Prognostic Role of the Platelet-to-Lymphocyte Ratio for Patients With Metastatic Colorectal Cancer Treated With Aflibercept

There are many studies on biomarkers for prognosis in the treatment of metastatic colorectal cancer.Neutrophil-lymphocyte radio (NLR) and Platelet-lymphocyte radio (PLR) are of interest with studies revealing the relationship between in ammatory biomarkers and cancer. Our study is a retrospective le study and the contribution of NLR and PLR to progression-free survival (PFS) and overall survival(OS) before rst line chemotherapy was investigated regardless treatment. The cut off values of NLR and TLR were determined using ROC curve analysis. NLR and PLR was divided into two groups according to the cut-off points. OS and PFS associated with NLR and TLR were performed by Kaplan-Meier method. In our study, we could not demonstrate the prognostic potential of pre-treatment NLR and PLR in patients with mCRC treated with rst-line chemotherapy. Our study was showed that the use of these biomarkers in mCRC is limited. Introduction:Colorectal cancer (CRC) is the third most common cancer worldwide. While the incidence and the mortality rate of colorectal cancer has decreased due to effective cancer screening, CRC is still the second most common cause of cancer-related deaths in the Western world (1) and 20% of patients with CRC have metastases at time of diagnosis (2).Advances in CRC therapy as combination of chemotherapy with targeted agents and supportive care have led to signi cant improvement in survival rates for CRC patients. However, metastatic colorectal cancer (mCRC) remains to have poor prognosis with with an approximately 2-year survival (3). A multitude of factors at diagnosis, including clinical parameters (age, performance status, comorbidities), biological properties of the tumor (local growth, distant metastasis, sidedness), molecular factors (KRAS, NRAS, and BRAF mutations) and biochemical markers such as carcinoembryonic antigen, lactate dehydrogenase, platelets, leucocytes, hemoglobin, alkaline phosphatase, albumin have important prognostic impact for outcome in mCRC (4,5). In recent decades, studies provided de nitive evidence about the association between in ammation and cancer development (6,7).The in ammation is essential for tumor microenvironment, and in ammatory cells can affect tumor proliferation, angiogenesis, metastasis, and genetic instability. Lymphocytes, macrophages, and granulocytes are involved in the anti-cancer battle (8). The main cell population in anti-cancer immune response is the population of cytotoxic T lymphocytes (CTLs) (9). Neutrophils may play a crucial role in in ammation driven tumorigenesis (10). Neutrophil population consists of pro-and antitumor subpopulations (11). It is controversy that neutrophil abundance correlates with a better prognosis. (12).Platelets release some tumor growth factors which play a signi cant role in cancer growth, progression, and metastasizing (13). In previous studies, elevated pretreatment neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in peripheral blood were identi ed as independent prognostic factors. As a resul...

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“…We used the 3. (26). We suggest that as the NLR cut-off value decreases, the probability of the NLR predicting OS and PFS may increase.…”

Section: Resultsmentioning

confidence: 84%

Prognostic Significance of Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio in Metastatic Colorectal Cancer

Bulut

Özdemi̇r

2021

J Gastrointest Canc

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“…Eleven records assessed progression-free survival (PFS) ( 18 , 29 – 31 , 33 , 34 , 46 , 48 , 49 , 50 ), whereas a non-significant association between PFS and the PLR (HR = 1.14, 95% CI = 0.84–1.54, P = 0.40; I 2 = 65%, PH = 0.002, Figure 5A ) was observed. Another five articles evaluated cancer-specific survival (CSS) ( 11 , 14 , 16 , 25 , 49 ).…”

Section: Resultsmentioning

confidence: 99%

“…However, the relationship between the PLR and CRC remains controversial. Some studies reported that an elevated PLR was an independent adverse prognostic factor in patients with CRC (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23), yet others showed that the PLR could not be a related prognostic biomarker of CRC (11,(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35).…”

Section: Introductionmentioning

confidence: 99%

Potential impact of platelet-to-lymphocyte ratio on prognosis in patients with colorectal cancer: A systematic review and meta-analysis

Guo

Gao

et al. 2023

Front. Surg.

