Abstract
The clinical significance of peripheral blood parameters has been considered to be a potential prognostic indicator for malignancies. In this study, 224 colorectal cancer (CRC; ncolon = 103; nrectal = 121) patients who underwent resection were enrolled, and the pre- and post-operative clinical laboratory data within 1 week, before and after surgery, were collected. The prognostic value of the counts of white blood cell (WBC), neutrophil, lymphocyte and platelet, the neutrophil to lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) were analyzed. Data revealed that pre-operative lymphocyte count (pre-LC) was much higher than that of post-LC (p < 0.001), and only rectal cancer patients with pre-LChigh (>median: 1.61 × 109/L) had a significantly better overall survival (OS) and 5-year survival rate (SR) than those with pre-LClow (OS: 62.3 vs. 49.5 months; SR: 74.0 vs. 43.0%; p = 0.006). Cox's proportional hazard models revealed that pre-LChigh was an independent, favorable prognostic factor for rectal cancer patients (hazard ratio = 0.348; p = 0.003). Moreover, when the disease stages were stratified, the pre-LChigh was significantly associated with better prognosis of rectal cancer patients with stage I + II rectal cancer (n = 65; OS: 67.5 vs. 54.3 months; p = 0.011). Taken together, our study revealed that pre-operative lymphocyte count is an independent prognostic factor for patients with stage I and II rectal cancer.
Highlights
Peripheral lymphocytes, neutrophils, and monocytes in the complete blood cell count have been considered to play important roles in cellular-mediated inflammatory response in cancers [1]
Data showed that only the pre-operative lymphocyte count were significantly associated with the status of patient survival, that the pre-LC was much higher in survived patients than in the Colorectal cancer (CRC) patients who died (1.66 × 109/L vs. 1.42 × 109/L; p = 0.029; Table 1; Supplementary Table 1)
We found that pre-LC was significantly higher than post-operative lymphocyte count for CRC patients (1.61 × 109/L vs. 1.10 × 109/L; p < 0.001; Supplementary Figure 1A), and the levels between pre- and post-LC were significantly correlated (R = 0.502; p < 0.001; Supplementary Figure 1B)
Summary
Peripheral lymphocytes, neutrophils, and monocytes in the complete blood cell count have been considered to play important roles in cellular-mediated inflammatory response in cancers [1] In this context, peripheral immune cell alterations have been frequently observed among various cancer patients, and their clinical significance, including the prognostic value of peripheral blood test parameters, have been intensively investigated during the past decades [2, 3]. The clinical significance of the absolute count of WBC and its subsets have been explored in many studies In this context, higher levels of pre-operative and/or post-operative lymphocyte count was found to be associated with better survival in CRC patients [19, 20]. We retrospectively reviewed 224 CRC patients and evaluated the prognostic value of pre-operative and post-operative absolute count of WBC, neutrophils, lymphocytes, platelets and the derived NLR and SII in these CRC patients. All statistical analysis were two-sided and p < 0.05 was considered statistically significant
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