Values of applying white blood cell counts in the prognostic evaluation of resectable colorectal cancer

Abstract

The count and classification of white blood cells (WBCs) may be used as prognostic markers in certain types of cancer. The present study investigated the prognostic potential of the counts of WBCs, including lymphocytes (LYs), monocytes (MOs), neutrophils (NEs), eosinophils (EOs) and basophils (BAs), in the prognosis of resectable colorectal cancer. The present study recruited 153 resectable colorectal cancer cases retrospectively, which were pathologically confirmed. All patients were divided into two groups, according to the median value of LY (low LY, ≤1.632x10 9 /l or high LY, >1.632x10 9 /l), MO (low MO, ≤0.330x10 9 /l or high MO, >0.330x10 9 /l), NE (low NE, ≤3.600x10 9 /l or high NE, >3.600x10 9 /l), EO (low EO, ≤0.085x10 9 /l or high EO, >0.085x10 9 /l), BA (low BA, ≤0.010x10 9 /l or high BA, >0.010x10 9 /l), or WBC (low WBC, ≤5.780x10 9 /l or high WBC, >5.780x10 9 /l). To evaluate the alterations in WBC counts following surgery and adjuvant chemotherapy; all samples received oxiplatin and capecitabine (XELOX) for 6-8 cycles or 5-fluorouracil, leucovorin and oxaliplatin (mFOLFOX6) for 10-12 cycles. XELOX included oxaliplatin administered intravenously at a dose of 130 mg/m 2 on day 1 and 850-1,250 mg/m 2 capecitabine twice daily for days 1-14, repeated every 3 weeks. mFOLFOX6 included oxaliplatin administered intravenously at a dose of 85 mg/m 2 , 400 mg/m 2 leucovorin and 400 mg/m 2 5-FU on day 1 followed by 1,200 mg/m 2 /days continuous infusion for 2 days (in total, 2,400 mg/m 2 over 46-48 h), repeated every 2 weeks. The present study investigated the post/pre-treatment of LY, MO, NE, EO, BA and WBC ratios (≤1 indicated that LY, MO, NE, EO, BA and WBC counts were not increased following therapy; whereas, >1 suggested increased counts). Kaplan-Meier curves were constructed to demonstrate overall survival (OS). A multivariate and univariate logistic regression analyses model was employed to identify the independent risk factors. Low pre-treatment BA counts were associated with larger tumor size (>5 cm); pre-treatment BA levels were positively associated with OS. Surgery significantly decreased the count of BAs and increased the count of EOs; whereas, no effect was observed on LYs, MOs, NEs or WBCs. Adjuvant chemotherapy markedly decreased the counts of LY, NE and WBC; whereas, no notable effects on MOs, EOs or BAs were observed. Whole course treatment (surgery combined with adjuvant chemotherapy) significantly decreased the values of LY, NE and WBC; however, increased the value of EO; no effects on the MO or BA counts were observed. An increased post-/pre-treatment NE ratio suggested poorer prognosis. Multivariate Cox regression analysis revealed that sex, tumor size, pre-treatment BA count and the post-/pre-treatment NE ratio were independent prognostic factors affecting OS. The results of the present study suggested that the pre-treatment BA count and post-/pre-treatment NE ratio may be potential prognostic factors for resectable colorectal cancer.

Circulating basophil count as a prognostic marker of tumor aggressiveness and survival outcomes in colorectal cancer

“…The findings of the present study could elicit further research on these underlying mechanisms. Two previous study investigated the relationship between basophils count level and prognosis of CRC, with just a cursory summary that a high level of pretreatment circulating basophils count correlated with a favorable prognosis of patients with CRC, which was in line with the findings of the present study [11,34]. In fact, the two studies with small sample size did not focus on the clinical value of circulating basophil count, without comparison to the prognostic value of serum CEA which had long been accepted as the most important and reliable prognostic factor in CRC, without detailed descriptions of the prognostic significance of circulating basophil count or comprehensive investigation of the mechanisms behind.…”

A persistent high neutrophil‑to‑lymphocyte ratio predicts poor prognosis in patients with colorectal cancer undergoing resection

“…Stress induced by psychological stressors such as surgery can lead to a high concentration of corticosteroids (37), which can increase neutrophils and impair the functions of lymphocytes (37,38). In contrast, a relatively low post-NLR could be found in patients who underwent adjuvant or first-line chemotherapy (39,40). In our study, patients with a low pre-NLR who shifted to a high post-NLR could present an obviously inferior prognosis when compared to those who maintained a low post-NLR, based on the aforementioned evidence (31,37,38), it is plausible that surgery for these patients could induce a high post-NLR, which could facilitate the outbreak of early micrometastases and the germination of new lesions.…”

Eosinophils in the gastrointestinal tract and their role in the pathogenesis of major colorectal disorders

“…Nevertheless, the presence of eosinophils in CRC patients is strongly linked with a decreased disease risk, better prognosis and extended patient survival. Indeed, elevated blood eosinophil counts were associated with a decreased CRC development risk[211] as well as better prognosis[212-214]. Eosinophil infiltration of colorectal tumours is a common phenomenon, and higher numbers of infiltrating eosinophils detected both in the tumour tissue[215-217] and peritumourally[218-220] were repeatedly shown to be prognostically favourable.…”