Correlation between neutrophil to lymphocyte ratio or platelet to lymphocyte ratio and TNM staging or prognosis in patients with colorectal cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XIA Zhigang ¹ , GAN Zhiming ¹ , XIANG Lili ¹ , YANG Chuanhua ² , WANG Xiaodong ¹ ,  LI Li ¹

1. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;
2. Department of Anorectal Surgery, The First People’s Hospital of Chengdu City, Chengdu 610041, P.R.China;

Corresponding?author：

LI Li, Email: drlili116@126.com

Keywords：

neutrophil to lymphocyte ratio; platelet to lymphocyte ratio; colorectal cancer; prognosis

DOI：

10.7507/1007-9424.201703103

Video：

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Objective To determine whether neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are important prognostic factors in patients with colorectal cancer, and to clarify relationship between NLR or PLR and TNM staging in colorectal cancer. Methods The clinical data of 304 patients with colorectal cancer who were admitted to the same medical group from January 2013 to December 2013 in the West China Hospital of Sichuan University were analyzed retrospectively. The relationship between NLR or PLR and the clinicopathologic characteristics and its effects on prognosis of patients with colorectal cancer were analyzed. Results The critical values of NLR (sensitivity=51.0%, specificity=75.4%, area under the receiver operating characteristic curve=0.66) and PLR (sensitivity=73.0%, specificity=46.4%, area under the receiver operating characteristic curve=0.60) was 2.27 and 155.92, respectively, with a 3-year cumulative survival rate as the end point. According to the critical values of NLR and PLR, there were 133 cases in a low NLR group (NLR≤2.27), 171 cases in a high NLR group (NLR>2.27), 207 cases in a low PLR group (PLR≤155.92), 97 cases in a high PLR group (PLR>155.92). ① The 3-year survival rate was 91.5% and 77.2% in the low NLR group and the high NLR group, respectively, which was 89.0% and 72.8% in the low PLR group and the high PLR group, respectively. The survival curves of NLR and PLR on prognosis prediction had significant differences (P=0.002, P=0.001). ② The results of multivariate analysis showed that the NLR was the independent risk factor for colorectal cancer (P=0.004), whereas PLR was not the independent risk factor for colorectal cancer (P=0.408). ③ The NLR and PLR were associated with the tumor TNM staging (P=0.002, P=0.000), which in the colorectal cancer with stage Ⅳ was significantly higher than those with stage Ⅰ–Ⅲ (P<0.05). ④ The NLR and PLR were associated with T stage (P=0.006, P=0.031). The NLR in the colorectal cancer with stage T4 was significantly higher than that with stage Ⅰ (P=0.015) or stage Ⅱ (P=0.032). The PLR in the colorectal cancer with stage T4 was significantly higher than that with stage Ⅱ (P=0.013). ⑤ The NLR was not associated with N staging (P=0.118). The PLR was associated with N staging (P=0.007), which in the colorectal cancer with N2 stage was significantly higher than that with N0 stage (P=0.008) or N1 stage (P=0.019). ⑥ The NLR and PLR in the colorectal cancer with stage M1/M2 were significantly higher than those with stage M0 (P=0.004, P=0.001). Conclusions Preliminary results of this study show that NLR is an important independent prognostic indicator for patient with colorectal cancer. While PLR is significantly increased when lymph node metastasis occurs, and platelet elevation might be related to lymph node metastasis.

Citation： XIA Zhigang, GAN Zhiming, XIANG Lili, YANG Chuanhua, WANG Xiaodong, LI Li. Correlation between neutrophil to lymphocyte ratio or platelet to lymphocyte ratio and TNM staging or prognosis in patients with colorectal cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(8): 963-969. doi: 10.7507/1007-9424.201703103 Copy

