Prognostic role of preoperative inflammatory markers in postoperative patients with colorectal cancer

Background Inflammatory response markers are prognostic factors for several cancers, but their role in postoperative colorectal cancer (CRC) is unclear. The purpose was to evaluate the role of preoperative Neutrophil-to-Lymphocyte ratio (NLR), Platelet-to-Lymphocyte-ratio (PLR), and Lymphocyte-to-Monocyte ratio (LMR) in the prognosis of postoperative CRC patients. Methods We retrospectively reviewed 448 CRC patients who had undergone surgical resection from December 2015 to December 2017 in our hospital. The plasma NLR, PLR, LMR, CEA, and CA19-9 were collected within 2 weeks before the operation. We recorded the clinical characteristics and survival data by reviewing medical records and phone calls. We analyzed preoperative inflammatory markers and clinical features using Pearson chi-squared tests or Fisher’s tests. Uni- and multivariate Cox regression analyses were performed, and overall survival (OS) was estimated with the Kaplan–Meier method. Results High NLR and PLR were associated with worse overall survival in postoperative CRC (HR = 2.140, 95%CI = (1.488-3.078), P < 0.001; HR =1.820, 95%CI = (1.271-2.605), P = 0.001). High LMR was associated with improved overall survival in postoperative CRC (HR = 0.341, 95%CI = (0.188-0.618), P < 0.001). In the multivariate regression analysis, the increase of NLR resulted in an increase in the risk of death (HR = 1.678, 95%CI = (1.114-2.527), P = 0.013), and for the LMR, a reduction of the risk of death (HR = 0.480, 95%CI = (0.256 - 0.902), P = 0.023). Moreover, TNM stage, CA-199, CEA, nerve or vascular invasion (NVI) and adjuvant chemotherapy after surgery also were associated with worse overall survival in postoperative CRC. Conclusion Current evidence indicates that preoperative inflammatory markers NLR, LMR, and PLR are associated with overall survival in postoperative patients with colorectal cancer. NLR is an independent risk factor, and LMR is an independent protective factor in CRC patients after surgery.

[1]  A. Zinellu,et al.  Inflammatory Indexes as Predictive Biomarkers of Postoperative Complications in Oncological Thoracic Surgery , 2022, Current oncology.

[2]  L. Wyrwicz,et al.  Correlation between Lymphocyte-to-Monocyte Ratio (LMR), Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR) and Tumor-Infiltrating Lymphocytes (TILs) in Left-Sided Colorectal Cancer Patients , 2022, Biology.

[3]  R. Zheng,et al.  Cancer incidence and mortality in China, 2016 , 2022, Journal of the National Cancer Center.

[4]  M. Milione,et al.  Low baseline neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios predict increased overall survival in locally recurrent rectal cancer despite R1 margins. , 2022, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[5]  Changli Wang,et al.  The Role of Neutrophil-to-Lymphocyte Ratio in Predicting Pathological Response for Resectable Non–Small Cell Lung Cancer Treated with Neoadjuvant Chemotherapy Combined with PD-1 Checkpoint Inhibitors , 2021, Cancer research and treatment.

[6]  S. Gururaj,et al.  Predictive Ability of Neutrophil-Lymphocyte Ratio in Determining Tumor Staging in Colorectal Cancer , 2021, Cureus.

[7]  K. Obama,et al.  Inflammation-Related Biomarkers for the Prediction of Prognosis in Colorectal Cancer Patients , 2021, International journal of molecular sciences.

[8]  P. Gao,et al.  The platelet to lymphocyte ratio is a potential inflammatory marker predicting the effects of adjuvant chemotherapy in patients with stage II colorectal cancer , 2021, BMC cancer.

[9]  Xiaohua Hu,et al.  Neutrophil-Lymphocyte Ratio and Circulating Tumor Cells Counts Predict Prognosis in Gastrointestinal Cancer Patients , 2021, Frontiers in Oncology.

[10]  R. Dahlstrom,et al.  Challenges and opportunities , 2021, Foundations of a Sustainable Economy.

