Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 7, 2019; 25(33): 4970-4984
Published online Sep 7, 2019. doi: 10.3748/wjg.v25.i33.4970
Lymphocyte-to-monocyte ratio effectively predicts survival outcome of patients with obstructive colorectal cancer
Xian-Qiang Chen, Chao-Rong Xue, Ping Hou, Bing-Qiang Lin, Jun-Rong Zhang
Xian-Qiang Chen, Chao-Rong Xue, Bing-Qiang Lin, Jun-Rong Zhang, Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
Ping Hou, Immunotherapy Institute, Fujian Medical University, Fuzhou 350122, Fujian Province, China
Author contributions: Chen XQ and Xue CR contributed equally to this work; Zhang JR, Hou P, and Chen XQ conceived the study, analyzed the data, and drafted the manuscript; Lin BQ helped revise the manuscript critically for important intellectual content; Xue CR helped collect the data and design the study.
Supported by Qihang Project of Fujian Medical University, No. 2017XQ1050.
Institutional review board statement: The study protocol was approved by the Institutional Review Board of Fujian Medical University Union Hospital.
Conflict-of-interest statement: All authors read and approved the final manuscript and declared no conflicts of interest.
Data sharing statement: No additional data are available.
STROBE statement: All the study design and drafting comply with the guidelines of the STROBE statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Jun-Rong Zhang, MD, Attending Doctor, Chief Doctor, Surgeon, Surgical Oncologist, Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No. 29, Xin Quan Road, Fuzhou 350001, Fujian Province, China.
Telephone: +86-13705955083
Received: April 29, 2019
Peer-review started: April 29, 2019
First decision: May 30, 2019
Revised: June 9, 2019
Accepted: July 19, 2019
Article in press: July 19, 2019
Published online: September 7, 2019
Research background

Obstructive colorectal cancer (OCC) presenting with acute abdominal symptoms is always accompanied by severe complications, and the optimal strategy for patients with OCCs remains undetermined. Emergency surgery (ES) and self-expandable metal stents (SEMS) as a bridge to surgery (BTS) were the major treatments for OCCs, however, the indications remain debated. According to different status of immunology and nutrition, predictive factors for prognosis might be different between the two groups. Preoperative inflammation indexes might favor patient selection in terms of the prognosis of OCC.

Research motivation

Weighing the waxes and wanes of ES and BTS, both acute and chronic inflammation responses should be accounted for the selection of optimal patients.

Research objectives

This study was designed to build an inflammatory model for the surgical indications for ES and BTS in OCC.

Research methods

This was a retrospective study in which 128 patients who underwent surgery for OCC at the Department of Emergency Surgery of Fujian Medical University Union Hospital from January 2008 to October 2015 were included in this study. Patients were divided into an ES group and a BTS group according to the surgeon’ advises and patients’ selection. Inflammation indexes were fully evaluated in this study.

Research results

Comparable survival outcomes were observed between the ES and BTS groups. Receiver operating characteristic curve analysis showed dNLR as the optimal biomarker for the prediction of DFS in ES, by contrast, LMR was recommended for BTS with regard to OS and DFS. dNLR was related to stoma construction, postoperative pneumonia, and DFS in the ES group. LMR was closely related to lymph nodes invasion, OS, and DFS in the BTS group. LMR could differentiate OS between the ES and BTS groups. A low LMR (< 1.67) was correlated with a low incidence of death and tumor recurrence in the BTS group.

Research conclusions

As a supplement for the latest ESGE guidelines, the indications for the use of SEMSs in OCC might elaborate to patients with low preoperative LMR, who would benefit from BTS via SEMS insertion.