Higher Levels of Pre-operative Peripheral Lymphocyte Count Is a Favorable Prognostic Factor for Patients With Stage I and II Rectal Cancer

Ying-Ying Zhang, Wan-Qing Li, Zhen-Fa Li, Xiao-Hua Guo, Shen-Kang Zhou, Aifen Lin, Wei-Hua Yan, Ying-Ying Zhang, Wan-Qing Li, Zhen-Fa Li, Xiao-Hua Guo, Shen-Kang Zhou, Aifen Lin, Wei-Hua Yan

Abstract

The clinical significance of peripheral blood parameters has been considered to be a potential prognostic indicator for malignancies. In this study, 224 colorectal cancer (CRC; ncolon = 103; nrectal = 121) patients who underwent resection were enrolled, and the pre- and post-operative clinical laboratory data within 1 week, before and after surgery, were collected. The prognostic value of the counts of white blood cell (WBC), neutrophil, lymphocyte and platelet, the neutrophil to lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) were analyzed. Data revealed that pre-operative lymphocyte count (pre-LC) was much higher than that of post-LC (p < 0.001), and only rectal cancer patients with pre-LChigh (>median: 1.61 × 109/L) had a significantly better overall survival (OS) and 5-year survival rate (SR) than those with pre-LClow (OS: 62.3 vs. 49.5 months; SR: 74.0 vs. 43.0%; p = 0.006). Cox's proportional hazard models revealed that pre-LChigh was an independent, favorable prognostic factor for rectal cancer patients (hazard ratio = 0.348; p = 0.003). Moreover, when the disease stages were stratified, the pre-LChigh was significantly associated with better prognosis of rectal cancer patients with stage I + II rectal cancer (n = 65; OS: 67.5 vs. 54.3 months; p = 0.011). Taken together, our study revealed that pre-operative lymphocyte count is an independent prognostic factor for patients with stage I and II rectal cancer.

Keywords: biomarker; blood lymphocyte count; colorectal cancer; prognosis; survival.

Copyright © 2019 Zhang, Li, Li, Guo, Zhou, Lin and Yan.

Figures

Figure 1
Figure 1
Kaplan-Meier survival analysis between the high and low levels of pre- and post-operation peripheral lymphocyte count (LC) in CRC patients. (A) Comparison of overall survival between pre-LChigh and pre-LClow among CRC patients. (B) Comparison of overall survival between post-LChigh and post-LClow among CRC patients.
Figure 2
Figure 2
Kaplan-Meier survival analysis of the high and low levels of pre-operation peripheral lymphocyte count in different disease stage of CRC patients. Comparison of overall survival between pre-LChigh and pre-LClow among CRC patients with disease stage I + II (A) and disease stage III + IV (B).
Figure 3
Figure 3
Kaplan-Meier survival analysis of the high and low levels of pre-operation peripheral lymphocyte count in rectal and colon cancer patients with AJCC I + II and III + IV disease stages. Comparison of overall survival between pre-LChigh and pre-LClow among patients with rectal cancer (A); colon cancer (B); rectal cancer patients with disease stage I + II (C) and III + IV (E); colon cancer patients with disease stage I + II (D) and III + IV (F).

