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Abstract
This study was to evaluate the prognostic value of pretreatment inflammatory indexes including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammation index (SII) in colorectal cancer (CRC) patients receiving neoadjuvant chemoradiotherapy (CRT). We enrolled 98 eligible CRC patients and divided them into high or low NLR, PLR, LMR, and SII groups according to their median index value, respectively. Univariate and multivariate analysis were performed to identify the potential predictors of progression-free survival (PFS) and overall survival (OS). In the univariate analysis, ECOG performance status, distant metastasis, NLR, PLR, LMR, and SII were found to be significantly associated with PFS and OS. In the multivariate analysis, ECOG performance status, distant metastasis, and NLR were identified to be independent predictors of PFS (HR 2.487, p = 0.012; HR 2.422, p = 0.042; HR 2.243, p = 0.034, respectively), and OS (HR 2.237, p = 0.018; HR 2.757, p = 0.020; HR 2.336, p = 0.017, respectively). The results of our study revealed that ECOG performance status, distant metastasis and NLR were independent prognostic factors of PFS and OS in CRC patients receiving neoadjuvant CRT.
Highlights
Previous investigations have indicated that inflammatory indexes such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR) and systemic immune-inflammation index (SII) play important roles in the prediction of survival in various types of malignant tumor, including colorectal cancer (CRC), pancreatic cancer, ovarian cancer, breast cancer, gastric cancer and esophageal cancer[12,13,14,15,16,17,18]
We investigated the associations between age, gender, ECOG performance status, tumor location, clinical T stage, lymph node metastasis, distant metastasis, neoadjuvant chemotherapy regimen, pathological differentiation, NLR, PLR, LMR, SII, lactic dehydrogenase (LDH), carbohydrate antigen [] (CA 19-9) and survival by performing Cox proportional hazard regression analysis
Inflammatory indexes were identified as important prognostic indicators in patients with CRC, the prognostic value of those indexes among CRC patients receiving neoadjuvant CRT has not been fully established so far[19,20]
Summary
Previous investigations have indicated that inflammatory indexes such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR) and systemic immune-inflammation index (SII) play important roles in the prediction of survival in various types of malignant tumor, including CRC, pancreatic cancer, ovarian cancer, breast cancer, gastric cancer and esophageal cancer[12,13,14,15,16,17,18]. Pretreatment inflammatory indexes have been demonstrated to be associated with survival in CRC patients undergoing surgical resection and chemotherapy, the prognostic value of those indexes has not been well evaluated in CRC patients receiving neoadjuvant CRT19,20. The aim of this study was to investigate pretreatment parameters including NLR, PLR, LMR and SII for their ability to predict survival of CRC patients receiving neoadjuvant CRT
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