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Research article
Zhenning Wang
The First Hospital of China Medical University
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0557-3097
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: The effect of adjuvant chemotherapy in stage II colorectal cancer (CRC) patients has been in controversy for a long time. Our study aimed to investigate the ability of several common inflammatory markers to predict the effect of chemotherapy in stage II CRC patients, finding an effective method for clinicians to distinguish chemotherapy-effective population.
Methods: A total of 708 stage II CRC patients who underwent radical resection (R0) were included. The Subpopulation Treatment Effect Pattern Plot (STEPP) analysis was used to determine the optimal inflammatory marker and cut-off value. Propensity Score Matching (PSM) was performed to balance discrepancy of the characteristics between the chemotherapy and non-chemotherapy group. Kaplan-Meier method with the log-rank test was used to calculate the restricted mean survival time (RMST) and compare survival difference between chemotherapy and non-chemotherapy patients. Univariate Cox proportional hazard regression analysis was used to calculate Hazard Ratio (HR). Multivariate Cox proportional hazard regression analysis was used to investigate the interaction between the effect of chemotherapy and the clinicopathological characteristics.
Results: Platelet to Lymphocyte Ratio (PLR) was chosen as the predictive marker with a cut-off value of 130 according to STEPP. For all the 708 patients, chemotherapy patients had a better OS than non-chemotherapy patients (p=0.007). Besides, the results of subgroup analysis interpreted that PLR was strongly associated with the effect of chemotherapy. In the high-PLR subgroup (PLR>130), chemotherapy patients obtained a significantly better survival benefit than non-chemotherapy patients (p＜0.001). However, in the low PLR subgroup (PLR≤130), such difference of survival benefit between chemotherapy and non-chemotherapy patients was not found (p=0.956). Multivariate Cox survival analysis also found that PLR was the only characteristic associated with the effect of chemotherapy (p interaction=0.027) among all the 11 clinicopathological characteristics. After PSM, no significant difference in OS was found between the chemotherapy group and the non-chemotherapy group (p=0.058). PLR was still the only characteristic associated with the effect of chemotherapy (p interaction=0.038).
Conclusions: PLR can be used as an effective marker to predict the effect of adjuvant chemotherapy in stage II CRC patients.
Keywords
colorectal cancer, stage II, adjuvant chemotherapy, inflammatory marker, platelet to lymphocyte ratio
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View the published article at BMC Cancer.
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Editorial decision: Major revision
On 11 Apr, 2021
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Received 17 Mar, 2021
Review #2 received
Received 13 Mar, 2021
Review #3 received
Received 06 Mar, 2021
Reviewer #4 agreed
On 25 Feb, 2021
Reviewer #3 agreed
On 19 Feb, 2021
Reviewer #2 agreed
On 14 Feb, 2021
Review #1 received
Received 29 Jan, 2021
Reviewer #1 agreed
On 25 Jan, 2021
Reviewers invited
Invitations sent on 24 Jan, 2021
Editor assigned
On 30 Oct, 2020
Submission checks complete
On 29 Oct, 2020
Editor invited
On 29 Oct, 2020
Version 1
Posted 04 Aug, 2020
No comments provided
Editorial decision: Major revision
On 30 Sep, 2020
Review #1 received
Received 31 Aug, 2020
Review #3 received
Received 27 Aug, 2020
Review #2 received
Received 27 Aug, 2020
Reviewer #3 agreed
On 23 Aug, 2020
Reviewers invited
Invitations sent on 20 Aug, 2020
Reviewer #1 agreed
On 20 Aug, 2020
Reviewer #2 agreed
On 20 Aug, 2020
Editor assigned
On 26 Jul, 2020
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See the published version of this preprint at BMC Cancer.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Zhenning Wang
The First Hospital of China Medical University
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0557-3097
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Cancer.
No community comments so far
Editorial decision: Major revision
On 11 Apr, 2021
Review #4 received
Received 17 Mar, 2021
Review #2 received
Received 13 Mar, 2021
Review #3 received
Received 06 Mar, 2021
Reviewer #4 agreed
On 25 Feb, 2021
Reviewer #3 agreed
On 19 Feb, 2021
Reviewer #2 agreed
On 14 Feb, 2021
Review #1 received
Received 29 Jan, 2021
Reviewer #1 agreed
On 25 Jan, 2021
Reviewers invited
Invitations sent on 24 Jan, 2021
Editor assigned
On 30 Oct, 2020
Submission checks complete
On 29 Oct, 2020
Editor invited
On 29 Oct, 2020
Version 1
Posted 04 Aug, 2020
No comments provided
Editorial decision: Major revision
On 30 Sep, 2020
Review #1 received
Received 31 Aug, 2020
Review #3 received
Received 27 Aug, 2020
Review #2 received
Received 27 Aug, 2020
Reviewer #3 agreed
On 23 Aug, 2020
Reviewers invited
Invitations sent on 20 Aug, 2020
Reviewer #1 agreed
On 20 Aug, 2020
Reviewer #2 agreed
On 20 Aug, 2020
Editor assigned
On 26 Jul, 2020
Submission checks complete
On 25 Jul, 2020
Editor invited
On 25 Jul, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Cancer.
Background: The effect of adjuvant chemotherapy in stage II colorectal cancer (CRC) patients has been in controversy for a long time. Our study aimed to investigate the ability of several common inflammatory markers to predict the effect of chemotherapy in stage II CRC patients, finding an effective method for clinicians to distinguish chemotherapy-effective population.
Methods: A total of 708 stage II CRC patients who underwent radical resection (R0) were included. The Subpopulation Treatment Effect Pattern Plot (STEPP) analysis was used to determine the optimal inflammatory marker and cut-off value. Propensity Score Matching (PSM) was performed to balance discrepancy of the characteristics between the chemotherapy and non-chemotherapy group. Kaplan-Meier method with the log-rank test was used to calculate the restricted mean survival time (RMST) and compare survival difference between chemotherapy and non-chemotherapy patients. Univariate Cox proportional hazard regression analysis was used to calculate Hazard Ratio (HR). Multivariate Cox proportional hazard regression analysis was used to investigate the interaction between the effect of chemotherapy and the clinicopathological characteristics.
Results: Platelet to Lymphocyte Ratio (PLR) was chosen as the predictive marker with a cut-off value of 130 according to STEPP. For all the 708 patients, chemotherapy patients had a better OS than non-chemotherapy patients (p=0.007). Besides, the results of subgroup analysis interpreted that PLR was strongly associated with the effect of chemotherapy. In the high-PLR subgroup (PLR>130), chemotherapy patients obtained a significantly better survival benefit than non-chemotherapy patients (p＜0.001). However, in the low PLR subgroup (PLR≤130), such difference of survival benefit between chemotherapy and non-chemotherapy patients was not found (p=0.956). Multivariate Cox survival analysis also found that PLR was the only characteristic associated with the effect of chemotherapy (p interaction=0.027) among all the 11 clinicopathological characteristics. After PSM, no significant difference in OS was found between the chemotherapy group and the non-chemotherapy group (p=0.058). PLR was still the only characteristic associated with the effect of chemotherapy (p interaction=0.038).
Conclusions: PLR can be used as an effective marker to predict the effect of adjuvant chemotherapy in stage II CRC patients.
Figure 1
Figure 2
Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
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