Combined use of preoperative lymphocyte counts and the post/preoperative lymphocyte count ratio as a prognostic marker of recurrence after curative resection of stage II colon cancer.

Seiichi Shinji,Takuma Iwai,Hayato Kan,Takeshi Yamada,Kohki Takeda,Michihiro Koizumi,Goro Takahashi,Mikihiro Okusa,Yasuyuki Yokoyama,Keisuke Hara,Masahiro Hotta,Eiji Uchida,Yoshibumi Ueda

doi:10.18632/oncotarget.23510

Abstract

PurposeDiagnostic markers for recurrence of colorectal cancer have not been established. The aim of the present study was to identify new diagnostic markers for recurrence after curative surgery of stage II colon cancer.Materials and MethodsIn this study, the prognostic values of the preoperative lymphocyte count and the post/preoperative lymphocyte count ratio (PPLR) were evaluated in 142 patients with localized colon cancer treated with surgery at a single medical center. The associations of patient demographics, blood chemistry, and serum biochemical indices with recurrence-free survival (RFS) and cancer-specific survival (CSS) were examined by univariate and multivariate analyses.ResultsReceiver operating characteristic (ROC) curve analysis showed that the optimal cut-off values of the lymphocyte count and PPLR were, respectively, 1555.2/μl and 1.151 for RFS. On univariate analysis, tumor depth of invasion, carbohydrate antigen 19-9 (CA19-9), and preoperative low lymphocyte count (≤1555.2/μl) were all correlated with poorer RFS (p < 0.05). On multivariate analysis, T4, low lymphocyte count, and low PPLR were independent predictors of poor RFS. Furthermore, the patients were categorized into four categories based on preoperative lymphocyte count high/low and PPLR high/low. Patients with a low preoperative lymphocyte count and low PPLR had the poorest RFS and CSS compared to the other patients.ConclusionThe combination of the preoperative lymphocyte count and the PPLR appears to be a potential marker for predicting recurrence of stage II colon cancer.

Highlights

Colorectal cancer (CRC) is the third most commonly diagnosed malignancy, the fourth leading cause of cancerrelated deaths worldwide [1], and the second most common cause of cancer-related death in Japan [2]
Receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off values of the lymphocyte count and preoperative lymphocyte count ratio (PPLR) were, respectively, 1555.2/ μl and 1.151 for recurrence-free survival (RFS)
Tumor depth of invasion, carbohydrate antigen 19-9 (CA19-9), and preoperative low lymphocyte count (≤1555.2/μl) were all correlated with poorer RFS (p < 0.05)

Summary

Introduction

Colorectal cancer (CRC) is the third most commonly diagnosed malignancy, the fourth leading cause of cancerrelated deaths worldwide [1], and the second most common cause of cancer-related death in Japan [2]. During the past two decades, advances in chemotherapy protocols have drastically decreased the risk of cancer recurrence and improved overall survival time of patients with stages III and IV [3,4,5,6,7,8]. Better prognostic markers are needed to improve the outcomes of patients with CRC. Carcinoembryonic antigen (CEA) is a prognostic marker for long-term CRC recurrence [11, 12]. According to the European Group on Tumor Markers (EGTM) published guidelines, CEA is more useful for postoperative surveillance than as a predictor of recurrence [19]. Other predictors have been emerging over the last several years, and they are not yet practically useful. The aim was to identify other prognostic markers for CRC, and it was found that combined use of the lymphocyte count and the post/preoperative lymphocyte count ratio (PPLR) was an effective prognostic marker

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Conclusion