Longitudinal changes in personalized platelet count metrics are good indicators of initial 3-year outcome in colorectal cancer

Zoltan Herold; Magdolna Herold; Julia Lohinszky; Attila Marcell Szasz; Magdolna Dank; Aniko Somogyi

doi:10.12998/wjcc.v10.i20.6825

Longitudinal changes in personalized platelet count metrics are good indicators of initial 3-year outcome in colorectal cancer

World J Clin Cases. 2022 Jul 16;10(20):6825-6844. doi: 10.12998/wjcc.v10.i20.6825.

Authors

Zoltan Herold^{1

2}, Magdolna Herold³, Julia Lohinszky³, Attila Marcell Szasz¹, Magdolna Dank¹, Aniko Somogyi³

Affiliations

¹ Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, Budapest 1083, Hungary.
² Department of Internal Medicine and Hematology, Semmelweis University, Budapest 1088, Hungary. herold.zoltan@med.semmelweis-univ.hu.
³ Department of Internal Medicine and Hematology, Semmelweis University, Budapest 1088, Hungary.

Abstract

Background: Platelet count or complete blood count (CBC)-based ratios including lymphocyte-to-monocyte (LMR), neutrophil-to-lymphocyte (NLR), hemoglobin-to-platelet (HPR), red blood cell count distribution width-to-platelet (RPR), and platelet-to-lymphocyte (PLR) ratio are good predictors of colorectal cancer (CRC) survival. Their change in time is not well documented, however.

Aim: To investigate the effect of longitudinal CBC ratio changes on CRC survival and their possible associations with clinicopathological properties, comorbidities, and anamnestic data.

Methods: A retrospective longitudinal observational study was conducted with the inclusion of 835 CRC patients, who attended at Semmelweis University, Budapest. CBC ratios and two additional newly defined personalized platelet count metrics (pPLT_D and pPLT_S, the platelet counts relative to the measurement at the time of CRC diagnosis and to the one 4-6 wk after tumor removal surgery, respectively) were recorded.

Results: The 835 CRC patients had a total of 4608 measurements (5.52 visits/patient, in average). Longitudinal survival models revealed that the increases/decreases in LMR [hazard ratio (HR): 0.4989, P < 0.0001], NLR (HR: 1.0819, P < 0.0001), HPR (HR: 0.0533, P = 0.0038), pPLT_D (HR: 4.9229, P < 0.0001), and pPLT_S (HR: 4.7568, P < 0.0001) values were poor prognostic signs of disease-specific survival. The same was obtained for all-cause mortality. Most abnormal changes occurred within the first 3 years after the diagnosis of CRC. RPR and PLR had an only marginal effect on disease-specific (P = 0.0675) and all-cause mortality (Bayesian 95% credible interval: 0.90-186.05), respectively.

Conclusion: LMR, NLR, and HPR are good metrics to follow the prognosis of the disease. pPLT_D and pPLT_S perform just as well as the former, while the use of RPR and PLR with the course of the disease is not recommended. Early detection of the abnormal changes in pPLT_D, pPLT_S, LMR, NLR, or HPR may alert the practicing oncologist for further therapy decisions in a timely manner.

Keywords: Colorectal neoplasms; Hemoglobin-to-platelet ratio; Lymphocyte-to-monocyte ratio; Neutrophil-to-lymphocyte ratio; Personalized platelet count; Platelet-to-lymphocyte ratio.