The prognostic significance of inflammation-based scores in patients with ampullary carcinoma after pancreaticoduodenectomy

Abstract Background Growing evidence indicates that systemic inflammatory response plays an important role in cancer development and progression. Several inflammatory markers have been reported to be associated with the clinical outcomes in patients with various types of cancer. This study was designed to evaluate the prognostic value of the inflammatory indexes in patients suffering from ampullary cancer (AC) who underwent pancreaticoduodenectomy (PD). Methods We retrospectively reviewed a database of 358 patients with AC who underwent PD between 2009 and 2018. R software was used to compare the area under the time-dependent receiver operating characteristic (ROC) curves (AUROCs) of the inflammation-based indexes, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), modified Glasgow Prognostic Score (mGPS), prognostic nutritional index (PNI) and prognostic index (PI), in terms of their predictive value of survival. The survival differences of these indexes were compared by Kaplan-Meier method and univariate and multivariate analyses were performed to determine the prognostic factors of progress-free survival (PFS) and overall survival (OS). Results The estimated 1-, 2-, and 3-year OS and PFS rates were 83.9%, 65.8%, 55.2% and 58.0%, 42.8%, 37.8%, respectively, for the entire cohort. The survival differences were significant in terms of OS and PFS when they were stratified by these inflammation-based indexes. The comparisons of AUROCs of these inflammation-based indexes illustrated that NLR and PI displayed highest prognostic value, compared to other indexes. When NLR and PI were combined, NLR-PI showed even higher AUROC values and was identified as a significant prognostic factor in terms of OS and PFS. Conclusion Specific inflammatory indexes, such as NLR, PLR and PI, were found to be able to predict the OS or PFS of patients. As a novel inflammatory index, the level of NLR-PI, which can be regarded as a more useful prognostic index, exhibited strong predictive power for predicting prognosis of patients with AC after PD procedure.

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The prognostic significance of inflammation-based scores in patients with ampullary carcinoma after pancreaticoduodenectomy

10.21203/rs.3.rs-23444/v1 ◽

2020 ◽

Author(s):

Shuxin Sun ◽

Chaobin He ◽

Jun Wang ◽

Xin Huang ◽

Jiali Wu ◽

...

Keyword(s):

Prognostic Value ◽

Prognostic Score ◽

Prognostic Significance ◽

Prognostic Index ◽

Glasgow Prognostic Score ◽

Prognostic Nutritional Index ◽

Significant Prognostic Factor ◽

Entire Cohort ◽

Lymphocyte Ratio ◽

Survival Differences

Abstract Background: Growing evidence indicates that systemic inflammatory response plays an important role in cancer development and progression. Several inflammatory markers have been reported to be associated with the clinical outcomes in patients with various types of cancer. This study was designed to evaluate the prognostic value of the inflammatory indexes in patients suffering from ampullary cancer (AC) who underwent pancreaticoduodenectomy (PD).Methods:We retrospectively reviewed a database of 358 patients with AC who underwent PD between 2009 and 2018. R software was used to compare the area under the time-dependent receiver operating characteristic (ROC) curves (AUROCs) of the inflammation-based indexes, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), modified Glasgow Prognostic Score (mGPS), prognostic nutritional index (PNI) and prognostic index (PI), in terms of their predictive value of survival. The survival differences of these indexes were compared by Kaplan-Meier method and univariate and multivariate analyses were performed to determine the prognostic factors of progress-free survival (PFS) and overall survival (OS).Results:The estimated 1-, 2-, and 3-year OS and PFS rates were 83.9%, 65.8%, 55.2% and 58.0%, 42.8%, 37.8%, respectively, for the entire cohort. The survival differences were significant in terms of OS and PFS when they were stratified by these inflammation-based indexes. The comparisons of AUROCs of these inflammation-based indexes illustrated that NLR and PI displayed highest prognostic value, compared to other indexes. When NLR and PI were combined, NLR-PI showed even higher AUROC values and was identified as a significant prognostic factor in terms of OS and PFS.Conclusion:Specific inflammatory indexes, such as NLR, PLR and PI, were found to be able to predict the OS or PFS of patients. As a novel inflammatory index, the level of NLR-PI, which can be regarded as a more useful prognostic index, exhibited strong predictive power for predicting prognosis of patients with AC after PD procedure.

