Prognostic value of combined systemic inflammation response index and prognostic nutritional index in colorectal cancer patients

Table 1 Relationship between preoperative prognostic nutritional index and systemic inflammation response index levels and clinicopathologic characteristics of colorectal cancer patients, n (%)

Characteristics	Overall patients, n = 470	High PNI (≥ 47.8), n = 315	Low PNI (< 47.8), n = 155	P value	High SIRI (≥ 1.38), n =112	Low SIRI (< 1.38), n = 358	P value
Age				0.031			0.794
≥ 60	261 (55.5)	164 (52.1)	97 (62.6)		61 (54.5)	200 (55.9)
< 60	209 (44.5)	151 (47.9)	58 (37.4)		51 (45.5)	158 (44.1)
Gender				0.317			0.011
Male	279 (59.4)	192 (61.0)	87 (56.1)		78 (69.6)	201 (56.1)
Female	191 (40.6)	123 (39.0)	68 (43.9)		34 (30.4)	157 (43.9)
BMI				0.278			0.688
< 18.5	14 (3.0)	9 (2.9)	5 (3.2)		5 (4.5)	9 (2.5)
18.5-24.0	203 (43.2)	129 (41.0)	74 (47.7)		48 (42.9)	155 (43.3)
24.0-28.0	189 (40.2)	135 (42.9)	54 (34.8)		44 (39.3)	145 (40.5)
≥ 28.0	64 (13.6)	42 (13.3)	22 (14.2)		15 (13.4)	49 (13.7)
Smoking				0.465			0.323
Yes	150 (31.9)	104 (33.0)	46 (29.7)		40 (35.7)	110 (30.7)
No	320 (68.1)	211 (67.0)	109 (70.3)		72 (64.3)	248 (69.3)
Drink				0.180			0.827
Yes	89 (18.9)	65 (20.6)	24 (15.5)		22 (19.6)	67 (18.7)
No	381 (81.1)	250 (79.4)	131 (84.5)		90 (80.4)	291 (81.3)
T stage				< 0.001			0.002
T1	33 (7.0)	29 (9.2)	4 (2.6)		2 (1.8)	31 (8.7)
T2	71 (15.1)	55 (17.5)	16 (10.3)		12 (10.7)	59 (16.5)
T3	335 (71.3)	218 (69.2)	117 (75.5)		87 (77.7)	248 (69.3)
T4	31 (6.6)	13 (4.1)	18 (11.6)		11 (9.8)	20 (5.6)
N stage				0.267			0.411
N0	282 (60.0)	193 (61.3)	89 (57.4)		64 (57.1)	218 (60.9)
N1	112 (23.8)	77 (24.4)	35 (22.6)		27 (24.1)	85 (23.7)
N2	76 (16.2)	45 (14.3)	31 (20.0)		21 (18.8)	55 (15.4)
Tumor stage				0.109			0.063
I	94 (20.0)	74 (23.5)	20 (12.9)		12 (10.7)	82 (22.9)
II	190 (40.4)	119 (37.8)	71 (45.3)		52 (46.4)	138 (38.5)
III	186 (39.6)	122 (38.7)	64 (41.3)		48 (42.9)	138 (38.5)
Differentiated degree				0.495			0.071
Poorly	73 (15.5)	47 (14.9)	26 (16.8)		25 (22.3)	48 (13.4)
Moderately	385 (81.9)	256 (82.2)	126 (81.3)		83 (74.1)	302 (84.4)
Well	12 (2.6)	9 (2.9)	3 (1.9)		4 (3.6)	8 (2.2)
Nerve invasion				0.141			< 0.001
Positive	84 (17.9)	50 (15.9)	34 (21.9)		87 (77.7)	59 (16.5)
Negative	386 (82.1)	265 (84.1)	121 (78.1)		25 (22.3)	299 (83.5)
Intravascular tumor emboli				0.497			< 0.001
Positive	87 (18.5)	61 (19.4)	26 (16.8)		88 (78.6)	63 (17.6)
Negative	383 (81.5)	254 (80.6)	129 (83.2)		24 (21.4)	295 (82.4)
CEA				0.462			0.103
High	171 (36.4)	111 (35.2)	60 (38.7)		48 (42.9)	123 (34.4)
Normal	299 (63.6)	204 (64.8)	95 (61.3)		64 (57.1)	235 (65.6)
NLR, median (IQR)	2 (1.50-2.69)	1.88 (1.43-2.52)	2.33 (1.69-3.04)	< 0.001	3.12 (2.61-3.83)	1.78 (1.40-2.20)	< 0.001
MLR, median (IQR)	0.24 (0.19-0.33)	0.23 (0.18-0.29)	0.30 (0.23-0.40)	< 0.001	0.40 (0.33-0.48)	0.22 (0.18-0.27)	< 0.001
PLR, median (IQR)	131.23 (101.07-173.58)	117.24 (95.14-151.97)	163.11 (122.92-223.84)	< 0.001	162 (120.46-211.60)	122.61 (96.34-161.73)	< 0.001

