimal surgical cytoreduction (CC0-CC1), type of peri-operative chemotherapy received by the patient, and tumor biology. the role played by HIPEC (and the various application protocols) is a matter of debate.
The population on which NRL is tested and then the nomogram constructed is heterogeneous in both staging and treatment received. Characteristics of pre-surgical extent of disease are not known. Any chemotherapy treatments received by patients are not known. The authors pool patients who received only palliative treatments and those who received radical therapy into the same population.
In summary, despite a large number of papers in the literature advocating the importance of careful evaluation/selection of patients with CRC-PM and the impact of treatments on patients' OS the authors support the selection role of a single inflammatory marker and base the construction of a nomogram on this.
There is a risk of providing non-expert clinicians with an inadequate assessment tool that could lead to incorrect treatment choices.
Reply from the Editorial Office:
First, thank you very much for your professional comments on the article published in World Journal of Gastrointestinal Oncology.
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