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The prognostic significance of inflammation-based scores in patients with ampullary carcinoma after pancreaticoduodenectomy

BMC Cancer ◽

10.1186/s12885-020-07482-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Shuxin Sun ◽

Chaobin He ◽

Jun Wang ◽

Xin Huang ◽

Jiali Wu ◽

...

Keyword(s):

Prognostic Value ◽

Prognostic Score ◽

Prognostic Significance ◽

Prognostic Index ◽

Glasgow Prognostic Score ◽

Disease Free Survival ◽

Significant Prognostic Factor ◽

Entire Cohort ◽

Lymphocyte Ratio ◽

Survival Differences

Abstract Background Growing evidence indicates that the systemic inflammatory response plays an important role in cancer development and progression. Several inflammatory markers have been reported to be associated with clinical outcomes in patients with various types of cancer. This study was designed to evaluate the prognostic value of inflammatory indexes in patients with ampullary cancer (AC) who underwent pancreaticoduodenectomy (PD). Methods We retrospectively reviewed the data of 358 patients with AC who underwent PD between 2009 and 2018. R software was used to compare the area under the time-dependent receiver operating characteristic (ROC) curves (AUROCs) of the inflammation-based indexes, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), modified Glasgow Prognostic Score (mGPS), prognostic nutritional index (PNI) and prognostic index (PI), in terms of their predictive value for survival. The survival differences of these indexes were compared by the Kaplan-Meier method and univariate and multivariate analyses were performed to determine the prognostic factors of disease-free survival (DFS) and overall survival (OS). Results The estimated 1-, 2-, and 3-year OS and DFS rates were 83.9, 65.8, and 55.2% and 58.0, 42.8, and 37.8%, respectively, for the entire cohort. The survival differences were significant in terms of OS and DFS when patients were stratified by these inflammation-based indexes. The comparisons of the AUROCs of these inflammation-based indexes illustrated that NLR and PI displayed the highest prognostic value, compared to the other indexes. When NLR and PI were combined, NLR-PI showed even higher AUROC values and was identified as a significant prognostic factor for OS and DFS. Conclusion Specific inflammatory indexes, such as NLR, PLR and dNLR, were found to be able to predict the OS or DFS of patients. As a novel inflammatory index, the level of NLR-PI, which can be regarded as a more useful prognostic index, exhibited strong predictive power for predicting the prognosis of patients with AC after the PD procedure.

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The prognostic significance of inflammation-based scores in patients with ampullary carcinoma after pancreaticoduodenectomy

10.21203/rs.3.rs-23444/v3 ◽

2020 ◽

Author(s):

Shuxin Sun ◽

Chaobin He ◽

Jun Wang ◽

Xin Huang ◽

Jiali Wu ◽

...

Keyword(s):

Prognostic Value ◽

Prognostic Score ◽

Prognostic Significance ◽

Prognostic Index ◽

Glasgow Prognostic Score ◽

Disease Free Survival ◽

Significant Prognostic Factor ◽

Entire Cohort ◽

Lymphocyte Ratio ◽

Survival Differences

Abstract Background: Growing evidence indicates that the systemic inflammatory response plays an important role in cancer development and progression. Several inflammatory markers have been reported to be associated with clinical outcomes in patients with various types of cancer. This study was designed to evaluate the prognostic value of inflammatory indexes in patients with ampullary cancer (AC) who underwent pancreaticoduodenectomy (PD).Methods:We retrospectively reviewed the data of 358 patients with AC who underwent PD between 2009 and 2018. R software was used to compare the area under the time-dependent receiver operating characteristic (ROC) curves (AUROCs) of the inflammation-based indexes, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), modified Glasgow Prognostic Score (mGPS), prognostic nutritional index (PNI) and prognostic index (PI), in terms of their predictive value for survival. The survival differences of these indexes were compared by the Kaplan-Meier method and univariate and multivariate analyses were performed to determine the prognostic factors of disease-free survival (DFS) and overall survival (OS).Results:The estimated 1-, 2-, and 3-year OS and DFS rates were 83.9%, 65.8%, and 55.2% and 58.0%, 42.8%, and 37.8%, respectively, for the entire cohort. The survival differences were significant in terms of OS and DFS when patients were stratified by these inflammation-based indexes. The comparisons of the AUROCs of these inflammation-based indexes illustrated that NLR and PI displayed the highest prognostic value, compared to the other indexes. When NLR and PI were combined, NLR-PI showed even higher AUROC values and was identified as a significant prognostic factor for OS and DFS.Conclusion:Specific inflammatory indexes, such as NLR, PLR and dNLR, were found to be able to predict the OS or DFS of patients. As a novel inflammatory index, the level of NLR-PI, which can be regarded as a more useful prognostic index, exhibited strong predictive power for predicting the prognosis of patients with AC after the PD procedure.

