The Diagnostic And Prognostic Value Of Preoperative The Ratio Of Circulating Inflammatory Cell In Colorectal Cancer

Aims:This study with large samples size was conducted to comprehensively analyze the diagnostic value of neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)and the diagnostic validity of combination of NLR,PLR,and carcino-embryonic antigen(CEA)in colorectal cancer(CRC).What’s more,this retrospective study with two centers was also conducted to evaluate the prognostic value of NLR,PLR,derived neutrophil-to-lymphocyte ratio(dNLR)and lymphocyte-to-monocyte ratio(LMR)in CRC patients.Methods:559 CRC patients who had undergone surgical resection and 559 gender-and age-matched healthy controls were enrolled in this case-control study.Baseline characteristics,clinical parameter,peripheral blood cell count and tumor biomarkers were collected for all patients.Receiver operation receiver operating characteristic(ROC)curve was used to evaluate the diagnostic performance and cut-off value of NLR,PLR and CEA.876 CRC patients who had undergone surgical resection were enrolled for prognostic study.Baseline characteristics,clinical parameter,peripheral blood cell count and tumor biomarkers were collected for all patients.What’s more,regularly follow-up was also carried out.X-tile software was used to determine the optimal cut-off value of NLR,PLR,dNLR and LMR.Kaplan-Meier survival curves and cox regression model were conducted to evaluate the correlation of these four biomarkers and 5-year overall survival(OS)and disease free survival(DFS).Moreover,a meta-analysis on the relationship between PLR and prognosis of CRC was also conducted.Results:Case-control study reveal that the optimal cut-off value of NLR and PLR for diagnostic study were 2.42 and 120,respectively.The diagnostic efficacy of NLR(AUC=0.755,95%CI=0.728-0.780)alone for CRC was significantly higher than PLR(AUC=0.723,95%CI=0.696-0.749,P=0.037)and CEA(AUC=0.690,95%CI=0.662-0.717,P=0.002)alone.In addition,the diagnostic efficacy of the combination of NLR,PLR and CEA(AUC=0.831,95%CI=0.807-0.852)for CRC was not only significantly higher than NLR alone but also higher than any combinations of the two of these three biomarkers(P<0.05).Moreover,the NLR and PLR in the patients with TNM stage Ⅰ/Ⅱ was higher than that in the healthy controls,and patients with stage Ⅲ had a higher NLR and PLR than those with stage Ⅰ/Ⅱ,but no significant difference was observed.The prognostic study indicated that the optimal cut-off value of NLR,PLR,dNLR and LMR for prognostic study were 3.1,203.3,1.7 and 3.9,respectively.Univariate analysis with cox regression model indicated that tumor stage,tumor invasion depth,lymph node metastasis,CEA,CA199,NLR,PLR,dNLR and LMR were significantly associated with OS and DFS(Pall<0.01).In multivariate analysis,invasion depth(HR=1.313,95%CI=1.021-1.689),lymph node metastasis(HR=1.601,95%CI=1.289-1.989),elevated CEA(HR=1.827,95%CI=1.236-2.701),CA199(HR=2.391,95%CI=1.660-3.443)and NLR(HR=3.002,95%=2.151-4.189)were also associated with reduced OS,respectively.And lymph node metastasis(HR=1.422,95%CI=1.193-1.694),elevated CEA(HR=1.953,95%CI=1.437-2.653),CA199(HR=2.904,95%CI= 2.174-3.879)and NLR(HR=1.905,95%CI=1.43 8-2.523)were also associated with poor DFS,respectively.Conclusion:Our study indicated that preoperative NLR could be a CRC diagnostic biomarker,even for early stage CRC,and the combination of NLR,PLR and CEA could significantly improve the diagnostic efficacy.NLR,PLR,dNLR and LMR were significantly associated with OS and DFS.NLR could be considered as an independent indicator for OS and DFS of CRC patients.