Prognostic evaluation of platelet to lymphocyte ratio in patients with colorectal cancer

Abstract

Growing evidence indicates that inflammation plays an important role in cancer progression and prognosis; however, the prognostic role of platelet to lymphocyte ratio (PLR) in colorectal cancer (CRC) is unknown. A cohort of 1845 CRC patients from the Department of Surgical Oncology at The First Hospital of China Medical University (CMU-SO) was retrospectively analyzed. Harrell’s concordance index (c-index) was used to determine the optimal cut-off value of PLR and evaluate its predictive ability. Our results from CMU-SO indicated that the overall survival (OS) rate was significantly lower in the high-PLR group compared with the low-PLR group (P = 0.001). A similar result was observed for the cancer-specific survival (CSS) rate between these two groups (P = 0.001). The multivariate analysis indicated that high PLR was an independent prognostic indicator of poor OS (hazard ratio [HR] = 1.356, 95% confidence interval [CI] = 1.117–1.647, P = 0.002) and CSS (HR = 1.364, 95% CI = 1.111–1.675, P = 0.003). In addition, the c-indexes of TNM staging combined with PLR were greater than those of TNM staging alone (OS: 0.768 vs. 0.732; CSS: 0.785 vs. 0.746). In conclusion, elevated PLR is a negative prognostic indicator of CRC and may serve as an additional index of the current TNM staging system for predicting CRC.

C‐reactive protein/albumin ratio is a poor prognostic factor of esophagogastric junction and upper gastric cancer

“…These biomarkers can be evaluated easily by sampling a small amount of peripheral blood. Prognostic significance has been gradually elucidated by accumulation of data from studies in gastrointestinal tumors such as esophageal cancer, gastric cancer, and colorectal cancer . However, few studies about the relationship between these biomarkers with respect to prognosis in patients with AEG have been published.…”

“…Prognostic significance has been gradually elucidated by accumulation of data from studies in gastrointestinal tumors such as esophageal cancer, gastric cancer, and colorectal cancer. [17][18][19][20][21][22][23][24][25] However, few studies about the relationship between these biomarkers with respect to prognosis in patients with AEG have been published. In patients with AEG, pre-Alb, 33 body mass index, and NLR 34 were reported as independent prognostic factors.…”

“…We previously reported that skeletal muscle loss was strongly associated with a poor long‐term prognosis in patients who underwent surgical treatment of AEG and UGC . Also, several common inflammation‐based prognostic scores, including the neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), Glasgow Prognostic Score (GPS), and controlling nutritional status (CONUT) score have been reported to have prognostic value in patients with many types of malignant, solid tumors . The C‐reactive protein (CRP)/albumin (Alb) ratio has also been reported as a novel inflammation‐based prognostic marker in multiple types of tumors, including hepatocellular carcinoma, colorectal cancer, esophageal cancer, renal cancer, pancreatic cancer, and gastric cancer …”

“…14 Also, several common inflammation-based prognostic scores, including the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), Glasgow Prognostic Score (GPS), and controlling nutritional status (CONUT) score have been reported to have prognostic value in patients with many types of malignant, solid tumors. 7,[15][16][17][18][19][20][21][22][23][24][25] The C-reactive protein (CRP)/albumin (Alb) ratio has also been reported as a novel inflammation-based prognostic marker in multiple types of tumors, including hepatocellular carcinoma, colorectal cancer, esophageal cancer, renal cancer, pancreatic cancer, and gastric cancer. 21,[26][27][28][29][30][31] In the present study, we investigated the prognostic value of the CRP/Alb ratio in patients who underwent surgery for AEG and UGC.…”

Systemic and local inflammation in colorectal cancer

“…Another extensively studied marker of systemic inflammation is PLR. Several publications state an association between elevated PLR and worse prognosis in CRC patients, namely, OS, CSS, disease-free and recurrence-free survival (50)(51)(52) in both localized and metastatic disease. There are several known mechanisms for increased PLR in cancer patients.…”