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Role of Inflammatory and Immune-Nutritional Prognostic Markers in Patients Undergoing Surgical Resection for Biliary Tract Cancers

Cancers ◽

10.3390/cancers13143594 ◽

2021 ◽

Vol 13 (14) ◽

pp. 3594

Author(s):

Simone Conci ◽

Tommaso Campagnaro ◽

Elisa Danese ◽

Ezio Lombardo ◽

Giulia Isa ◽

...

Keyword(s):

Biliary Tract ◽

Cox Regression ◽

Prognostic Score ◽

Prognostic Index ◽

Glasgow Prognostic Score ◽

Postoperative Mortality ◽

Prognostic Nutritional Index ◽

Term Survival ◽

Lymphocyte Ratio

The relationship between immune-nutritional status and tumor growth; biological aggressiveness and survival, is still debated. Therefore, this study aimed to evaluate the prognostic performance of different inflammatory and immune-nutritional markers in patients who underwent surgery for biliary tract cancer (BTC). The prognostic role of the following inflammatory and immune-nutritional markers were investigated: Glasgow Prognostic Score (GPS), modified Glasgow Prognostic Score (mGPS), Prognostic Index (PI), Neutrophil to Lymphocyte ratio (NLR), Platelet to Lymphocyte ratio (PLR), Lymphocyte to Monocyte ratio (LMR), Prognostic Nutritional Index (PNI). A total of 282 patients undergoing surgery for BTC were included. According to Cox regression and ROC curves analysis for survival, LMR had the best prognostic performances, with hazard ratio (HR) of 1.656 (p = 0.005) and AUC of 0.652. Multivariable survival analysis identified the following independent prognostic factors: type of BTC (p = 0.002), T stage (p = 0.014), N stage (p < 0.001), histological grading (p = 0.045), and LMR (p = 0.025). Conversely, PNI was related to higher risk of severe morbidity (p < 0.001) and postoperative mortality (p = 0.005). In conclusion, LMR appears an independent prognostic factor of long-term survival, whilst PNI seems associated with worse short-term outcomes.

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Systemic Inflammatory Markers for Predicting Overall Survival in Patients with Osteosarcoma: A Systematic Review and Meta-Analysis

Mediators of Inflammation ◽

10.1155/2021/3456629 ◽

2021 ◽

Vol 2021 ◽

pp. 1-16

Author(s):

Xiaotong Song ◽

Hao Zhang ◽

Fanxing Yin ◽

Panpan Guo ◽

Xiaocheng Yang ◽

...

Keyword(s):

