The Role of Complete Blood Count Parameters in Patients with Colorectal Cancer

Abstract

SUMMARY – Chronic inflammation has been linked with many cancers. It seems that easily available and usual blood inflammatory markers might serve as a prognostic factor for overall survival and disease-free survival in patients with various cancers. Preoperative neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), as well as hemoglobinemia, thrombocytosis, elevated C-reactive protein values, neutropenia and leukocytosis have been shown to affect overall survival and disease-free survival in patients with colorectal cancer (CRC), however, with controversial results. Complete blood count, NLR and PLR were determined in 71 patients with CRC (stages 3 and 4) after neoadjuvant chemo-radiotherapy and before surgery, treated at Hospital for Tumors in Zagreb. Statistical analysis included Mann-Whitney U test, Student’s t-test, univariate and multivariate analysis. The results of Mann-Whitney U test and Student’s t-test showed that neutrophil count (p=0.024), NLR (p=0.003) and PLR (p=0.007) correlated significantly with overall survival. However, there was no significant correlation of age, leukocyte, lymphocyte and platelet counts and hemoglobin values with overall survival of patients. Furthermore, the same tests showed that leukocyte (p=0.04), neutrophil (p=0.0014) and platelet (p=0.006) counts, NLR (p=0.0006) and PLR (p=0.0015), as well as hemoglobin values (p=0.028) correlated significantly with disease-free survival. The results of univariate analysis showed that unlike PLR, NLR correlated with overall survival and disease-free survival (p=0.0002), although the correlation of PLR and disease-free survival almost reached significance (p=0.059). Furthermore, the results of univariate analysis showed significant correlation of advanced pathological TNM stage with overall survival. There was no correlation of patient age and gender, tumor stage and neoadjuvant chemo-radiotherapy with overall survival and disease-free survival. The results of multivariate analysis showed that NLR (cut-off value 3.27) and advanced pathological TNM stage significantly correlated with disease-free survival but not with overall survival. It seems that NLR might be an accurate marker for overall survival and disease-free survival in CRC patients after neoadjuvant chemo-radiotherapy and before surgery.

Lymphocyte-to-Monocyte Ratio is Associated with the Poor Prognosis of Breast Cancer Patients Receiving Neoadjuvant Chemotherapy

“…The increase of the NLR level indicates a decrease in the lymphocyte level or an increase in the neutrophil count relative to that in normal patients. NLR has been proven to be closely associated with the prognosis of tumor patients, with higher PLR suggesting poor prognosis in lung cancer, 11 ovarian cancer, 23 colorectal cancer, 9 , 24 osteosarcoma 25 and gastric cancer. 10 Some studies have been conducted on the clinical significance of PLR and NLR in the prognosis of breast cancer.…”

Higher Levels of Pre-operative Peripheral Lymphocyte Count Is a Favorable Prognostic Factor for Patients With Stage I and II Rectal Cancer

“…In line with this, another study with the cut-off of 1.0 × 10 9 /L for pre-operative lymphocyte count, Shibutani et al (32) showed that RFS and OS rates were significantly higher in the high-lymphocyte group compared with the low-lymphocyte group. On the contrary, no prognostic significance of pre-operative lymphocyte count was observed for both RFS and OS in another cohort of patients with colorectal cancer (33). The discrepancy findings between previous studies might be owing to the different cut-off values, and actually no reference of cut-off values has been recommended or established (36).…”

The Role of Preoperative Carcinoembryonic Antigen in Recurrence of Resectable Colorectal Carcinoma

“…Colorectal carcinoma is the third most common cancer and has fatal outcome 9 . Preoperative CEA levels have shown relationship with disease prognosis in CRC.…”