Περίληψη:
Background: The incidence of colorectal cancer (CRC) is expected to increase by 80% in year 2035. Even though advantages in treatment of CRC have being made over the last decades, the outcome remains poor. Recently, several inflammatory markers including pretreatment neutrophil to lymphocyte ratio (NLR), have being used as prognostic factors, since host inflammatory response to cancer is believed to determine disease progression. The aim of this study is to evaluate the prognostic significance of pretreatment NLR, in terms of overall survival (OS), 5-year survival, disease-free survival (DFS) and recurrence, in CRC patients who underwent curative resection. Methods: We retrospectively reviewed 296 patients, who were submitted to elective surgery as first therapeutic option in curative intent, between January 2010 and December 2015. Pretreatment NLR, as well as demographics, clinical, histopathologic, and laboratory data were analyzed. Univariate and multivariate analyses were conducted to identify prognostic factors associated with OS, 5-year survival, DFS and recurrence. Results: The cutoff point of NLR was calculated with Kaplan-Meier curves and log-rank test to 4.7. Univariate and multivariate analyses disclosed elevated NLR as a significant dismal prognostic factor for DFS (HR 1.88; 95% CI 1.01-3.52; p = 0.048), 5-year survival (HR 2.14; 95% CI 1.12-4.10; p = 0.021) and OS (HR 2.11; 95% CI 1.11-4.03; p = 0.023). In a subgroup analysis, in patients with stage II CRC, NLR > 4.7 was a stronger poor predictor for DFS (HR 2.76; 95% CI 1.07-7.13; p = 0.036), 5-year survival (HR 3.84; 95% CI 1.39-10.63; p = 0.01) and OS (HR 3.62; 95% CI 1.33-4.82; p = 0.012). After adjusting stage for gender, age, location of the primary tumor, differentiation, as well as the presence of perineural, vascular, and lymphovascular invasion, the significance of NLR > 4.7 became more prominent for DFS (HR 2.85; 95% CI 1.21-6.73; p = 0.0176), 5-year survival (HR 4.06; 95% CI 1.66-9.93; p = 0.002) and OS (HR 4.07; 95% CI 1.69-9.91; p = 0.002) in stage II patients. Conclusion: Pretreatment NLR > 4.7 is a poor prognostic factor for DFS, 5-year survival and OS in CRC patients undergoing curative resection. The dismal prognostic effect of NRL is magnified in Stage II CRC patients. © 2018 The Author(s).
Συγγραφείς:
Dimitriou, N.
Felekouras, E.
Karavokyros, I.
Alexandrou, A.
Pikoulis, E.
Griniatsos, J.
Λέξεις-κλειδιά:
adult; age distribution; aged; Article; cancer patient; cancer prognosis; cancer recurrence; cancer staging; cancer survival; colorectal cancer; confidence interval; controlled study; data analysis; demography; disease free survival; elective surgery; female; hazard ratio; histopathology; human; human cell; Kaplan Meier method; log rank test; lymph vessel metastasis; major clinical study; male; multivariate analysis; neutrophil lymphocyte ratio; overall survival; perineural invasion; postoperative period; retrospective study; sex difference; tumor differentiation; tumor localization; univariate analysis; blood; colorectal tumor; follow up; lymphocyte; metabolism; middle aged; neutrophil; procedures; prognosis, tumor marker, Aged; Biomarkers, Tumor; Colorectal Neoplasms; Female; Follow-Up Studies; Humans; Lymphocytes; Male; Middle Aged; Neoplasm Staging; Neutrophils; Prognosis; Retrospective Studies
