| Objective: The aim of this study was to collect preoperative peripheral blood samples from patients with colorectal cancer and analyze the neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),and lymphocyte-to-monocyte ratio(LMR)to retrospectively investigate their correlation with clinical and pathological features as well as survival prognosis.The findings from this study may can provide valuable reference for the clinical diagnosis,treatment,and prognosis evaluation in CRC.Methods: We included 294 patients who were diagnosed with colorectal cancer and underwent surgical treatment at the Department of Gastrointestinal Surgery,Affiliated Hospital of Southwest Medical University,between September 2018 and June 2020.Clinical and pathological data,as well as survival outcomes,were collected for analysis.The mean values of NLR,PLR,and LMR were used as cutoff values to divide the patients into high-value and low-value groups.We compared the relationship between clinical and pathological features and prognosis in the two groups using frequency and percentage(%),chi-square test,logistic regression analysis,Pearson’s chi-square test,or Fisher’s exact test.Univariate regression analysis was performed to identify variables with statistical significance,and Cox multivariate model was used for analysis after considering sample size and clinical significance to avoid missing important variables.We also plotted survival curves of independent influencing factors to compare their true effects.Results: Among the 294 studied colon cancer patients,103 cases(35%)were classified as high NLR(> 3.09)and 191 cases(65%)as low NLR(≤ 3.09).Univariate analysis showed that there were statistically significant differences in tumor diameter,infiltration depth(T stage),lymph node metastasis(N stage),CEA level,and TNM stage between the high and low NLR groups.However,the analysis of gender,age,and differentiation degree showed no significant differences.Logistic multivariate regression analysis showed that there were statistically significant differences in tumor diameter and CEA level between the two NLR groups in peripheral blood before surgery,indicating that tumor diameter and CEA level were independent risk factors affecting the value of NLR in peripheral blood before surgery.Among the studied patients,117 cases(40%)were classified as high PLR(> 177.42)and 177 cases(60%)as low PLR(≤ 177.42)using the mean value of PLR as the cutoff.Univariate analysis showed statistically significant differences in age,tumor diameter,infiltration depth(T stage),TNM stage,and CEA level between the high and low PLR groups,while the analysis of gender,lymph node metastasis(N stage),and differentiation degree showed no significant differences.A logistic multiple regression analysis showed that there was a statistically significant difference in tumor diameter between the high and low peripheral blood PLR groups before surgery,indicating that tumor diameter may be an independent risk factor that affects PLR values.With an LMR mean of 4.11 as the threshold,there were 146patients(49%)in the high LMR(>4.11)group and 148 patients(51%)in the low LMR(≤4.11)group.Univariate analysis showed that there were significant differences between the high and low LMR groups in terms of patient gender,tumor diameter,depth of invasion(T staging),lymph node metastasis(N staging),TNM staging,and CEA level,while age and degree of differentiation did not show significant differences.The logistic multiple regression analysis showed that the differences between the high and low LMR groups in terms of tumor diameter,gender,and CEA level before surgery were statistically significant,indicating that tumor diameter,gender,and CEA level are independent risk factors that affect LMR values.Survival analysis results showed that based on the endpoint of overall survival(OS),the future risk of death for patients with an NLR >3.09 was 3.291 times that of patients with an NLR ≤3.09,with a 95% confidence interval of 1.696-6.386 times and a P value<0.001.On the premise of adjusting for other factors,the future risk of death for patients with a PLR >177.42 was 2.043 times that of patients with a PLR≤177.42,with a 95% confidence interval of 1.069-3.902 times and a P value of0.031.Therefore,both NLR and PLR are independent factors that affect patient OS.Based on the endpoint of progression-free survival(PFS),the future risk of tumor metastasis for patients with an NLR >3.09 was 8.396 times that of patients with an NLR ≤3.09,with a 95% confidence interval of 4.797-14.695 times and a P value <0.001.On the premise of adjusting for other factors,the future risk of tumor metastasis for patients with an LMR ≤4.11 was 1.942 times that of patients with an LMR >4.11,with a 95% confidence interval of1.042-3.619 times and a P value of 0.037.Therefore,both NLR and LMR are independent factors that affect patient PFS.After adjusting for other factors,with patients in stage 1 as the reference group,the risk of future tumor metastasis in patients in stage 2 is 1.171 times that of patients in stage 1,with a95% confidence interval of 0.482-2.842 times and a P value of 0.727,indicating no statistical difference.The risk of future tumor metastasis in patients in stage 3 is 3.292 times that of patients in stage 1,with a 95%confidence interval of 1.415-7.658 times and a P value of 0.006.At the same time,tumor staging is an independent risk factor affecting patient PFS.Conclusion: 1.The NLR,PLR,and LMR in preoperative peripheral blood are closely related to clinical and pathological features such as CEA levels and tumor diameter in colorectal cancer,and can be used to evaluate the occurrence and development of colorectal cancer.2.NLR,PLR,and LMR can be a new auxiliary method for evaluating the prognosis of colorectal cancer patients. |
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