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Potential Diagnostic Value Of Combining Inflammatory Cell Ratios With Carcinoembryonic Antigen For Colorectal Cancer

Authors Li X, Guo D, Chu L, Huang Y, Zhang F, Li W, Chen J

Received 11 July 2019

Accepted for publication 21 October 2019

Published 14 November 2019 Volume 2019:11 Pages 9631—9640

DOI https://doi.org/10.2147/CMAR.S222756

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Melinda Thomas

Peer reviewer comments 2

Editor who approved publication: Dr Teng


Xinxin Li,1,* Dongming Guo,1,* Lingyu Chu,2 Yiteng Huang,3 Feiran Zhang,1 Wei Li,1 Juntian Chen1

1Department of Gastrointestinal Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, People’s Republic of China; 2Department of Biochemistry and Molecular Biology, Shantou University Medical College, Shantou, People’s Republic of China; 3Department of Health Care Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Juntian Chen
Department of Gastrointestinal Surgery, The First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou 515041, Guangdong Province, People’s Republic of China
Tel/Fax +86 754 8890 5256
Email 13809846668@163.com

Purpose: To evaluate the diagnostic value of combining the neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR) or lymphocyte–monocyte ratio (LMR) with carcinoembryonic antigen (CEA) in patients with colorectal cancer (CRC).
Patients and methods: The diagnostic performance of inflammatory makers and CEA was evaluated in cohort 1 (664 patients with CRC, 336 patients with colorectal polyps and 664 healthy controls) and validated in cohort 2 (87 patients with CRC and 87 healthy controls) by using receiver operating characteristic curve analysis.
Results: In cohort 1, the NLR, PLR and CEA levels were significantly higher, while the LMR was markedly lower in patients with CRC than in healthy controls. The PLR and LMR were significantly associated with invasion depth and lymph node metastasis. Moreover, significant differences in the PLR and LMR were observed between patients with stage I/II CRC and healthy or polyp controls and those with stage III/IV CRC. Using the NLR, PLR or LMR with CEA resulted in a significantly larger area under the curve (AUC) than any of them used alone. Combining the PLR and LMR with CEA exhibited the best diagnostic value for CRC (AUC=0.892). The AUCs of this combination were 0.864 and 0.783 for distinguishing stage I/II CRC from healthy and polyp controls, respectively. When we used the same cut-off values to assess the diagnostic ability of these markers in cohort 2, similar results were observed, and the PLR, LMR and CEA combination also showed the highest accuracy (AUC=0.936).
Conclusion: Combining inflammatory cell ratios with CEA could improve the diagnostic efficacy for CRC patients. The combination of the PLR and LMR with CEA might be a valuable indicator in the early detection and monitoring of CRC patients.

Keywords: colorectal cancer, neutrophil–lymphocyte ratio, platelet–lymphocyte ratio, lymphocyte–monocyte ratio, carcinoembryonic antigen, diagnosis

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