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BackgroundNumerous studies have confirmed that inflammation promotes the occurrence, development and prognosis of colorectal cancer (CRC).ObjectiveThis study focuses on the potentially prognostic value of the platelet-to-lymphocyte ratio (PLR) in CRC patients.Data SourcesThis study was registered at PROSPERO (ID: CRD42020219215). Relative studies were searched on PubMed, Cochrane Library, Embase, Web of Science, and clinical trial databases by two back-to-back reviewers. Study Selection and Intervention: Studies were screened according to the predetermined inclusion and exclusion criteria, comparing prognosis differences between low PLR levels and high PLR levels for CRC patients. Main Outcome Measures: Studies were integrated and compared to analyze the value of PLR in predicting overall survival (OS), progression-free survival (PFS), cancer-specific survival (CSS), disease-free survival (DFS) and recurrence-free survival (RFS) of CRC. Results: Outcomes were compared using Review Manager (version 5.4) software from Cochrane Collaboration. A total of 27 literary works, including 13,330 patients, were incorporated into our study. The final results showed that higher PLR levels had worse OS (hazard ratio [HR] = 1.40, 95% confidence interval [CI] = 1.21–1.62, P < 0.00001), DFS (HR = 1.44, 95% CI = 1.09–1.90, P = 0.01) and RFS (HR = 1.48, 95% CI = 1.13–1.94, P = 0.005) than lower PLR levels, respectively. However, there was no evidence of significance for PFS (HR = 1.14, 95% CI = 0.84–1.54, P = 0.40) and CSS (HR = 1.16, 95% CI = 0.88–1.53, P = 0.28) in the final meta-analysis.LimitationsOur study has the following limitations. First of all, we only included literature published in English, which means that some publication bias may be inevitable. In addition, our study used aggregate data, not individual data; furthermore, we did not define the exact cut-off value representing the PLR level.ConclusionAn elevated PLR seems to be an adverse prognostic factor affecting survival outcomes in patients with CRC. Meanwhile, more prospective studies are required to confirm our conclusion.PROSPERO ID: CRD42020219215.

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“…Different from OMCC, the strong association between PLR and survival in patients with non-invasive colorectal cancer was not found reported by Woo Jin Choi [ 38 ] and Huizhong Li [ 39 ]. Data concerning prognostic values of PLR in widespread metastatic colorectal were inadequate and controversial, but the latest study indicated that high PLR played a negative role on PFS [ 40 ]. These findings might help us to identify that PLR as a serum biomarker may be important to stratify patients with OMCC based on the current criteria.…”

Section: Discussionmentioning

confidence: 99%

The decreased platelet-to-lymphocyte ratio could predict a good prognosis in patients with oligometastatic colorectal cancer: a single-center cohort retrospective study

Huang

Cui

et al. 2021

World J Surg Onc

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Background Inflammation markers have an important effect on tumor proliferation, invasion, and metastasis. Oligometastatic disease (OMD) is an intermediate state between widespread metastases and locally confined disease, where curative strategies may be effective for some patients. We aimed to explore the predictive value of inflammatory markers in patients with oligometastatic colorectal cancer (OMCC) and build a nomogram to predict the prognosis of these patients. Methods Two hundred nine patients with OMCC were retrospectively collected in this study. The Kaplan-Meier survival curves and Cox regression analysis were used to estimate overall survival (OS) and progression-free survival (PFS). A multivariate Cox analysis model was utilized to establish the nomogram. The concordance index (C-index), calibration curve, and receiver operating characteristics (ROC) were established to verify the validity and accuracy of the prediction model. Results According to the multivariate analysis, decreased platelet-to-lymphocyte ratio (PLR) might independently improve OS in patients with OMCC (HR = 2.396, 95% CI 1.391–4.126, P = 0.002). Metastases of extra-regional lymph nodes indicated poor OS (HR = 2.472, 95% CI 1.247–4.903, P = 0.010). While the patients with early N stage had better OS (HR = 4.602, 95% CI 2.055–10.305, P = 0.001) and PFS (HR = 2.100, 95% CI 1.364–3.231, P = 0.007). Primary tumor resection (HR = 0.367, 95% CI 0.148–0.908, P = 0.030) and lower fibrinogen (HR = 2.254, 95% CI 1.246–4.078, P = 0.007) could significantly prolong the OS in patients with OMCC. PLR, metastases of extra-regional lymph nodes, N stage, primary tumor resection, and fibrinogen were used to make up the nomogram. The C-index and area under the curve (AUC) of the ROC in nomogram were 0.721 and 0.772 respectively for OS, showed good consistency between predictive probability of OS and actual survival. Conclusions Decreased PLR could predict a good prognosis in patients with OMCC. The nomogram including inflammatory factors and clinicopathological markers was credible and accurate to predict survivals in patients with OMCC.

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Prognostic Role of the Platelet-to-Lymphocyte Ratio for Patients With Metastatic Colorectal Cancer Treated With Aflibercept

Cited by 9 publications

References 29 publications

Prognostic Significance of Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio in Metastatic Colorectal Cancer

Prognostic Significance of Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio in Metastatic Colorectal Cancer

Potential impact of platelet-to-lymphocyte ratio on prognosis in patients with colorectal cancer: A systematic review and meta-analysis

The decreased platelet-to-lymphocyte ratio could predict a good prognosis in patients with oligometastatic colorectal cancer: a single-center cohort retrospective study

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