Systematic Review ◽

Overall Survival ◽

Inflammatory Markers ◽

Prognostic Value ◽

Meta Analysis ◽

Prognostic Score ◽

Prognostic Significance ◽

Glasgow Prognostic Score ◽

Lymphocyte Ratio ◽

Lymphocyte To Monocyte Ratio

Background. Inflammatory markers are associated with tumor genesis and progression, but their prognostic significance in osteosarcoma remains unclear. Therefore, we discussed the prognostic value of related inflammatory markers in osteosarcoma through a meta-analysis and systematic review. These inflammatory markers include C-reactive protein (CRP), neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), platelet to lymphocyte ratio (PLR), and Glasgow prognostic score (GPS). Methods. The Chinese National Knowledge Infrastructure (CNKI), Wanfang, Chinese Scientific Journals (VIP), PubMed, Embase, and Cochrane libraries were searched. The design of meta-analysis was made based on the PICOS (population, intervention/exposure, control, outcomes, and study design) principles, and STATA 15.1 was used to analyze the data. The Newcastle-Ottawa scale (NOS) was used to assess the quality of included studies. Hazard ratios (HRs) for overall survival (OS) and disease-specific survival (DPS) were extracted for the investigation of the prognostic value of inflammatory markers. Results. Twelve researches with 2162 osteosarcoma patients were included in total. The pooled results showed that elevated NLR, CRP, and GPS are all greatly related to shortening of OS among patients with osteosarcoma ( HR = 1.68 , P = 0.007 , 95% CI: 1.15-2.45; HR = 1.96 , P = 0.002 , 95% CI: 1.28-3.00; HR = 2.54 , P < 0.0001 , 95% CI: 1.95-3.31, respectively), and CRP level is significantly associated with shortening of DPS among patients with osteosarcoma ( HR = 2.76 , 95% CI:2.01-3.80, P < 0.0001 ), additionally. However, the correlation between LMR or PLR and the prognosis of osteosarcoma is not statistically significant ( HR = 0.60 , 95% CI: 0.30-1.18, P = 0.138 ; HR = 1.13 , 95% CI: 0.85-1.49, P = 0.405 , respectively). The outcomes of subgroup analysis to NLR and CRP suggested that histology, ethnicity, metastasis, and sample size all have an impact on its prognosis of patients with osteosarcoma. Conclusion. Worsened prognosis may be related to high levels of NLR, CRP, and GPS before treatment rather than LMR or PLR, which can provide the basis for clinicians to judge the outcomes of prognosis. Trial Registration. PROSPERO (CRD42021249954), https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=249954.

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Systemic pro-inflammatory response identifies patients with cancer with adverse outcomes from SARS-CoV-2 infection: the OnCovid Inflammatory Score

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2020-002277 ◽

2021 ◽

Vol 9 (3) ◽

pp. e002277 ◽

Cited By ~ 1

Author(s):

Gino M Dettorre ◽

Saoirse Dolly ◽

Angela Loizidou ◽

John Chester ◽

Amanda Jackson ◽

...

Keyword(s):

Inflammatory Response ◽

Cancer Progression ◽

Systemic Inflammation ◽

Prognostic Score ◽

Prognostic Index ◽

Glasgow Prognostic Score ◽

Prognostic Nutritional Index ◽

Adverse Outcomes ◽

Patients With Cancer ◽

Inflammatory Score

BackgroundPatients with cancer are particularly susceptible to SARS-CoV-2 infection. The systemic inflammatory response is a pathogenic mechanism shared by cancer progression and COVID-19. We investigated systemic inflammation as a driver of severity and mortality from COVID-19, evaluating the prognostic role of commonly used inflammatory indices in SARS-CoV-2-infected patients with cancer accrued to the OnCovid study.MethodsIn a multicenter cohort of SARS-CoV-2-infected patients with cancer in Europe, we evaluated dynamic changes in neutrophil:lymphocyte ratio (NLR); platelet:lymphocyte ratio (PLR); Prognostic Nutritional Index (PNI), renamed the OnCovid Inflammatory Score (OIS); modified Glasgow Prognostic Score (mGPS); and Prognostic Index (PI) in relation to oncological and COVID-19 infection features, testing their prognostic potential in independent training (n=529) and validation (n=542) sets.ResultsWe evaluated 1071 eligible patients, of which 625 (58.3%) were men, and 420 were patients with malignancy in advanced stage (39.2%), most commonly genitourinary (n=216, 20.2%). 844 (78.8%) had ≥1 comorbidity and 754 (70.4%) had ≥1 COVID-19 complication. NLR, OIS, and mGPS worsened at COVID-19 diagnosis compared with pre-COVID-19 measurement (p<0.01), recovering in survivors to pre-COVID-19 levels. Patients in poorer risk categories for each index except the PLR exhibited higher mortality rates (p<0.001) and shorter median overall survival in the training and validation sets (p<0.01). Multivariable analyses revealed the OIS to be most independently predictive of survival (validation set HR 2.48, 95% CI 1.47 to 4.20, p=0.001; adjusted concordance index score 0.611).ConclusionsSystemic inflammation is a validated prognostic domain in SARS-CoV-2-infected patients with cancer and can be used as a bedside predictor of adverse outcome. Lymphocytopenia and hypoalbuminemia as computed by the OIS are independently predictive of severe COVID-19, supporting their use for risk stratification. Reversal of the COVID-19-induced proinflammatory state is a putative therapeutic strategy in patients with cancer.

