Abstract
Previous studies demonstrated that several inflammation-based hematological indices are closely related to various malignancies, including colorectal cancer (CRC). In this study, the prognostic value of inflammation-based markers, including a combination index termed coNLR-PDW, comprising the preoperative neutrophil-to-lymphocyte ratio (NLR) and the platelet distribution width (PDW), was evaluated in 206 patients with non-metastatic CRC treated with surgery at a single medical center. The association of patient demographics, blood chemistry, and serum biochemical indices with recurrence-free survival (RFS) and overall survival (OS) were examined through univariate and multivariate analysis. Receiver operating characteristic curve analysis revealed the optimal cut-off values of the NLR and lymphocyte-to-monocyte ratio (LMR) to be, respectively, 2.0 and 3.32 for both RFS and OS. For PDW, cut-off values of 17.25% and 17.35% were defined for RFS and OS, respectively. On univariate analysis, lymph node involvement, stage, presence of intravascular emboli (IVE), carbohydrate antigen 199 (CA199) ≥ 35 kU/L, NLR ≥ 2.0, LMR ≤ 3.32, elevated PDW, a high coNLR-PDW score, high blood glucose, and high neutrophil and lymphocyte percentages correlated with poorer RFS and OS (P < 0.05). On multivariate analysis, lymph node involvement, IVE, CA199, PDW, and coNLR-PDW correlated with both RFS and OS (P < 0.05), while NLR correlated only with OS (P = 0.001). These results highlight the usefulness of the coNLR-PDW index as a prognostic marker of non-metastatic CRC outcome. In clinical practice, its assessment could contribute to establishing more personalized regimes for patients undergoing tumor resection surgery.
Highlights
Colorectal cancer (CRC) is one of the most common malignancies worldwide, ranking third and fourth, respectively, in cancer-related morbidity and mortality
By univariate analysis we found that lymph node involvement, TNM stage, intravascular emboli (IVE), carbohydrate antigen 199 (CA199), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet distribution width (PDW), coNLR-PDW, blood glucose, neutrophil percentage, and lymphocyte percentage were all associated with both recurrencefree survival (RFS) and overall survival (OS)
We assessed the value of several inflammatory indices including neutrophil and lymphocyte percentages, platelet count, PDW, white blood cell ratios such as NLR and LMR, as well as a prognostic system that combines NLR and PDW, i.e. the coNLR-PDW index
Summary
Colorectal cancer (CRC) is one of the most common malignancies worldwide, ranking third and fourth, respectively, in cancer-related morbidity and mortality. In non-metastatic colon cancer, 5-years survival rates range from 58.3% to 82.7% [3], clinical outcomes vary considerably among patients with the same TNM stage [4]. Other factors such as microsatellite instability (MSI), the state of KRAS and BRAF, and tumor location have been added to supplement the TNM stage system with the goal of improving prognosis prediction and helping guide clinical therapies [5]. These prognostic markers are often insufficient to accurately predict CRC prognosis
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