Abstract
The neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and mean platelet volume (MPV) have been reported to be associated with the prognosis of various types of tumors. This study evaluated the prognostic value and clinical use of inflammatory markers for predicting 1-year survival in patients undergoing cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). This retrospective study included 160 patients who underwent CRS with HIPEC between July 2014 and April 2017. Data on NLR, PLR, and MPV were collected preoperatively and on postoperative days (POD) 1, 2, 3, 4, and 5. In a multivariate analysis using a cox proportional hazard regression model, higher values of preoperative NLR and MPV, PLR, and MPV on POD 2, 3, and 5 were associated with reduced 1-year survival after CRS with HIPEC. Patients with increased MPV showed lower rates of 1-year survival following CRS with HIPEC. In addition, elevated preoperative NLR and postoperative PLR were correlated with poor survival. These markers are able to stratify patients by risk profile, which may ultimately improve perioperative management and be helpful in improving outcomes following CRS with HIPEC.
Highlights
Peritoneal invasion of tumors is generally regarded as a terminal cancer stage, which has very poor survival outcomes indicating metastasis of a primary cancer into the peritoneum [1]
We evaluated the prognostic value and clinical use of inflammatory biomarkers, including the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and mean platelet volume (MPV), for predicting 1-year survival in patients undergoing cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) and compared their prognostic abilities
We evaluated the prognostic value of the NLR, PLR, and MPV for predicting 1-year survival in patients undergoing CRS combined with HIPEC
Summary
Peritoneal invasion of tumors is generally regarded as a terminal cancer stage, which has very poor survival outcomes indicating metastasis of a primary cancer into the peritoneum [1]. For treatment of patients with peritoneal carcinomatosis, cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has become a promising strategy to improve survival benefits [2,3,4,5,6,7] For such advanced cancer patients undergoing CRS with HIPEC, measured and accurate prognostic biomarkers are needed to predict the course of postoperative outcomes and even guide treatment. Inflammation plays an important role in the development of cancer in that inflammatory conditions augment carcinogenesis and inflammatory mediators produced by tumor cells further promote the development of tumors [8] This imbalance in the immune system due to excessive inflammatory responses promotes tumor cell growth and can lead to poor survival outcomes. Many studies have investigated the ability of inflammatory biomarkers to act as potential prognostic predictors capable of demonstrating the inflammatory status in various types of cancers [9,10,11,12,13]
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