'Sestre Milosrdnice University Hospital Center (KBC Sestre milosrdnice)'
Doi
Abstract
Chronic inflammation has been linked with many cancers. It seems that easily available and usual blood inflammatory markers might serve as a prognostic factor for overall survival and disease-free survival in patients with various cancers. Preoperative neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), as well as hemoglobinemia, thrombocytosis, elevated C-reactive protein values, neutropenia and leukocytosis have been shown to affect overall survival and disease-free survival in patients with colorectal cancer (CRC), however, with controversial results. Complete blood count, NLR and PLR were determined in 71 patients with CRC (stages 3 and 4) after neoadjuvant chemo-radiotherapy and before surgery, treated at Hospital for Tumors in Zagreb. Statistical analysis included Mann-Whitney U test, Student’s t-test, univariate and multivariate analysis. The results of Mann-Whitney U test and Student’s t-test showed that neutrophil count (p=0.024), NLR (p=0.003) and PLR (p=0.007) correlated significantly with overall survival. However, there was no significant correlation of age, leukocyte, lymphocyte and platelet counts and hemoglobin values with overall survival of patients. Furthermore, the same tests showed that leukocyte (p=0.04), neutrophil (p=0.0014) and platelet (p=0.006) counts, NLR (p=0.0006) and PLR (p=0.0015), as well as hemoglobin values (p=0.028) correlated significantly with disease-free survival. The results of univariate analysis showed that unlike PLR, NLR correlated with overall survival and disease-free survival (p=0.0002), although the correlation of PLR and disease-free survival almost reached significance (p=0.059). Furthermore, the results of univariate analysis showed significant correlation of advanced pathological TNM stage with overall survival. There was no correlation of patient age and gender, tumor stage and neoadjuvant chemo-radiotherapy with overall survival and disease-free survival. The results of multivariate analysis showed that NLR (cut-off value 3.27) and advanced pathological TNM stage significantly correlated with disease-free survival but not with overall survival. It seems that NLR might be an accurate marker for overall survival and disease-free survival in CRC patients after neoadjuvant chemo-radiotherapy and before surgery.Kronična upala je povezana s mnogim karcinomima. Čini se da lako dostupni i uobičajeni upalni biljezi u serumu mogu biti prognostički čimbenik za ukupno preživljenje i razdoblje bez bolesti u bolesnika s različitim karcinomima. Prijeoperacijski odnos neutrofila i limfocita (NLR) te trombocita i limfocita (TLR), kao i hemoglobinemija, trombocitoza, neutropenija i leukocitoza su povezani s ukupnim preživljenjem i razdobljem bez bolesti u bolesnika s kolorektalnim karcinomom (KRK), doduše, s proturječnim rezultatima. Kompletna krvna slika, NLR i TLR su određeni u 71 bolesnika s KRK (stadij 3 i 4) nakon neoadjuvantne kemoradioterapije i prije kirurškog zahvata, koji su liječeni na Klinici za tumore u Zagrebu. Statistička analiza je uključivala Mann-Whitneyev U test, Studentov t-test, univarijatnu i multivarijatnu analizu. Rezultati Mann-Whitneyeva U testa i Studentova t-testa su pokazali da su broj neutrofila (p=0,024), NLR (p=0,003) i TLR (p=0,007) značajno povezani s ukupnim preživljenjem. Ipak, nije bilo značajne povezanosti između dobi, broja leukocita, limfocita i trombocita te hemoglobina s ukupnim preživljenjem bolesnika. Nadalje, isti testovi su pokazali da su broj leukocita (p=0,04), neutrofila (p=0,0014) i trombocita (p=0,006), NLR (p=0,0006) i TLR (p=0,0015), kao i hemoglobin (p=0,028) značajno povezani s razdobljem bez bolesti. Rezultati univarijatne analize su pokazali da, za razliku od TLR, NLR korelira s ukupnim preživljenjem i preživljenjem bez bolesti, iako je korelacija zamalo postignuta između TLR i razdoblja bez bolesti (p=0,059). Nije bilo povezanosti između bolesnikove dobi i spola, stadija tumora i neoadjuvantne kemoradioterapije s ukupnim preživljenjem i razdobljem bez bolesti. Rezultati multivarijatne analize su pokazali kako NLR (granična vrijednost 3,27) i uznapredovali patološki stadij TNM značajno koreliraju s preživljenjem bez bolesti za razliku od ukupnog preživljenja. Čini se da je NLR pouzdan biljeg ukupnog preživljenja kao i preživljenja bez bolesti u bolesnika s KRK nakon neoadjuvantne kemoradioterapije i prije kirurškog zahvata
