The Importance of Pan-Immune-Inflammation Value Score in Locally Advanced Rectal Cancer

In this study, we aimed to observe the prognostic significance of the pan-immune-inflammation value (PIV) score calculated at the time of diagnosis in patients with locally advanced rectal cancer, as well as its effect on treatment response, survival, and prognosis.

This retrospective, single-center observational study was designed to analyze patients with nonmetastatic (stages II-III) rectal cancer who received neoadjuvant treatment, categorized into two groups: PIV-L (n = 67, 50%) and PIV-H (n = 67, 50%). The median PIV score was used for cutoff determination. Survival analysis was applied. Univariate and multivariate Cox regression analyses were used to determine prognostic factors.

Preoperative clinical lymph node status (p = 0.011), liver metastasis (p = 0.028), carcinoembryonic antigen (CEA; p = 0.013), and cancer antigen 19.9 (CA19.9; p = 0.040) levels; pathological complete response (p = 0.035); tumor regression score (p = 0.030); postoperative lymph node status (p = 0.019); tumor deposits (p = 0.035); and budding (p = 0.043) were statistically different between the groups. The 5- and 10-year overall survival (OS) rates were 77% versus 69% and 62% versus 38% in the PIV-L and PIV-H groups, respectively (p = 0.032). While the PIV score was prognostic for OS in univariate analysis (HR: 1.85, 95% CI: 1.04-3.31, p = 0.035), a result of insignificance was obtained in multivariate analysis (HR: 1.76, 95% CI: 0.98-3.01 p = 0.056). The 5- and 10-year disease-free survival (DFS) rates were 67% versus 54% and 56% versus 39% in the PIV-L and PIV-H groups, respectively, with the PIV-H group showing a statistically significantly lower rate (p = 0.048). For DFS, the PIV score was found to be a statistically insignificant prognostic factor in univariate analysis (HR: 0.052, 95% CI: 0.99-2.86, p = 0.052) and recognized as an independent prognostic factor in multivariate analysis (HR: 1.87, 95% CI: 1.08-3.26, p = 0.026).

A higher pretreatment PIV score was associated with poorer clinicopathological features, a worse treatment response, lower survival rates, and a poor prognosis for DFS.