Abstract
IntroductionThe systemic inflammatory response has been proven to have a prognostic value. There are two methods of assessing the systemic inflammatory response composite ratios (R) and cumulative scores (S). The aim of this study was to compare the prognostic value of ratios and scores in patients undergoing surgery for colon cancer.MethodsPatients were identified prospectively in a single surgical unit. Preoperative neutrophil (N), lymphocyte (L), monocyte (M) and platelet (P) counts, CRP (C) and albumin (A) levels were recorded. The relationship between composite ratios neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), lymphocyte–monocyte ratio (LMR), C-reactive protein albumin ratio (CAR) and the cumulative scores neutrophil– lymphocyte score (NLS), platelet–lymphocyte score (PLS), lymphocyte–monocyte score (LMS), neutrophil– platelet score (NPS), modified Glasgow prognostic score (mGPS) and clinicopathological characteristics, cancer-specific survival (CSS) and overall survival (OS), were examined.ResultsA total of 801 patients were examined. When adjusted for tumour node metastasis (TNM) stage, NLR >5 (p < 0.001), NLS (p < 0.01), PLS (p < 0.001), LMR <2.4 (p < 0.001), LMS (p < 0.001), NPS (p < 0.001), CAR >0.22 (p < 0.001) and mGPS (p < 0.001) were significantly associated with CSS. In patients undergoing elective surgery (n = 689), the majority of the composite ratios/scores correlated with age (p < 0.01), BMI (p < 0.01), T stage (p < 0.01), venous invasion (p < 0.01) and peritoneal involvement (p < 0.01). When NPS (myeloid) and mGPS (liver) were directly compared, their relationship with CSS and OS was similar.ConclusionsBoth composite ratios and cumulative scores had prognostic value, independent of TNM stage, in patients with colon cancer. However, cumulative scores, based on normal reference ranges, are simpler and more consistent for clinical use.
Highlights
The systemic inflammatory response has been proven to have a prognostic value
The systemic inflammatory response represents an important prognostic domain to be monitored in patients with colon cancer
With reference to platelet–lymphocyte ratio (PLR) >150, it was associated with a platelet count of approximately 200, within the normal range (Fig. 5b)
Summary
The systemic inflammatory response has been proven to have a prognostic value. There are two methods of assessing the systemic inflammatory response composite ratios (R) and cumulative scores (S). CONCLUSIONS: Both composite ratios and cumulative scores had prognostic value, independent of TNM stage, in patients with colon cancer. Over the last decade or so it has become clear that markers of the systemic inflammatory response are clinically useful to identify patients at high risk of tumour progression in a variety of common solid tumours, in particular lung and gastrointestinal cancer.[2,3] These markers of the systemic inflammatory response are usually based around composite ratios or cumulative scores of different circulating white blood cells or acute phase proteins representing the systemic responses of two different organs, lymphoid/myeloid tissue and liver, respectively (Table 1). The most repeatedly validated example of this approach is the neutrophil–lymphocyte ratio (NLR) based on the ratio of circulating neutrophil and lymphocyte counts (Table 1).[2,3] Other validated examples are the platelet–lymphocyte ratio (PLR) based on the ratio of circulating platelet and lymphocyte counts (Table 1) and the lymphocyte–monocyte score (LMR) based on the ratio of circulating lymphocyte and monocyte counts (Table 1).[2,3] recently a similar approach has been applied to the acute phase proteins, C-reactive protein and albumin, and C-reactive protein albumin ratio (CAR) has been recently validated (Table 1).[2,3] it is clear that the above ratios have prognostic value, a disadvantage of the ratio approach is that, depending on the threshold used, an abnormal ratio may be defined with one or both markers having a normal value
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