Blood-Cell-Based Inflammatory Markers as a Useful Tool for Early Diagnosis in Colorectal Cancer

Abstract

BackgroundSystemic inflammation seems to be involved in the pathogenetic pathways of colorectal cancer (CRC). Analytical markers that reflect the inflammatory status, such as neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) or systemic immune-inflammation index (SII), have been proposed as tools for the prognosis of CRC. Nevertheless, their use for diagnosis has been scarcely investigated.AimsTo analyze the ability of these markers and of a new marker combining SII and hemoglobin concentration, named NP/LHb = [neutrophils x platelets]/[lymphocytes x hemoglobin], as tools for CRC diagnosis. Furthermore, we studied their association with CRC-related variables.MethodsCase-control study including 214 CRC patients and 214 controls without CRC, matched by age (±5 years) and sex. We collected demographic, CRC-related and laboratory variables to calculate NLR, PLR, SII, and NP/LHb. In the case group, the laboratory variables were collected at two different period times, 6 months (IQR 4–8) before the CRC diagnosis and at the time of the diagnosis. ROC analysis was performed to evaluate the discriminatory accuracy of each index and we calculated Se, Sp, PPV, NPV, and OR to identify the diagnostic performance of each positive marker.ResultsNP/LHb showed high Sp (92.06%) and PPV (87.50%) to diagnose patients with CRC. This index exhibited an OR of 14.52 (8.26–25.52) and the best area under the curve (AUC: 0.78) for a positive CRC diagnosis. We found significant differences in all indices according to the presence of CRC, observing the highest values in CRC patients at time of diagnosis, in comparison with the analysis performed in the previous months to diagnosis or with control patients. There were significant differences in all ratios according to TNM stages (p < 0.05). PLR, SII and NP/LHb (but not NLR) showed significant differences according to tumor location (p < 0.05). Right-sided colon cancers presented the highest values, in comparison with left-sided and rectal cancers.ConclusionsSystemic inflammatory cell ratios (especially NP/LHb) change over time with the development of CRC, so they could be useful in its early diagnosis. We suggest that they could be routinely measured in patients with suspicion of CRC, to identify those ones with a higher risk of cancer, considering the high positive predictive value they have shown in our study.

The systemic immune-inflammation index and neutrophil-lymphocyte ratio in pediatric burned patients – a pilot study

“…Recently, increasing attention has been paid to peripheral blood inflammatory markers and their usefulness in establishing prognosis in different diseases, such as cervical cancer, colorectal cancer, psychiatric disorders, and infections [4,[6][7][8][9]. Neutrophil-lymphocyte ratio and SII were shown to be prognostic markers for malignancies and inflammatory conditions [4,[6][7][8][9].…”

“…The burn-induced inflammatory process is very complex. The balance between all inflammatory mediators can be analytically reflected by the blood levels of PLT and leukocytes, especially neutrophils and lymphocytes [8]. Neutrophils and monocytes play a crucial role in the initial inflammatory phase [10].…”

ALDH2 gene rs671 G > a polymorphism and the risk of colorectal cancer: A hospital‐based study

“… 43 Systemic inflammatory cell ratios could be useful in early diagnosis of CRC. 44 NRL and PLR are useful markers in diagnostic and early recognition of different stages of CRC. 45 Monocyte‐to‐lymphocyte ratio (MLR), NLR and PLR are valuable predictive markers of colorectal cancer.…”

“…In addition, fibrinogen to pre‐albumin ratio is a biomarker for diagnosis of CRC 43 . Systemic inflammatory cell ratios could be useful in early diagnosis of CRC 44 . NRL and PLR are useful markers in diagnostic and early recognition of different stages of CRC 45 .…”

Research Progress of Intestinal Microecology in the Pathogenesis of Colorectal Adenoma and Carcinogenesis

“…Lymphocytes can weaken tumor immune monitoring by inducing cytotoxicity and further reducing the host's antitumor immunity. 62 , 63 Emir et al 64 found that preoperative NLR and preoperative platelet-to-lymphocyte ratio (PLR) could be used as markers to monitor the progression of adenomatous polyps to aggressive tumors, indicating that the higher NLR and PLR values, the greater the carcinogenesis risk.…”