Abstract
ObjectiveTo elucidate the prognostic significance of mean corpuscular volume (MCV), with implications of habitual alcohol intake in stage II-III colorectal cancer (CRC).BackgroundMCV had the potential to become an ideal prognostic biomarker and be put into clinical application. Few studies, however, have explored whether habitual alcohol intake which greatly increased the value of MCV would affect the prognostic role of MCV.MethodsEligible patients were identified from the CRC database of Fudan University Shanghai Cancer Center (FUSCC) between January 2012 and December 2013. Survival analyses were constructed using the Kaplan–Meier method to evaluate the survival time distribution, and the log-rank test was used to determine the survival differences. Univariate and multivariate Cox proportional hazard models were built to calculate the hazard ratios of different prognostic factors.ResultsA total of 694 patients diagnosed with stage II-III CRC between January 2012 and December 2013 were identified from FUSCC. Low pretreatment MCV was independently associated with 72.0% increased risk of overall mortality compared with normal MCV (HR = 1.720, 95%CI =1.028-2.876, P =0.039, using normal MCV as the reference). In patients with habitual alcohol intake, however, pretreatment MCV positively correlated with the mortality (P = 0.02) and tumor recurrence (P = 0.002) after adjusting for other known prognostic factors.ConclusionsIn CRC patients without habitual alcohol intake, low (<80 fL) level of pretreatment MCV was a predictor of poor prognosis. In patients with habitual alcohol intake, however, pretreatment MCV showed the opposite prognostic role, which would elicit many fundamental studies to elucidate the mechanisms behind.
Highlights
Colorectal cancer (CRC) was one of the most commonly diagnosed malignances worldwide [1]
409 (58.9%) patients were men and 285 (41.1%) patients were women; 81 (11.7%) patients were associated with low levels of pretreatment mean corpuscular volume (MCV) and 613 (88.3%) patients were associated with normal levels of pretreatment MCV; 122 (17.6%) patients had habitual alcohol intake and 572 (82.4%) patients not; the median age at diagnosis was 60 years; 313 (45.1%) patients were diagnosed with colon cancer and 381 (54.9%) patients were diagnosed with rectal cancer; 331 (47.7%) patients were with stage II disease and 363 (52.3%) patients were with stage III disease
In patients with habitual alcohol intake, pretreatment MCV showed the opposite prognostic role and pretreatment MCV positively correlated with the mortality and tumor recurrence after adjusting for other prognostic factors
Summary
Colorectal cancer (CRC) was one of the most commonly diagnosed malignances worldwide [1]. Researchers were looking for new biomarkers related to cancer incidence, mortality and oncologic outcomes [5, 6]. Enough, MCV was reported to be associated with the risk of colorectal adenoma [10], advanced CRC [11] and response to chemotherapy in CRC [12, 13], suggesting MCV had the potential to be an ideal biomarker and be put into clinical application. Previous study revealed that high MCV value may be used as an index of the risk of colorectal adenomas [10], but a recent research reported decreased MCV was an independent predictor for the detection of advanced colorectal cancer [11], indicating that the clinical role of MCV in colorectal cancer was still uncertain.
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