Prognostic role of preoperative inflammatory markers in postoperative patients with colorectal cancer

Zilong Xiao; Xinxin Wang; Xiaoxiao Chen; Jiawei Zhou; Haitao Zhu; Jiangnan Zhang; Wensheng Deng

doi:10.3389/fonc.2023.1064343

Prognostic role of preoperative inflammatory markers in postoperative patients with colorectal cancer

Front Oncol. 2023 Mar 29:13:1064343. doi: 10.3389/fonc.2023.1064343. eCollection 2023.

Authors

Zilong Xiao^{1

2}, Xinxin Wang³, Xiaoxiao Chen¹, Jiawei Zhou^{1

2}, Haitao Zhu⁴, Jiangnan Zhang^{1

2}, Wensheng Deng^{1

2}

Affiliations

¹ Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang, China.
² Laboratory of Digestive Surgery, Nanchang University, Nanchang, China.
³ Department of Radiation Oncology, The Third Hospital of Nanchang, Nanchang, China.
⁴ Department of Intensive Care Unit, Jining Public Health Medical Center, Jining, China.

Abstract

Background: Inflammatory response markers are prognostic factors for several cancers, but their role in postoperative colorectal cancer (CRC) is unclear. The purpose was to evaluate the role of preoperative Neutrophil-to-Lymphocyte ratio (NLR), Platelet-to-Lymphocyte-ratio (PLR), and Lymphocyte-to-Monocyte ratio (LMR) in the prognosis of postoperative CRC patients.

Methods: We retrospectively reviewed 448 CRC patients who had undergone surgical resection from December 2015 to December 2017 in our hospital. The plasma NLR, PLR, LMR, CEA, and CA19-9 were collected within 2 weeks before the operation. We recorded the clinical characteristics and survival data by reviewing medical records and phone calls. We analyzed preoperative inflammatory markers and clinical features using Pearson chi-squared tests or Fisher's tests. Uni- and multivariate Cox regression analyses were performed, and overall survival (OS) was estimated with the Kaplan-Meier method.

Results: High NLR and PLR were associated with worse overall survival in postoperative CRC (HR = 2.140, 95%CI = (1.488-3.078), P < 0.001; HR =1.820, 95%CI = (1.271-2.605), P = 0.001). High LMR was associated with improved overall survival in postoperative CRC (HR = 0.341, 95%CI = (0.188-0.618), P < 0.001). In the multivariate regression analysis, the increase of NLR resulted in an increase in the risk of death (HR = 1.678, 95%CI = (1.114-2.527), P = 0.013), and for the LMR, a reduction of the risk of death (HR = 0.480, 95%CI = (0.256 - 0.902), P = 0.023). Moreover, TNM stage, CA-199, CEA, nerve or vascular invasion (NVI) and adjuvant chemotherapy after surgery also were associated with worse overall survival in postoperative CRC.

Conclusion: Current evidence indicates that preoperative inflammatory markers NLR, LMR, and PLR are associated with overall survival in postoperative patients with colorectal cancer. NLR is an independent risk factor, and LMR is an independent protective factor in CRC patients after surgery.

Keywords: colorectal cancer; lymphocyte-to-monocyte ratio; neutrophil-to-lymphocyte ratio; overall survival; platelet-to-lymphocyte ratio.

Grants and funding

This study was supported by a grant from the National Natural Science Foundation of China (No. 82100665).