Abstract
Background This study was to evaluate the prognostic value of the preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and carcinoembryonic antigen (CEA) in colorectal cancer (CRC) patients and to identify the potential and easily accessible prognostic biomarkers for CRC. Methods We retrospectively reviewed altogether the records of 330 CRC patients according to inclusion criteria. The clinical characteristics include age at diagnosis, body mass index (BMI), preoperative CEA level, neutrophil , lymphocyte, and platelet count, tumor primary site and size, clinical pathological TNM stage, and survival status were recorded through the review of medical records. The overall survival (OS) was calculated using the Kaplan–Meier method. The Cox proportional hazards model was used for the univariate and multivariate analysis to evaluate the prognostic factors of CRC. Results A total of 330 patients were finally included in the current study. The mean follow-up duration was 32.8 ± 19.1 months (range, 0.1–67.7). Compared with the median OS, preoperative high NLR, PLR, and CEA, and low BMI had lower median OS. The NLR and PLR value rise indicates lower median OS in stage I-II CRC; however, the NLR value and CEA level rise indicates lower median OS in stage III-IV CRC. Preoperative high NLR, PLR, and CEA level and low BMI have poorer OS by univariate analysis. By multivariate analysis, the age, sex, N, M stage, and BMI demonstrated independently influence the OS of CRC. NLR was an independent predictor of stage I-II CRC, and the CEA level was an independent predictor of stage III-IV CRC. Conclusions Our results show that preoperative high NLR, PLR, CEA, and low BMI had poorer OS, NLR was an independent predictor of stage I-II CRC, and the CEA level was an independent predictor of stage III-IV CRC.
Highlights
Blood samples were drawn from venous blood within 1 week before the date of surgery by a nurse. e blood samples are tested for complete blood count and the Carcinoembryonic antigen (CEA) value. e reference range of CEA value is 0.0–4.7 ng/mL, the reference range is (2.0–7.0) × 109/L for neutrophils count, (100–300) × 109/L for platelets count, and (0.80–4.0) × 109/L for lymphocytes count. e neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were calculated by dividing the absolute number of neutrophils or platelets by the absolute number of lymphocytes, respectively
The CEA level elevated in stage III-IV colorectal cancer indicates a poor prognosis
When we conducted the study by stage, we found that NLR was an independent predictor of stage I-II colorectal cancer prognosis, and the CEA level was an independent predictor of stage III-IV colorectal cancer prognosis (Table 6)
Summary
Colorectal cancer (CRC) is the third most common cancer worldwide, and the incidence of CRC in China is rising continuously in recent years; most of the patients were still diagnosed in the advanced stage leading to unsatisfactory prognosis for them [1]. e prognoses of CRC are mainly influenced by the completeness of surgical resection and the pathological stage [2,3,4]. us, it is urgent for us to identify the effective potential prognostic biomarkers for the survival improvement of CRC patients.As we all know, systemic inflammatory response plays a vital role as a leading cause of the neoplastic process, and it was actively engaged in the genesis and propagation of various cancers [5, 6]. Colorectal cancer (CRC) is the third most common cancer worldwide, and the incidence of CRC in China is rising continuously in recent years; most of the patients were still diagnosed in the advanced stage leading to unsatisfactory prognosis for them [1]. Us, it is urgent for us to identify the effective potential prognostic biomarkers for the survival improvement of CRC patients. E neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) have been confirmed to be the prognosis indicators for many malignancies such as biliary tract cancer and gastric cancer [7, 8]. Systemic inflammation has been linked to poor prognosis of colorectal. Elevated NLR and PLR have been associated with poor survival of colorectal cancer [11]. Carcinoembryonic antigen (CEA) is regarded as the common serological biomarker for the detection and monitoring of CRC but has insufficient sensitivity and specificity for prognostic [12]
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