1.	Proctor MJ, Morrison DS, Talwar D, et al. An inflammation-based prognostic score (mGPS) predicts cancer survival independent of tumour site: a Glasgow inflammation outcome study. Br J Cancer, 2011, 104(4): 726-734.
2.	Elinav E, Nowarski R, Thaiss CA, et al. Inflammation-induced cancer: crosstalk between tumours, immune cells and microorganisms. Nat Rev Cancer, 2013, 13(11): 759-771.
3.	汪曉東, 劉丹, 呂東昊, 等. 結直腸癌血清纖維蛋白原和炎性介質、腫瘤標志物的術前診斷價值. 腫瘤防治研究, 2010, 37(5): 566-569.
4.	汪曉東, 高命, 呂東昊, 等. 炎性介質 CRP 和 SAA 與腫瘤標記物 CEA、CA19-9 和 CA72-4 術前聯合評估結直腸癌. 臨床腫瘤學雜志, 2009, 14(4): 336-340.
5.	Wang DS, Luo HY, Qiu MZ, et al. Comparison of the prognostic values of various inflammation based factors in patients with pancreatic cancer. Med Oncol, 2012, 29(5): 3092-3100.
6.	Kos FT, Hocazade C, Kos M, et al. Assessment of prognostic value of neutrophil to lymphocyte ratio and prognostic nutritional index as a sytemic inflammatory marker in non-small cell lung cancer. Asian Pac J Cancer Prev, 2015, 16(9): 3997-4002.
7.	Templeton AJ, Ace O, McNamara MG, et al. Prognostic role of platelet to lymphocyte ratio in solid tumors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev, 2014, 23(7): 1204-1212.
8.	Turner N, Tran B, Tran PV, et al. Primary tumor resection in patients with metastatic colorectal cancer is associated with reversal of systemic inflammation and improved survival. Clin Colorectal Cancer, 2015, 14(3): 185-191.
9.	Turner N, Wong HL, Templeton A, et al. Analysis of local chronic inflammatory cell infiltrate combined with systemic inflammation improves prognostication in stage Ⅱ colon cancer independent of standard clinicopathologic criteria. Int J Cancer, 2016, 138(3): 671-678.
10.	He W, Yin C, Guo G, et al. Initial neutrophil lymphocyte ratio is superior to platelet lymphocyte ratio as an adverse prognostic and predictive factor in metastatic colorectal cancer. Med Oncol, 2013, 30(1): 439.
11.	Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell, 2011, 144(5): 646-674.
12.	Mariani F, Sena P, Roncucci L. Inflammatory pathways in the early steps of colorectal cancer development. World J Gastroenterol, 2014, 20(29): 9716-9731.
13.	Goubran HA, Burnouf T, Radosevic M, et al. The platelet-cancer loop. Eur J Intern Med, 2013, 24(5): 393-400.
14.	Coffelt SB, Kersten K, Doornebal CW, et al. IL-17-producing γδ T cells and neutrophils conspire to promote breast cancer metastasis. Nature, 2015, 522(7556): 345-348.
15.	潘穎, 管世鶴, 楊凱, 等. 外周血血小板/淋巴細胞比值在非小細胞肺癌診斷中的價值. 細胞與分子免疫學雜志, 2016, 32(12): 1683-1686.
16.	Jiang K, Lei J, Chen W, et al. Association of the preoperative neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios with lymph node metastasis and recurrence in patients with medullary thyroid carcinoma. Medicine (Baltimore), 2016, 95(40): e5079.
17.	Wang D, Yang JX, Cao DY, et al. Preoperative neutrophil lympho?cyte and platelet-lymphocyte ratios as independent predictors of cervical stromal involvement in surgically treated endometrioid ade?nocarcinoma. Onco Targets Ther, 2013, 6: 211-216.
18.	Frattini M, Balestra D, Suardi S, et al. Different genetic features associated with colon and rectal carcinogenesis. Clin Cancer Res, 2004, 10(12): 4015-4021.
19.	Templeton AJ, McNamara MG, ?eruga B, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst,2014, 106(6): dju124.
20.	Yao M, Liu Y, Jin H, et al. Prognostic value of preoperative inflammatory markers in Chinese patients with breast cancer. Onco Targets Ther, 2014, 7: 1743-1752.
21.	Azab B, Bhatt VR, Phookan J, et al. Usefulness of the neutrophil-to-lymphocyte ratio in predicting short- and long-term mortality in breast cancer patients. Ann Surg Oncol, 2012, 19(1): 217-224.
22.	Wang K, Xu J, Zhang T, et al. Tumor-infiltrating lymphocytes in breast cancer predict the response to chemotherapy and survival outcome: A meta-analysis. Oncotarget, 2016, 7(28): 44288-44298.
23.	Ertas IE, Gungorduk K, Akman L, et al. Can preoperative neutrophil:lymphocyte and platelet:lymphocyte ratios be used as predictive markers for lymph node metastasis in squamous cell carcinoma of the vulva? Eur J Obstet Gynecol Reprod Biol, 2013, 171(1): 138-142.
24.	胡赟宏, 王錚元, 崔嶸嶸, 等. 中性粒細胞/淋巴細胞比值與血小板/淋巴細胞比值對乳腺癌復發轉移的預測價值及乳腺癌預后影響因素研究. 中國全科醫學雜志, 2016, 19(30): 3657-3661.

