Significance of inflammation-based indices in the prognosis of patients with non-metastatic colorectal cancer

// Xiangping Song 1 , Hong Zhu 2 , Qian Pei 1 , Fengbo Tan 1 , Chenglong Li 1 , Zhongyi Zhou 1 , Yuan Zhou 1 , Nanhui Yu 1 , Yuqiang Li 1 , Haiping Pei 1 1 Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha, China 2 Department of Oncology, Xiangya Hospital, Central South University, Changsha, China Correspondence to: Haiping Pei, email: peihaiping1966@hotmail.com Keywords: colorectal cancer, prognostic factors, inflammation, survival, coNLR-PDW Received: January 17, 2017      Accepted: March 21, 2017      Published: April 01, 2017 ABSTRACT Previous studies demonstrated that several inflammation-based hematological indices are closely related to various malignancies, including colorectal cancer (CRC). In this study, the prognostic value of inflammation-based markers, including a combination index termed coNLR-PDW, comprising the preoperative neutrophil-to-lymphocyte ratio (NLR) and the platelet distribution width (PDW), was evaluated in 206 patients with non-metastatic CRC treated with surgery at a single medical center. The association of patient demographics, blood chemistry, and serum biochemical indices with recurrence-free survival (RFS) and overall survival (OS) were examined through univariate and multivariate analysis. Receiver operating characteristic curve analysis revealed the optimal cut-off values of the NLR and lymphocyte-to-monocyte ratio (LMR) to be, respectively, 2.0 and 3.32 for both RFS and OS. For PDW, cut-off values of 17.25% and 17.35% were defined for RFS and OS, respectively. On univariate analysis, lymph node involvement, stage, presence of intravascular emboli (IVE), carbohydrate antigen 199 (CA199) ≥ 35 kU/L, NLR ≥ 2.0, LMR ≤ 3.32, elevated PDW, a high coNLR-PDW score, high blood glucose, and high neutrophil and lymphocyte percentages correlated with poorer RFS and OS ( P < 0.05). On multivariate analysis, lymph node involvement, IVE, CA199, PDW, and coNLR-PDW correlated with both RFS and OS ( P < 0.05), while NLR correlated only with OS ( P = 0.001). These results highlight the usefulness of the coNLR-PDW index as a prognostic marker of non-metastatic CRC outcome. In clinical practice, its assessment could contribute to establishing more personalized regimes for patients undergoing tumor resection surgery.