Blood cholesterol-to-lymphocyte ratio as a novel prognostic marker to predict postoperative overall survival in patients with colorectal cancer

Abstract

Background Lipid disequilibrium and systemic inflammation are reported to correlate with tumorigenesis and development of colorectal cancer (CRC). We construct the novel biomarker cholesterol-to-lymphocyte ratio (CLR) to reflect the synergistic effect of cholesterol metabolism and inflammation on CRC outcomes. This study aims to investigate the clinical significance of CLR and establish a prognostic model for CRC. Methods Our study retrospectively enrolled 223 CRC patients who underwent curative surgical resection. The Kaplan-Meier method was employed to estimate the overall survival (OS) rates, and the association between serological biomarkers and survival was assessed with a log-rank test. Cox proportional hazard regression was applied in the univariate and multivariate analyses to identify independent prognostic factors, which were then used to develop a predictive nomogram model for OS in CRC. The nomogram was evaluated by the C-index, receiver operator characteristic curve (ROC) analysis, and calibration plot. All cases were grouped into three stratifications according to the total risk points calculated from the nomogram, and the difference in OS between them was assessed with the Kaplan-Meier method. Results At the end of the study, death occurred in 47 (21%) cases. Patients with low CLR (< 3.23) had significantly prolonged survival (P < 0.001). Multivariate analyses revealed that N stage (P < 0.001), harvested lymph nodes (P = 0.021), and CLR (P = 0.005) were independent prognostic factors for OS and a prognostic nomogram was established based on these variables. The nomogram showed good calibration and predictive performance with a superior C-index than TNM stage (0.755 (0.719–0.791) vs. 0.663 (0.629–0.697), P = 0.001). Patients of different risk stratifications based on the total score of nomogram showed distinct survival (P < 0.001). Conclusions The nomogram based on CLR and other clinical features can be used as a potentially convenient and reliable tool in predicting survival in patients with CRC.

Predicting long-term outcomes after primary PCI in Acute ST-segment elevation myocardial infarction patients with single-vessel disease

“…The CLR index is a crucial parameter, re ecting the dual aspects of the body's cholesterol accumulation and lymphocyte-mediated in ammatory response 9,10 . Central to the dynamic formation and progression of coronary atherosclerosis is the interplay between cholesterol accumulation and the involvement of lymphocytes in the in ammatory response 16 .…”

“…Recent investigations have introduced the Cholesterol-to-Lymphocyte Ratio (CLR) as a quanti able metric. It assesses both cholesterol accumulation and immune system activation and has demonstrated prognostic value in high-risk patients, particularly following cancer-related surgeries 9,10 . Notably, the CLR index incorporates two easily measurable metabolic measures, offering cost-effectiveness, widespread availability in clinical practice, and ease of implementation for practical use.…”

Supervised training of laparoscopic colorectal cancer resections does not adversely affect short- and long-term outcomes: a Propensity-score-matched cohort study

“…However, the meta-analysis showed significantly less R0 resections in the supervised training case collective which is in contrast to our findings. Recently, overall survival prognostic models including blood cholesterol-to-lymphocyte ratios, carcinoembryonic antigen levels or RNA-binding proteins have been investigated and may help to further delineate the individual risk profile in the future [ 27 – 29 ]. None of these newer and often still experimental risk factors was consistently investigated in our study group.…”

Significance of malnutrition defined with Global Leadership Initiative on Malnutrition criteria in patients with hepatocellular carcinoma after hepatic resection

“…Neutrophil–lymphocyte ratio was defined by dividing the neutrophil count by the lymphocyte count 18 . Cholesterol–lymphocyte ratio was defined by dividing total cholesterol by the lymphocyte count 19 . The CONUT scores were calculated based on serum albumin concentrations, peripheral lymphocyte counts, and total cholesterol concentrations 2 : (1) albumin concentrations ≥3.5 g/dL, 3.0–3.49 g/dL, 2.5–2.99 g/dL, and <2.5 g/dL were scored as 0, 2, 4, and 6 points, respectively; (2) total lymphocyte counts ≥1600, 1200–1599, 800–1199, and <800/mm 3 were scored as 0, 1, 2, and 3 points, respectively; and (3) total cholesterol concentrations ≥180 mg/dL, 140–179 mg/dL, 100–139 mg/dL, and <100 mg/dL were scored as 0, 1, 2, and 3 points, respectively.…”