PNI: Prognostic nutritional index; SIRI: Systemic inflammation response index; BMI: Body mass index; CEA: Carcinoembryonic antigen; NLR: Neutrophil to lymphocyte ratio; MLR: Monocyte to lymphocyte ratio; IQR: Interquartile range.

Table 2 Univariate and multivariate analysis on the overall survival of prognostic nutritional index and systemic inflammation response index

Variables	Model 1		Model 2		Model 3		Model 4
	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value
PNI
≥ 47.82	1.00 (reference)		1.00 (reference)		1.00 (reference)		1.00 (reference)
< 47.82	3.93 (2.53-6.10)	< 0.001	3.33 (2.08-5.33)	< 0.001	3.33 (2.08-5.33)	< 0.001	2.96 (1.79-4.92)	< 0.001
SIRI
< 1.38	1.00 (reference)		1.00 (reference)		1.00 (reference)		1.00 (reference)
≥ 1.38	4.00 (2.61-6.12)	< 0.001	3.78 (2.42-5.92)	< 0.001	3.78 (2.42-5.92)	< 0.001	2.27 (1.26-4.11)	0.007

Model 1: Crude; Model 2: Adjusted with age and gender; Model 3: Adjusted with Model 2 + body mass index, smoke, and drink; Model 4: Adjusted with Model 3 + T stage, N stage, differentiated degree, nerve invasion, intravascular tumor emboli, carcinoembryonic antigen, neutrophil to lymphocyte ratio, monocyte to lymphocyte ratio, and platelet-to-lymphocyte ratio. HR: Hazard ratio; 95%CI: 95% confidence interval; PNI: Prognostic nutritional index; SIRI: Systemic inflammation response index.

Table 3 Development of PSIRI

PSIRI	PNI	SIRI	Number
0	< 47.82	≥ 1.38	46
1	PNI ≥ 47.82 or SIRI < 1.38		175
2	≥ 47.82	< 1.38	249

PNI: Prognostic nutritional index; SIRI: Systemic inflammation response index.

Table 4 Cox regression analysis of PSIRI and overall survival

Variables	Model 1		Model 2		Model 3		Model 4
	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value
PSIRI
2	1.00 (reference)		1.00 (reference)		1.00 (reference)		1.00 (reference)
1	4.00 (2.24-7.13)	< 0.001	3.92 (2.13-7.21)	< 0.001	3.92 (2.13-7.21)	< 0.001	3.56 (1.89-6.71)	0.018
0	13.61 (7.35-25.19)	< 0.001	13.26 (6.76-26.00)	< 0.001	13.26 (6.76-26.00)	< 0.001	9.53 (4.08-22.26)	< .001
PSIRI
2	1.00 (reference)		1.00 (reference)		1.00 (reference)		1.00 (reference)
≤ 1	5.60 (3.25-9.64)	< 0.001	5.30 (2.97-9.45)	< 0.001	5.30 (2.97-9.45)	< 0.001	3.77 (2.03-6.98)	< 0.001

Model 1: Crude; Model 2: Adjusted with age and gender; Model 3: Adjusted with Model 2 + body mass index, smoke, and drink; Model 4: Adjusted with Model 3 + T stage, N stage, differentiated degree, nerve invasion, intravascular tumor emboli, carcinoembryonic antigen, neutrophil to lymphocyte ratio, monocyte to lymphocyte ratio, and platelet-to-lymphocyte ratio. HR: Hazard ratio; 95%CI: 95% confidence interval.