Prognostic Significance of Preoperative Lymphocyte-to-C-Reactive Protein Ratio in Patients with Non-Metastatic Colorectal Cancer
Received 4 November 2020
Accepted for publication 31 December 2020
Published 12 January 2021 Volume 2021:14 Pages 337—346
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Prof. Dr. Takuya Aoki
Wenting Ou,1 Caijin Zhou,2 Xiaoqing Zhu,2 Lin Lin,2 Qingwen Xu2
1Department of Oncology, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong 524001, People’s Republic of China; 2Department of Gastrointestinal Surgery, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong 524001, People’s Republic of China
Correspondence: Caijin Zhou
Department of Gastrointestinal Surgery, The Affiliated Hospital of Guangdong Medical University, No. 57, South of Renmin Avenue, Zhanjiang, Guangdong 524001, People’s Republic of China
Background: The inflammatory indexes are attracting increasing attention as a prognostic predictor for colorectal cancer (CRC). However, the prognostic value of the preoperative lymphocyte-to-C-reactive protein ratio (LCR) in patients with non-metastatic CRC remains to be established.
Methods: A total of 955 patients from 2010 to 2014 at a single center were included. Receiver operating characteristic curves (ROC) were generated to define the optimal cutoff value of the inflammatory indexes, and the areas under the curve (AUC) were calculated to compare the predictive value among the inflammatory indexes. The Fine and Gray competing risk regression model and Cox proportional hazard model were used to determine the prognostic factors for cancer-specific survival (CSS) and overall survival (OS) by using sub-distribution hazard ratio (SHR) and hazard ratio (HR) as size effects, respectively.
Results: A ratio of 6500 was defined as the optimal cutoff value for LCR for dividing CRC patients into the high (> 6500, n = 528) and low (≤ 6500, n = 427) LCR groups. The LCR had the highest value of prognostic prediction among all inflammation-based scores. Low LCR was significant correlated with several clinicopathological features of tumor invasion and development. The patients with low LCR had poorer CSS and OS as compared to those with high LCR. Multivariate analyses showed that low LCR was independently associated with worse OS (HR = 0.61, 95% CI: 0.53– 0.70) and CSS (SHR = 0.55, 95% CI: 0.43– 0.71).
Conclusion: Preoperative LCR can be a useful biomarker for prognostic prediction in non-metastatic CRC patients with a better predictive value than other inflammatory indexes.
Keywords: lymphocyte-to-C-reactive protein ratio, colorectal cancer, prognosis, competing risk model