The preoperative neutrophil to lymphocyte ratio is a superior indicator of prognosis compared with other inflammatory biomarkers in resectable colorectal cancer

Abstract

BackgroundGrowing evidence has indicated that some inflammatory markers, including lymphocyte to monocyte ratio (LMR), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and prognostic nutritional index (PNI), can be used as indicators in the prognosis of colorectal cancer (CRC). However, there is controversy concerning what is the best predictor of prognosis in CRC.MethodsA cohort of 1744 CRC patients in our institution was analyzed retrospectively. Harrell’s concordance index (c-index) and Bayesian information criterion (BIC) were used to determine the optimal cut-off values of inflammatory markers and compare their predictive capacity. The association of inflammatory markers with overall survival (OS) and cancer-specific survival (CSS) was analyzed using Kaplan-Meier methods with log-rank test, followed by multivariate Cox proportional hazards model.ResultsThe multivariate analysis indicated that among these inflammatory markers, NLR (< 2.0 vs. ≥ 2.0) was the only independent prognostic factor for poor OS [hazard ratio (HR) = 0.758, 95% confidence intervals (CI) = 0.598–0.960, P = 0.021)] and CSS (HR = 0.738, 95% CI = 0.573–0.950, P = 0.018). Among these inflammatory markers, the c-index and BIC value for NLR were maximum and minimum for OS, respectively. In addition, the c-index was higher and the BIC value was smaller in TNM staging combined with NLR compared with the values obtained in TNM staging alone.ConclusionNLR is a superior indicator of prognosis compared with LMR, PLR, and PNI in CRC patients, and NLR may serve as an additional indicator based on the current tumor staging system.Electronic supplementary materialThe online version of this article (10.1186/s12885-017-3752-0) contains supplementary material, which is available to authorized users.

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.…”

Neoadjuvant chemotherapy-induced decrease of prognostic nutrition index predicts poor prognosis in patients with breast cancer

“…Increasing evidence suggests that high preoperative PNI is a predictor of better postoperative complications and patients outcomes in various types of malignancy [4][5][6][7][8][9][10]. Meanwhile, both high serum albumin level and low preoperative NLR also have been reported to be associated with better postoperative outcomes in several cancers [19][20][21][22][23][24][25][26][27]. BMI is also a well-known prognostic factor in breast cancers [28][29][30], and body weight is also associated with the patients' nutritional condition [31].…”