References

    1. Upadhyay S, Sharma N, Gupta KB, Dhiman M. Role of immune system in tumor progression and carcinogenesis. J Cell Biochem. (2018) 119:5028–42. 10.1002/jcb.26663
    1. Templeton AJ, McNamara MG, Seruga B, Vera-Badillo FE, Aneja P, Ocana A, et al. . Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. (2014) 106:dju124. 10.1093/jnci/dju124
    1. Menetrier-Caux C, Ray-Coquard I, Blay JY, Caux C. Lymphopenia in cancer patients and its effects on response to immunotherapy: an opportunity for combination with Cytokines? J Immunother Cancer. (2019) 7:85. 10.1186/s40425-019-0549-5
    1. Mei Z, Shi L, Wang B, Yang J, Xiao Z, Du P, et al. . Prognostic role of pretreatment blood neutrophil-to-lymphocyte ratio in advanced cancer survivors: a systematic review and meta-analysis of 66 cohort studies. Cancer Treat Rev. (2017) 58:1–13. 10.1016/j.ctrv.2017.05.005
    1. Zhang Y, Lin S, Yang X, Wang R, Luo L. Prognostic value of pretreatment systemic immune-inflammation index in patients with gastrointestinal cancers. J Cell Physiol. (2019) 234:5555–63. 10.1002/jcp.27373
    1. Dupre A, Malik HZ. Inflammation and cancer: what a surgical oncologist should know. Eur J Surg Oncol. (2018) 44:566–70. 10.1016/j.ejso.2018.02.209
    1. Buccafusca G, Proserpio I, Tralongo AC, Rametta Giuliano S, Tralongo P. Early colorectal cancer: diagnosis, treatment and survivorship care. Crit Rev Oncol Hematol. (2019) 136:20–30. 10.1016/j.critrevonc.2019.01.023
    1. Mercier J, Voutsadakis IA. The platelets-neutrophils to lymphocytes ratio: a new prognostic marker in metastatic colorectal cancer. J Gastrointest Oncol. (2018) 9:478–86. 10.21037/jgo.2018.03.13
    1. Li MX, Liu XM, Zhang XF, Zhang JF, Wang WL, Zhu Y, et al. . Prognostic role of neutrophil-to-lymphocyte ratio in colorectal cancer: a systematic review and meta-analysis. Int J Cancer. (2014) 134:2403–13. 10.1002/ijc.28536
    1. Lam M, Roszik J, Kanikarla-Marie P, Davis JS, Morris J, Kopetz S, et al. . The potential role of platelets in the consensus molecular subtypes of colorectal cancer. Cancer Metastasis Rev. (2017) 36:273–88. 10.1007/s10555-017-9678-9
    1. Rossi S, Basso M, Strippoli A, Schinzari G, D'Argento E, Larocca M, et al. . Are markers of systemic inflammation good prognostic indicators in colorectal cancer? Clin Colorectal Cancer. (2017) 16:264–74. 10.1016/j.clcc.2017.03.015
    1. Song A, Eo W, Lee S. Comparison of selected inflammation-based prognostic markers in relapsed or refractory metastatic colorectal cancer patients. World J Gastroenterol. (2015) 21:12410–20. 10.3748/wjg.v21.i43.12410
    1. Ozawa T, Ishihara S, Nishikawa T, Tanaka T, Tanaka J, Kiyomatsu T, et al. . The preoperative platelet to lymphocyte ratio is a prognostic marker in patients with stage II colorectal cancer. Int J Colorectal Dis. (2015) 30:1165–71. 10.1007/s00384-015-2276-9
    1. He W, Yin C, Guo G, Jiang C, Wang F, Qiu H, et al. . Initial neutrophil lymphocyte ratio is superior to platelet lymphocyte ratio as an adverse prognostic and predictive factor in metastatic colorectal cancer. Med Oncol. (2013) 30:439. 10.1007/s12032-012-0439-x
    1. Dimitriou N, Felekouras E, Karavokyros I, Alexandrou A, Pikoulis E, Griniatsos J. Neutrophils to lymphocytes ratio as a useful prognosticator for stage II colorectal cancer patients. BMC Cancer. (2018) 18:1202. 10.1186/s12885-018-5042-x
    1. Li Y, Jia H, Yu W, Xu Y, Li X, Li Q, et al. . Nomograms for predicting prognostic value of inflammatory biomarkers in colorectal cancer patients after radical resection. Int J Cancer. (2016) 139:220–31. 10.1002/ijc.30071
    1. Chen JH, Zhai ET, Yuan YJ, Wu KM, Xu JB, Peng JJ, et al. . Systemic immune-inflammation index for predicting prognosis of colorectal cancer. World J Gastroenterol. (2017) 23:6261–72. 10.3748/wjg.v23.i34.6261
    1. Peng F, Hu D, Lin X, Chen G, Liang B, Li C, et al. . The monocyte to red blood cell count ratio is a strong predictor of postoperative survival in colorectal cancer patients: the Fujian prospective investigation of cancer (FIESTA) study. J Cancer. (2017) 8:967–75. 10.7150/jca.18000
    1. Yamamoto M, Saito H, Uejima C, Tanio A, Takaya S, Ashida K, et al. Combined pre- and postoperative lymphocyte count accurately predicts outcomes of patients with colorectal cancer. Dig Surg. (2018) 14:1–8. 10.1159/000492340
