Análise de marcadores inflamatórios na sobrevida livre de progressão e sobrevida global no cancro colorretal

• Main Author: Ligia Cristina Nobre Moreira
• Publication Date: 2024
• Format: Master thesis
• Language: por
• Source: Repositórios Científicos de Acesso Aberto de Portugal (RCAAP)
• Download full: https://hdl.handle.net/10216/161720
• topic: Ciências médicas e da saúde; Medical and Health sciences

Introduction. During tumor development, the high proliferation of malignant cells that release cytokines triggers a chronic inflammatory process. Obesity, which contributes to chronic low-grade disease, can stimulate the development of cancer, leading to progression and a worse prognosis. The patient's nutritional status can also impact prognosis and survival due to metabolic changes generated by excess fat, mainly visceral, in addition to systemic inflammation. Therefore, hematological and nutritional markers have been trained. The goal is to test whether inflammation and overweight/obesity disruptions can predict progression-free survival and overall survival through five inflammatory markers: Systemic Immunoinflammation Index (SII); Nutritional Prognostic Index (PNI), Neutrophil-Lymphocyte Ratio (NRL), Advanced Lung Inflammation Index (ALI), and Platelet-Lymphocyte Ratio (PRL). Methodology. Clinical and anthropometric data were collected every three months after diagnosis of colorectal cancer from adult and elderly patients between 2009 and 2023 at the Unidade Local de Saúde de São João. The evolution of Bdy Mass Index (BMI) and biochemical data throughout treatment was demonstrated in graphs and the analysis of progression-free survival and overall survival was performed using the Kaplan-Meier curve. To test the association, the chi-square test and Forest Plot of inflamed markers with disease progression were performed. Cox regression of inflamed markers with progression-free survival and overall survival was performed. Results. Data were collected from 214 patients, the majority of whom were men (57%) of adult age (60.8 years ±12 years). More than half of patients experienced disease progression (57.9%) and half died (49.5%). We observed that more than 50% of adults had progression. Of the 124 patients who progressed, 65 had weight gain from diagnosis until before progression, and the variation in weight during this period between the groups with and without progression showed a significant difference (p<0.002). Comparing the BMI groups at the first appointment and BMI before progression there was also a significant difference (p=0.009) for the BMI group before progression. In the chi-square test, an association between BMI before progression and the progression outcome, showed that a eutrophic patient before progression has almost twice the chance of an obese individual of having progression. When testing the associations between all collected data and inflammatory markers with the stage of disease progression, we found a positive, statistically significant association with progressive advancement for BMI (p=0.02), ALI (p=0.015), and PNI (p=0.003). When performing Cox regression, only the PNI marker was associated with progression (p=0.023) and for overall survival, three of them highlighted a significant difference SII (p=0.008), PLR (p=0.014) and PNI (p=0.022). Conclusion. In this study, we conclude that inflammatory parameters are good ways to assist health professionals in their clinical management, as they can be good predictors of disease-free survival and overall survival in patients with CRC, with PNI being the one that showed the greatest association with outcomes. Therefore, more studies are needed to determine which indices of inflammation are prognostic factors in patients with colorectal cancer.