Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jul 15, 2017; 9(7): 300-307
Published online Jul 15, 2017. doi: 10.4251/wjgo.v9.i7.300
Prognostic efficacy of inflammation-based markers in patients with curative colorectal cancer resection
Özgür Akgül, Erdinç Çetinkaya, Metin Yalaza, Sabri Özden, Mesut Tez
Özgür Akgül, Erdinç Çetinkaya, Metin Yalaza, Sabri Özden, Mesut Tez, General Surgery Department, Ankara Numune Training and Research Hospital, 06100 Ankara, Turkey
Author contributions: Akgül Ö and Tez M designed the study; Akgül Ö, Çetinkaya E, Yalaza M and Özden S collected the data from the patients; Akgül Ö and Çetinkaya E drafted the initial manuscript; Tez M supervised the study, analysed the data, and critically reviewed the manuscript; all authors approved the final manuscript as submitted.
Institutional review board statement: Due to the retrospective nature of the study, approval from an institutional review board was not obtained.
Informed consent statement: The data retrospectively collected and anonymized.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at drozgurakgul@gmail.com.
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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Özgür Akgül, General Surgery Department, Ankara Numune Training and Research Hospital, 06100 Ankara, Turkey. drozgurakgul@gmail.com
Telephone: +90-505-7924983 Fax: +90-312-5084312
Received: November 7, 2016
Peer-review started: November 8, 2016
First decision: December 27, 2016
Revised: January 19, 2017
Accepted: March 23, 2017
Article in press: March 24, 2017
Published online: July 15, 2017
Abstract
AIM

To evaluate the prognostic significance of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and prognostic nutritional index (PNI) and other clinicopathological factors in patients undergoing curative resection of colon cancer.

METHODS

183 patients with histologically proven colorectal cancer who had undergone potentially curative resection between 2010 and 2016 at Ankara Numune Training and Research Hospital were retrospectively analyzed and clinicopathological characteristics included age, sex, tumor type, grade, size and localization, the number of metastatic and total number of lymph nodes removed, vascular and perineural invasion of the tumor, TNM stages, tumor marker levels (CEA, CA19-9, AFP, CA-125, CA15-3), complete blood counts, albumin levels, overall survival (months), NLR, PLR, LMR and PNI ratios were retrospectively reviewed and analyzed from the electronic database. The primary outcome measure was overall survival.

RESULTS

Regarding overall survival, on univariate analysis the following variables were significantly associated with poor outcome following resection: T-stage (P = 0.037), lymph node invasion (P = 0.037), cancer stage (P = 0.034), CEA (P = 0.042), CA19-9 (P = 0.004), and PNI (P = 0.001). To evaluate the independent prognostic value, multivariate Cox proportional hazard analysis to control for other prognostic factors was used. Using cancer-specific death as an end point for NLR, PLR, LMR, PNI and CA19-9 the optimal cut off values were calculated by ROC analysis. Regarding overall survival, on multivariate analysis high CA19-9 (HR = 1.001, 95%CI: 1.00-1.002, P = 0.012) and low PNI (HR = 0.938, 95%CI: 0.891-0.987, P = 0.014) were the only variables independently associated with shortened overall survival. Patients with a PNI < 35 had a median OS of 52.25 mo. In contrast, patients with an PNI > 35 had a median OS of 66 mo. Patients with a CA 19-9 < 17 had a median OS of 66 mo and in patients with a CA19-9 > 17 had a median OS of 53.76 mo.

CONCLUSION

This study shows that decrease in the PNI and increase in CA 19-9 is associated with poor survival in patients with resectable colon cancer.

Keywords: Colorectal cancer, Prognosis, Overall survival, Prognostic nutritional index, CA19-9

Core tip: Predictors of colorectal cancer (CRC) that may determine overall survival are extremely important. Inflammation is now widely recognised to be a key element of disease advancement and survival in CRC. Aim of this study was to evaluate the prognostic significance of clinicopathologic factors and the indicators of systematic inflammatory response by using neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and prognostic nutritional index in patients undergoing curative resection of colon cancer. In the present study, we report, for the first time, a longitudinal comparison of the four systemic inflammation-based prognostic scores and CA19-9 in patients with resectable CRC.