The neutrophil-to-lymphocyte ratio and lactate dehydrogenase combined in predicting liver metastasis and prognosis of colorectal cancer

Qin Chen; Guo-Lin Li; Hong-Quan Zhu; Jian-Dong Yu; Zhi-Ping Chen; Jia-Yan Wu; Ze-Yu Lin; Yun-Le Wan

doi:10.3389/fmed.2023.1205897

The neutrophil-to-lymphocyte ratio and lactate dehydrogenase combined in predicting liver metastasis and prognosis of colorectal cancer

Front Med (Lausanne). 2023 Jun 23:10:1205897. doi: 10.3389/fmed.2023.1205897. eCollection 2023.

Authors

Qin Chen¹, Guo-Lin Li^{2

3}, Hong-Quan Zhu⁴, Jian-Dong Yu^{2

3}, Zhi-Ping Chen^{2

3}, Jia-Yan Wu^{2

3}, Ze-Yu Lin², Yun-Le Wan^{2

3}

Affiliations

¹ Department of general Surgery, The No.2 People's Hospital, Wuxi, Jiangsu, China.
² Department of General Surgery (Hepatobiliary Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
³ Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
⁴ Department of General Surgery, Jiangmen Central Hospital, Jiangmen, Guangdong, China.

Abstract

Background: The neutrophil-to-lymphocyte ratio (NLR) and lactate dehydrogenase (LDH) level are inflammatory markers related to tumor growth and metabolism. This study investigated the value of preoperative NLR, LDH and the combination of NLR and LDH (NLR-LDH) for predicting colorectal cancer liver metastasis (CRLM) and tumor prognosis in the early stages of colorectal cancer (CRC).

Materials and methods: Three hundred patients undergoing CRC resection were included. Logistic regression analysis was used to estimate the correlation between CRLM time and inflammatory markers, and Kaplan-Meier survival and Cox regression analyses were used to estimate overall survival (OS). Forest plots were prepared based on the multivariate Cox analysis model and evaluated by receiver operating characteristic (ROC) curve analysis.

Results: The NLR cut-off value was 2.071 according to the ROC curve. The multivariate analysis showed that the elevated LDH level and a high NLR-LDH level were independent predictors of synchronous CRLM and OS (p < 0.05). The combination of a high NLR and elevated LDH and NLR-LDH levels suggested a poor prognosis and a significantly shorter median survival time than a low NLR and low levels of LDH and NLR-LDH. The ROC curve analysis results illustrated that the predictive value of the NLR-LDH score for synchronous CRLM [area under the curve (AUC) = 0.623, p < 0.001] and OS (AUC = 0.614, p = 0.001) was superior to that of the NLR or LDH score used alone.

Conclusion: LDH and NLR-LDH are reliable, easy-to-use, independent biomarkers for predicting synchronous or metachronous CRLM and OS in CRC patients. The NLR is an important monitoring index for CRLM. Preoperative NLR, LDH and NLR-LDH may help to guide the use of therapeutic strategies and cancer surveillance.

Keywords: colorectal cancer liver metastasis; lactate dehydrogenase; neutrophil-to-lymphocyte ratio; prognosis; the combination of NLR and LDH (NLR-LDH).