Abstract
Growing evidence indicates that inflammation plays an important role in cancer progression and prognosis; however, the prognostic role of platelet to lymphocyte ratio (PLR) in colorectal cancer (CRC) is unknown. A cohort of 1845 CRC patients from the Department of Surgical Oncology at The First Hospital of China Medical University (CMU-SO) was retrospectively analyzed. Harrell’s concordance index (c-index) was used to determine the optimal cut-off value of PLR and evaluate its predictive ability. Our results from CMU-SO indicated that the overall survival (OS) rate was significantly lower in the high-PLR group compared with the low-PLR group (P = 0.001). A similar result was observed for the cancer-specific survival (CSS) rate between these two groups (P = 0.001). The multivariate analysis indicated that high PLR was an independent prognostic indicator of poor OS (hazard ratio [HR] = 1.356, 95% confidence interval [CI] = 1.117–1.647, P = 0.002) and CSS (HR = 1.364, 95% CI = 1.111–1.675, P = 0.003). In addition, the c-indexes of TNM staging combined with PLR were greater than those of TNM staging alone (OS: 0.768 vs. 0.732; CSS: 0.785 vs. 0.746). In conclusion, elevated PLR is a negative prognostic indicator of CRC and may serve as an additional index of the current TNM staging system for predicting CRC.
Highlights
Colorectal cancer (CRC) is one of the most common digestive cancers and the third leading cause of cancerrelated death in the United States [1]
We found that elevated platelet to lymphocyte ratio (PLR) was an independent prognostic factor for poor overall survival (OS) and cancer-specific survival (CSS)
Elevated PLR was significantly associated with advanced tumor features, including larger tumor size, poorer differentiation, deeper depth of tumor, and advanced TNM stages
Summary
Colorectal cancer (CRC) is one of the most common digestive cancers and the third leading cause of cancerrelated death in the United States [1]. Patients with the same TNM stage may have a different clinical prognosis. Novel biomarkers are required to complement the current TNM staging system and accurately predict the prognosis of CRC. Previous studies have indicated that inflammatory biomarkers, including neutrophil to lymphocyte ratio [4,5,6], prognostic nutritional index [7, 8], lymphocyte to monocyte ratio [9, 10] and C-reactive protein [11, 12], can be used in the prognosis of gastrointestinal cancers. No studies have evaluated the potential use of PLR as an additional tool in the current tumor staging system, and the optimal cut-off value of PLR for predicting prognosis in CRC remains unknown
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