[11]  Yibing Bai,et al.  Inflammatory Markers Predict Survival in Patients With Advanced Gastric and Colorectal Cancers Receiving Anti–PD-1 Therapy , 2021, Frontiers in Cell and Developmental Biology.

[12]  A. Jemal,et al.  Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries , 2021, CA: a cancer journal for clinicians.

[13]  P. V. van Dam,et al.  A high neutrophil-lymphocyte ratio and platelet-lymphocyte ratio are associated with a worse outcome in inflammatory breast cancer , 2020, Breast.

[14]  D. Chang,et al.  Platelet and neutrophil to lymphocyte ratios predict survival in patients with resectable colorectal liver metastases. , 2020, American journal of surgery.

[15]  H. Putter,et al.  Elevated CEA and CA19-9 serum levels independently predict advanced pancreatic cancer at diagnosis , 2020, Biomarkers : biochemical indicators of exposure, response, and susceptibility to chemicals.

[16]  Huy Q. Dinh,et al.  Monocyte heterogeneity and functions in cancer , 2019, Journal of leukocyte biology.

[17]  Y. Sakai,et al.  The Role of Tumor-Associated Neutrophils in Colorectal Cancer , 2019, International journal of molecular sciences.

[18]  A. Sood,et al.  The Platelet Lifeline to Cancer: Challenges and Opportunities. , 2018, Cancer cell.

[19]  P. Hodgkin,et al.  The regulation of lymphocyte activation and proliferation. , 2018, Current opinion in immunology.

[20]  Qiong Yang,et al.  Clinical baseline and prognostic difference of platelet lymphocyte ratio (PLR) in right-sided and let-sided colon cancers , 2017, BMC Cancer.

[21]  Z. Pan,et al.  Lymphocyte-to-monocyte ratio before chemoradiotherapy represents a prognostic predictor for locally advanced rectal cancer , 2017, OncoTargets and therapy.

[22]  M. Delgado-Rodríguez,et al.  Systematic review and meta-analysis. , 2017, Medicina intensiva.

[23]  E. Otsuji,et al.  The Prognostic Value of Preoperative Neutrophil-to-Lymphocyte Ratio in Colorectal Cancer , 2016, World Journal of Surgery.

[24]  M. Caligiuri,et al.  Obesity, Inflammation, and Cancer. , 2016, Annual review of pathology.

[25]  H. Muss,et al.  Prognostic value of lymphocyte-to-monocyte ratio in patients with solid tumors: A systematic review and meta-analysis. , 2015, Cancer treatment reviews.

[26]  S. Clarke,et al.  Cancer-related inflammation and treatment effectiveness. , 2014, The Lancet. Oncology.

[27]  F. Başak,et al.  CEA and CA 19-9 are still valuable markers for the prognosis of colorectal and gastric cancer patients. , 2013, Asian Pacific journal of cancer prevention : APJCP.

[28]  S. Clarke,et al.  A derived neutrophil to lymphocyte ratio predicts survival in patients with cancer , 2012, British Journal of Cancer.

[29]  E. Mohammadi,et al.  Barriers and facilitators related to the implementation of a physiological track and trigger system: A systematic review of the qualitative evidence , 2017, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[30]  L. Coussens,et al.  Leukocytes in mammary development and cancer. , 2011, Cold Spring Harbor perspectives in biology.

[31]  L. Coussens,et al.  Inflammation and cancer , 2002, Nature.

[32]  M. Tanaka,et al.  CEA and CA 19-9 as prognostic indexes in colorectal cancer. , 1999, Hepato-gastroenterology.

[33]  D. Firescu,et al.  The Importance of Systemic Inflammation Markers in the Survival of Patients with Complicated Colorectal Cancer, Operated in Emergency. , 2020, Chirurgia.

[34]  M. Kerin,et al.  The prognostic value of neutrophil‐to‐lymphocyte ratio in colorectal cancer: A systematic review , 2017, Journal of surgical oncology.