Abstract
BackgroundGrowing evidence has indicated that some inflammatory markers, including lymphocyte to monocyte ratio (LMR), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and prognostic nutritional index (PNI), can be used as indicators in the prognosis of colorectal cancer (CRC). However, there is controversy concerning what is the best predictor of prognosis in CRC.MethodsA cohort of 1744 CRC patients in our institution was analyzed retrospectively. Harrell’s concordance index (c-index) and Bayesian information criterion (BIC) were used to determine the optimal cut-off values of inflammatory markers and compare their predictive capacity. The association of inflammatory markers with overall survival (OS) and cancer-specific survival (CSS) was analyzed using Kaplan-Meier methods with log-rank test, followed by multivariate Cox proportional hazards model.ResultsThe multivariate analysis indicated that among these inflammatory markers, NLR (< 2.0 vs. ≥ 2.0) was the only independent prognostic factor for poor OS [hazard ratio (HR) = 0.758, 95% confidence intervals (CI) = 0.598–0.960, P = 0.021)] and CSS (HR = 0.738, 95% CI = 0.573–0.950, P = 0.018). Among these inflammatory markers, the c-index and BIC value for NLR were maximum and minimum for OS, respectively. In addition, the c-index was higher and the BIC value was smaller in TNM staging combined with NLR compared with the values obtained in TNM staging alone.ConclusionNLR is a superior indicator of prognosis compared with LMR, PLR, and PNI in CRC patients, and NLR may serve as an additional indicator based on the current tumor staging system.
Highlights
Growing evidence has indicated that some inflammatory markers, including lymphocyte to monocyte ratio (LMR), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and prognostic nutritional index (PNI), can be used as indicators in the prognosis of colorectal cancer (CRC)
Our results indicated that the c-index values were maximum for LMR, NLR, PLR, and PNI values of 5.8, 2.0, 134.6, and 46.4, respectively (Table 1)
The results indicated that LMR was significantly associated with sex, tumor size, tumor location, pT category, and TNM stage (P < 0.05); NLR was significantly associated with age, sex, tumor size, tumor differentiation, pT category, and TNM stage (P < 0.05); PLR was significantly associated with sex, tumor size, tumor location, tumor differentiation, pT category, and TNM stage (P < 0.05); PNI was significantly associated with age, tumor size, tumor location, tumor differentiation, pT category, and TNM stage (P < 0.05, Table 2)
Summary
Growing evidence has indicated that some inflammatory markers, including lymphocyte to monocyte ratio (LMR), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and prognostic nutritional index (PNI), can be used as indicators in the prognosis of colorectal cancer (CRC). TNM staging has been the most commonly used method to predict the prognosis of CRC. Novel biomarkers are necessary to improve the current tumor staging system and accurately predict the prognosis of CRC. Growing evidence has indicated that the progression and prognosis of cancer are affected by tumor features and by the inflammatory response of the host [3, 4]. The inflammatory response involves neutrophils, lymphocytes, monocyte, platelets, and acute-phase proteins, including albumin in peripheral blood.
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