1. Proctor MJ, Morrison DS, Talwar D, et al. An inflammation-based prognostic score (mGPS) predicts cancer survival independent of tumour site: a Glasgow inflammation outcome study. Br J Cancer, 2011, 104(4): 726-734.
2. Elinav E, Nowarski R, Thaiss CA, et al. Inflammation-induced cancer: crosstalk between tumours, immune cells and microorganisms. Nat Rev Cancer, 2013, 13(11): 759-771.
3. 汪曉東, 劉丹, 呂東昊, 等. 結直腸癌血清纖維蛋白原和炎性介質、腫瘤標志物的術前診斷價值. 腫瘤防治研究, 2010, 37(5): 566-569.
4. 汪曉東, 高命, 呂東昊, 等. 炎性介質 CRP 和 SAA 與腫瘤標記物 CEA、CA19-9 和 CA72-4 術前聯合評估結直腸癌. 臨床腫瘤學雜志, 2009, 14(4): 336-340.
5. Wang DS, Luo HY, Qiu MZ, et al. Comparison of the prognostic values of various inflammation based factors in patients with pancreatic cancer. Med Oncol, 2012, 29(5): 3092-3100.
6. Kos FT, Hocazade C, Kos M, et al. Assessment of prognostic value of neutrophil to lymphocyte ratio and prognostic nutritional index as a sytemic inflammatory marker in non-small cell lung cancer. Asian Pac J Cancer Prev, 2015, 16(9): 3997-4002.
7. Templeton AJ, Ace O, McNamara MG, et al. Prognostic role of platelet to lymphocyte ratio in solid tumors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev, 2014, 23(7): 1204-1212.
8. Turner N, Tran B, Tran PV, et al. Primary tumor resection in patients with metastatic colorectal cancer is associated with reversal of systemic inflammation and improved survival. Clin Colorectal Cancer, 2015, 14(3): 185-191.
9. Turner N, Wong HL, Templeton A, et al. Analysis of local chronic inflammatory cell infiltrate combined with systemic inflammation improves prognostication in stage Ⅱ colon cancer independent of standard clinicopathologic criteria. Int J Cancer, 2016, 138(3): 671-678.
10. He W, Yin C, Guo G, et al. Initial neutrophil lymphocyte ratio is superior to platelet lymphocyte ratio as an adverse prognostic and predictive factor in metastatic colorectal cancer. Med Oncol, 2013, 30(1): 439.
11. Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell, 2011, 144(5): 646-674.
12. Mariani F, Sena P, Roncucci L. Inflammatory pathways in the early steps of colorectal cancer development. World J Gastroenterol, 2014, 20(29): 9716-9731.
13. Goubran HA, Burnouf T, Radosevic M, et al. The platelet-cancer loop. Eur J Intern Med, 2013, 24(5): 393-400.
14. Coffelt SB, Kersten K, Doornebal CW, et al. IL-17-producing γδ T cells and neutrophils conspire to promote breast cancer metastasis. Nature, 2015, 522(7556): 345-348.
15. 潘穎, 管世鶴, 楊凱, 等. 外周血血小板/淋巴細胞比值在非小細胞肺癌診斷中的價值. 細胞與分子免疫學雜志, 2016, 32(12): 1683-1686.
16. Jiang K, Lei J, Chen W, et al. Association of the preoperative neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios with lymph node metastasis and recurrence in patients with medullary thyroid carcinoma. Medicine (Baltimore), 2016, 95(40): e5079.
17. Wang D, Yang JX, Cao DY, et al. Preoperative neutrophil lympho?cyte and platelet-lymphocyte ratios as independent predictors of cervical stromal involvement in surgically treated endometrioid ade?nocarcinoma. Onco Targets Ther, 2013, 6: 211-216.
18. Frattini M, Balestra D, Suardi S, et al. Different genetic features associated with colon and rectal carcinogenesis. Clin Cancer Res, 2004, 10(12): 4015-4021.
19. Templeton AJ, McNamara MG, ?eruga B, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst,2014, 106(6): dju124.
20. Yao M, Liu Y, Jin H, et al. Prognostic value of preoperative inflammatory markers in Chinese patients with breast cancer. Onco Targets Ther, 2014, 7: 1743-1752.
21. Azab B, Bhatt VR, Phookan J, et al. Usefulness of the neutrophil-to-lymphocyte ratio in predicting short- and long-term mortality in breast cancer patients. Ann Surg Oncol, 2012, 19(1): 217-224.
22. Wang K, Xu J, Zhang T, et al. Tumor-infiltrating lymphocytes in breast cancer predict the response to chemotherapy and survival outcome: A meta-analysis. Oncotarget, 2016, 7(28): 44288-44298.
23. Ertas IE, Gungorduk K, Akman L, et al. Can preoperative neutrophil:lymphocyte and platelet:lymphocyte ratios be used as predictive markers for lymph node metastasis in squamous cell carcinoma of the vulva? Eur J Obstet Gynecol Reprod Biol, 2013, 171(1): 138-142.
24. 胡赟宏, 王錚元, 崔嶸嶸, 等. 中性粒細胞/淋巴細胞比值與血小板/淋巴細胞比值對乳腺癌復發轉移的預測價值及乳腺癌預后影響因素研究. 中國全科醫學雜志, 2016, 19(30): 3657-3661.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Correlation between neutrophil to lymphocyte ratio or platelet to lymphocyte ratio and TNM staging or prognosis in patients with colorectal cancer

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