Effect Of Preoperative Neutrophil Lymphocyte Count Ratio On Prognosis In 469 Patients With Colorectal Adenocarcinoma

BackgroundColorectal adenocarcinoma is a common malignant tumor of the digestive system.In addition,colorectal cancer is listed as one of the leading causes of cancer-related deaths worldwide due to its high mortality rate.In clinical practice,pathological type,degree of differentiation and tumor stage have been widely used as prognostic factors for patients with colorectal adenocarcinoma.In addition,vascular nerve invasion,level of carcinoembryonic antigen and lymph node metastasis have also been reported to affect the prognosis of patients.In recent years,with the progress of science and technology,the detection technology based on body fluids has been developed continuously,which has attracted extensive attention.Biomarkers based on blood test can be proved to be a practical tool for detection of colorectal adenocarcinoma,and the monitoring of biomarkers in the biological liquid has many advantages,such as low invasiveness and easy access.Some biomarkers have high specificity and sensitivity,which can be used for the early detection of colorectal cancer,so as to detect and improve the prognosis at an early stage,and help predict the treatment response and recurrence risk of patients.As a method of prognosis evaluation,gene testing is expensive and its clinical application is limited.It has been suggested that the involvement of inflammation and immune response plays an important role in the development of colorectal adenocarcinoma,leading to great differences in the prognosis of patients with the same stage and pathological type.ObjectiveNeutrophils,as part of the immune system,are important players in inflammation and infection in the body,and certain substances released by activated cells may be associated with tumor progression,allowing neutrophils and possibly related cancer cells to leave the blood and enter inflamed/infected tissues.Lymphocytes can play a role in immune surveillance of tumors and help generate an anti-tumor immune response.Immunotherapy of lymphocytes has also made great progress.More recently,in some cancer populations,the neutrophil to lymphocyte count ratio(NLR)has been used as an indicator,and overall survival is often lower in some populations where neutrophil lymphocyte counts are higher.However,there are few studies on this index in colorectal adenocarcinoma.In this study,the relationship between preoperative neutrophil lymphocyte count ratio and pathological characteristics of patients with colorectal adenocarcinoma and its effect on prognosis were discussed.MethodsRetrospective analysis was performed on the clinical data of 469 patients with colorectal adenocarcinoma who received surgical treatment in the first affiliated hospital of zhengzhou university between November 1,2012 and September 30,2013.Including gender(227 males,accounting for 59.06%;192 females,accounting for 40.94%),age(> 60 years old 213 cases,accounting for 45.42%;≤60 years old 256 cases,accounting for 54.58%;The average age of the patients in the whole group was 58.61 13.06 years old),tumor location(355 cases in the left-sided colon,accounting for 75.69%;114 cases in the right-sided colon,accounting for 24.31%),the degree of tissue differentiation(low differentiation and undifferentiation was 89 cases,accounting for 18.98%;medium differentiation and high differentiation was 380 cases,accounting for 81.02%),vascular nerve invasion(There were 22 cases of vascular nerve invasion,accounting for 4.69%.There were 447 cases without vascular nerve invasion,accounting for 95.31%),local infiltration depth(T1/T2 stage 117 cases,accounting for 24.95%;T3/T4 stage 352 cases,accounting for 75.05%),local lymph node metastasis(no lymph node metastasis in 310 cases,accounting for 66.10%;with lymph node metastasis in 159 cases,accounting for 33.90%),distant metastasis(no distant metastasis in 422 cases,accounting for 89.98%;with distant metastasis in 47 cases,accounting for 10.02%).Blood neutrophil count and lymphocyte count were measured by automatic blood routine analyzer,and neutrophil lymphocyte count ratio was calculated manually.Using ELISA method for detection of serum carcinoembryonic antigen(CEA)and carbohydrate antigen 19-9(CAl9-9)level.The measurement data were converted into count data by binary classification,and the chi-square test was used for univariate analysis to analyze the differences between preoperative neutrophil lymphocyte count ratio(NLR)and various clinicopathological parameters.Binary Logistic regression was used to analyze the relationship between preoperative NLR level and various clinicopathological features.Cox risk ratio model was used to analyze the relationship between preoperative NLR level,clinicopathological characteristics and prognosis,the relative risk(HR)of each factor and their 95% confidence interval(95%CI)were analyzed,and the influence of each factor on the prognosis of colorectal adenocarcinoma was evaluated.Kaplan-meier survival curve and log-rank test were used to compare the survival differences between the two groups with different preoperative NLR levels.Results1.Results of univariate analysis showed that preoperative NLR levels were different in different gender groups,different CEA levels groups,different tumor locations groups,different differentiation degrees groups,and different T staging groups(all P < 0.05).2.The results of multivariate analysis showed that the preoperative NLR level was correlated with gender(HR=0.568,P =0.016),tumor location(HR=2.171,P =0.002)and CEA level(HR=1.829,P =0.011).3.Patients with colorectal cancer with different preoperative NLR levels had different prognosis(2=5.052,P=0.025).higher preoperative NLR(HR=1.537,P=0.046),higher preoperative CEA(HR=1.654,P=0.011),right hemicolon cancer(HR=1.721,P=0.014),lymph node metastasis(HR=3.311,P < 0.001),and distant metastasis(HR=7.705,P < 0.001)were independent risk factors for poor prognosis.ConciusionCompared with patients with high preoperative NLR level,patients with low preoperative NLR level in colorectal adenocarcinoma have better prognosis and higher 5-year survival rate.NLR is an easy and inexpensive detection method,which is expected to be used as a reference index to evaluate the prognosis of patients with colorectal adenocarcinoma.