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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 find an effective inflammatory marker to predict the effect of chemotherapy.
Methods: 708 stage II CRC patients in our institution 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 between the chemotherapy and non-chemotherapy group. Survival analysis based on overall survival (OS) and cancer-specific survival (CSS) was performed using Kaplan-Meier methods with log-rank test and Cox proportional hazards regression. The restricted mean survival time (RMST) was used to measure treatment effect.
Results: Platelet to Lymphocyte Ratio (PLR) was chosen as the optimal marker with a cut-off value of 130 according to STEPP analysis. In overall survival analysis, PLR level was significantly associated with the effect of chemotherapy (interaction p=0.027). In low-PLR subgroup, chemotherapy patients did not have a better OS than non-chemotherapy patients (RMST: 56.0 months vs. 56.0 months, HR: 0.983, 95 % CI: 0.528-1.829). In high-PLR subgroup, chemotherapy patients had a significant better OS than non-chemotherapy patients (RMST: 56.5 months vs. 51.3 months, HR: 0.371, 95% CI: 0.212-0.649). After PSM, PLR level was still associated with the effect of chemotherapy. In cancer-specific survival analysis, PLR level was not significantly associated with the effect of chemotherapy (interaction p=0.116). In low-PLR subgroup, chemotherapy patients did not have a better CSS than non-chemotherapy patients (RMST: 56.0 months vs. 56.0 months, HR: 1.016, 95 % CI: 0.494-2.087). In high-PLR subgroup, chemotherapy patients had a better CSS than non-chemotherapy patients (RMST: 56.5 months vs.51.3 months, HR: 0.371, 95% CI: 0.212-0.649). After PSM, PLR level was not associated with the effect of chemotherapy.
Conclusions: PLR is an effective marker to predict the effect of chemotherapy in stage II CRC patients.
Keywords
colorectal cancer, stage II, adjuvant chemotherapy, inflammatory marker, platelet to lymphocyte ratio
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CURRENT STATUS: Under Review
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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
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
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This preprint is under consideration at BMC Cancer. A preprint is 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: Under Review
Version 2
Posted 04 Nov, 2020
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
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
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 find an effective inflammatory marker to predict the effect of chemotherapy.
Methods: 708 stage II CRC patients in our institution 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 between the chemotherapy and non-chemotherapy group. Survival analysis based on overall survival (OS) and cancer-specific survival (CSS) was performed using Kaplan-Meier methods with log-rank test and Cox proportional hazards regression. The restricted mean survival time (RMST) was used to measure treatment effect.
Results: Platelet to Lymphocyte Ratio (PLR) was chosen as the optimal marker with a cut-off value of 130 according to STEPP analysis. In overall survival analysis, PLR level was significantly associated with the effect of chemotherapy (interaction p=0.027). In low-PLR subgroup, chemotherapy patients did not have a better OS than non-chemotherapy patients (RMST: 56.0 months vs. 56.0 months, HR: 0.983, 95 % CI: 0.528-1.829). In high-PLR subgroup, chemotherapy patients had a significant better OS than non-chemotherapy patients (RMST: 56.5 months vs. 51.3 months, HR: 0.371, 95% CI: 0.212-0.649). After PSM, PLR level was still associated with the effect of chemotherapy. In cancer-specific survival analysis, PLR level was not significantly associated with the effect of chemotherapy (interaction p=0.116). In low-PLR subgroup, chemotherapy patients did not have a better CSS than non-chemotherapy patients (RMST: 56.0 months vs. 56.0 months, HR: 1.016, 95 % CI: 0.494-2.087). In high-PLR subgroup, chemotherapy patients had a better CSS than non-chemotherapy patients (RMST: 56.5 months vs.51.3 months, HR: 0.371, 95% CI: 0.212-0.649). After PSM, PLR level was not associated with the effect of chemotherapy.
Conclusions: PLR is an effective marker to predict the effect of chemotherapy in stage II CRC patients.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
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