    1. Liang L, Zhu J, Jia H, Huang L, Li D, Li Q, et al. . Predictive value of pretreatment lymphocyte count in stage II colorectal cancer and in high-risk patients treated with adjuvant chemotherapy. Oncotarget. (2016) 7:1014–28. 10.18632/oncotarget.5835
    1. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. (2010) 17:1471–4. 10.1245/s10434-010-0985-4
    1. Jomrich G, Gruber ES, Winkler D, Hollenstein M, Gnant M, Sahora K, et al. . Systemic Immune-Inflammation Index (SII) predicts poor survival in pancreatic cancer patients undergoing resection. J Gastrointest Surg. (2019). [Epub ahead of print]. 10.1007/s11605-019-04187-z
    1. Pedrazzani C, Mantovani G, Fernandes E, Bagante F, Luca Salvagno G, Surci N, et al. . Assessment of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and platelet count as predictors of long-term outcome after R0 resection for colorectal cancer. Sci Rep. (2017) 7:1494. 10.1038/s41598-017-01652-0
    1. Kim HS, Ku JH. Systemic inflammatory response based on neutrophil-to-lymphocyte ratio as a prognostic marker in bladder cancer. Dis Markers. (2016) 2016:8345286. 10.1155/2016/8345286
    1. Roxburgh CS, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future Oncol. (2010) 6:149–63. 10.2217/fon.09.136
    1. Yang J, Guo X, Wu T, Niu K, Ma X. Prognostic significance of inflammation-based indexes in patients with stage III/IV colorectal cancer after adjuvant chemoradiotherapy. Medicine (Baltimore). (2019) 98:e14420. 10.1097/MD.0000000000014420
    1. He WZ, Hu WM, Kong PF, Yang L, Yang YZ, Xie QK, et al. . Systemic neutrophil lymphocyte ratio and mismatch repair status in colorectal cancer patients: correlation and prognostic value. J Cancer. (2018) 9:3093–100. 10.7150/jca.26669
    1. Wei Y, Zhang X, Wang G, Zhou Y, Luo M, Wang S, et al. . The impacts of pretreatment circulating eosinophils and basophils on prognosis of stage - colorectal cancer. Asia Pac J Clin Oncol. (2018) 14:e243–51. 10.1111/ajco.12871
    1. Zou ZY, Liu HL, Ning N, Li SY, Du XH, Li R. Clinical significance of pre-operative neutrophil lymphocyte ratio and platelet lymphocyte ratio as prognostic factors for patients with colorectal cancer. Oncol Lett. (2016) 11:2241–8. 10.3892/ol.2016.4216
    1. Kubo H, Murayama Y, Arita T, Kuriu Y, Nakanishi M, Otsuji E. The prognostic value of preoperative neutrophil-to-lymphocyte ratio in colorectal cancer. World J Surg. (2016) 40:2796–802. 10.1007/s00268-016-3595-x
    1. Iseki Y, Shibutani M, Maeda K, Nagahara H, Tamura T, Ohira G, et al. . The impact of the preoperative peripheral lymphocyte count and lymphocyte percentage in patients with colorectal cancer. Surg Today. (2017) 47:743–54. 10.1007/s00595-016-1433-2
    1. Shibutani M, Maeda K, Nagahara H, Iseki Y, Ikeya T, Hirakawa K. Prognostic significance of the preoperative lymphocyte-to-monocyte ratio in patients with colorectal cancer. Oncol Lett. (2017) 13:1000–6. 10.3892/ol.2016.5487
    1. Solak Mekić M, Pedišić I, Šobat H, Vučićević Boras V, Kirac I, Štefančić L, et al. The role of complete blood count parameters in patients with colorectal cancer. Acta Clin Croat. (2018) 57:624–9. 10.20471/acc.2018.57.04.03
    1. Saroha S, Uzzo RG, Plimack ER, Ruth K, Al-Saleem T. Lymphopenia is an independent predictor of inferior outcome in clear cell renal carcinoma. J Urol. (2013) 189:454–61. 10.1016/j.juro.2012.09.166
    1. Kozak MM, von Eyben R, Pai JS, Anderson EM, Welton ML, Shelton AA, et al. . The prognostic significance of pretreatment hematologic parameters in patients undergoing resection for colorectal cancer. Am J Clin Oncol. (2017) 40:405–12. 10.1097/COC.0000000000000183
    1. Haram A, Boland MR, Kelly ME, Bolger JC, Waldron RM, Kerin MJ. The prognostic value of neutrophil-to-lymphocyte ratio in colorectal cancer: a systematic review. J Surg Oncol. (2017) 115:470–9. 10.1002/jso.24523
    1. Cha YJ, Park EJ, Baik SH, Lee KY, Kang J. Clinical significance of tumor-infiltrating lymphocytes and neutrophil-to-lymphocyte ratio in patients with stage III colon cancer who underwent surgery followed by FOLFOX chemotherapy. Sci Rep. (2019) 9:11617. 10.1038/s41598-019-48140-1

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir