Prognostic role of a new index (multi inflammatory index) in patients with metastatic colorectal cancer: results from the randomized ITACa trial

Andrea Casadei Gardini, Emanuela Scarpi, Martina Valgiusti, Manlio Monti, Silvia Ruscelli, Laura Matteucci, Giulia Bartolini, Bernadette Vertogen, Flavia Pagan, Giulia Rovesti, Giovanni Luca Frassineti, Alessandro Passardi

Research output: Contribution to journalArticlepeer-review


Aims: We created a new index (Multi Inflammatory Index, MII) composed of an inflammatory index [neutrophil-to lymphocyte-ratio (NLR): MII-1; platelet-to-lymphocyte ratio (PLR): MII-2; or systemic immune-inflammation index (SII): MII-3] and C-reactive protein (CRP). Our aim was to evaluate the prognostic and/or predictive capacity of the MII in the randomized ITACa (Italian Trial in Advanced Colorectal Cancer) study on patients with metastatic colorectal cancer undergoing first-line chemotherapy. Methods: Between November 2007 and March 2012, baseline NLR, PLR; SII and CRP were available for 131 patients, 66 receiving chemotherapy plus bevacizumab and 65 receiving chemotherapy alone. Results: Patients with low (<25) MII-1 levels had a better outcome than those with high (⩾25) levels: median progression-free survival (PFS) was 12.4 versus 8.9 months [hazard ratio (HR) = 1.74, 95% confidence interval (CI) 1.21–2.51, p = 0.003] and median overall survival (OS) was 30.9 months versus 15.0 months (HR = 2.05, 95% CI 1.40–3.02, p = 0.0002), respectively. Similar results were obtained for patients with low (<1424) MII-2 levels compared with those with high (⩾1424) levels: median PFS was 12.6 versus 8.9 months (HR = 1.95, 95% CI 1.35–2.82, p = 0.0004) and median OS was 32.4 versus 14.6 months, respectively (HR = 2.42, 95% CI 1.64–3.57, p < 0.0001). Patients with low (<6068) MII-3 levels had a longer median PFS and OS than those with high (⩾6068) levels: 12.6 versus 8.9 months (HR = 1.91, 95% CI 1.33–2.76, p = 0.005) and 30.9 versus15.0 months (HR = 2.10, 95% CI 1.43–3.09, p = 0.0002), respectively. Following adjustment for clinical covariates, multivariate analysis confirmed all MII indexes as independent prognostic factors for predicting PFS and OS. Conclusion: All MII indexes appear to be useful as prognostic markers. Trial registration: identifier: NCT01878422 (registration date: 07/06/2013)

Original languageEnglish
JournalTherapeutic Advances in Medical Oncology
Publication statusPublished - 2020


  • bevacizumab
  • first-line
  • inflammation
  • metastatic colorectal cancer
  • neutrophil-to-lymphocyte ratio
  • prognosis

ASJC Scopus subject areas

  • Oncology


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