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The prognostic value of modified Glasgow Prognostic Score in pancreatic cancer: a meta-analysis

Cancer Cell International ◽

10.1186/s12935-020-01558-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Huan Zhang ◽

Dianyun Ren ◽

Xin Jin ◽

Heshui Wu

Keyword(s):

Pancreatic Cancer ◽

Prognostic Value ◽

Close Association ◽

Meta Analysis ◽

Prognostic Score ◽

Prognostic Significance ◽

Glasgow Prognostic Score ◽

Cochrane Library ◽

Modified Glasgow Prognostic Score ◽

High Level

Abstract Background Several studies were conducted to explore the prognostic value of modified Glasgow Prognostic Score (mGPS) in pancreatic cancer, which reported contradictory results. The purpose of this meta-analysis was to summarize and further investigate the correlation between mGPS and overall survival (OS) in pancreatic cancer. Methods A systematic literature search was performed in PubMed, EMBASE, ISI Web of Science, Cochrane library databases and OVID to identify eligible studies published from Jan 1, 2011 to June 20, 2020. Pooled hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) were used to detect the prognostic significance of mGPS in patients with pancreatic cancer. Results A total of 222 non-repetitive studies were identified, and 20 related studies that explored the association between survival outcomes and mGPS in pancreatic cancer patients were finally enrolled in this meta-analysis. The results showed a significant correlation between high level of mGPS and poor OS (HR = 1.50, 95% CI 1.20–1.89, P < 0.0001). Similar results were observed in the subgroup analyses based on the treatment regimen and research region. Conclusions Our study suggested the close association between poor prognosis and high level of mGPS, which will be helpful for future clinical applications in patients with pancreatic cancer.

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Systemic inflammatory response in predicting survival in patients with operable colorectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.456 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 456-456 ◽

Cited By ~ 1

Author(s):

K. A. Kwon ◽

S. Oh ◽

S. Kim ◽

S. Lee ◽

J. Han ◽

...

Keyword(s):

Colorectal Cancer ◽

Inflammatory Response ◽

Survival Data ◽

Prognostic Score ◽

Prognostic Significance ◽

Prognostic Index ◽

Scoring Systems ◽

Systemic Inflammatory Response ◽

Lymphocyte Ratio

456 Background: Several inflammatory response materials could be biomarkers for prediction of prognosis of cancer patients; elevated C-reactive protein (CRP), increased white cell, neutrophil, platelet, and decreased albumin. The Glasgow Prognostic Score (GPS) combines circulating CRP and albumin level, the neutrophil/lymphocyte ratio (NLR), and the platelet/lymphocyte ratio (PLR) has been introduced for prognostic scoring system in colorectal cancer (CRC). Thus, in this study, we attempted to identify an more adequate prognostic model related with systemic inflammatory response for CRC. Methods: Between Mar 2005 and Dec 2008, 200 patients who underwent curative resection for colorectal cancer were enrolled in this study. Systemic inflammatory parameters (CRP, albumin, neutrophil, lymphocyte, and platelet count) were checked for making 3 scoring systems. Based on clinical survival data, we then compared PFS and OS with GPS, NLR, and PLR. Results: Male to female were 123:77. Median age of the patients was 64 years (range, 26-83 years). Median follow-up duration was 27.2 months (range 7.8-52.7 months). 36 patients were observed disease progression or death. 19 patients were passed away during follow-up duration. 3 year PFS and OS were 72% and 86%, respectively. Numbers of GPS 0,1, and 2 patients were 154 (77%), 44 (22%), and 2 (1%), respectively. Survival analysis according to GPS, PFS and OS could not be able to show the prognostic significance (P=0.313 and P=263). Cut-off value of NLR and PLR were determined 3 and 180 by ROC curve. Both of NLR and PLR were observed as a good prognostic biomarker of PFS and OS (P=0.009 and P<0.001 in PFS, P=0.006 and P=0.001 in OS). Conclusions: Although GPS, NLR, and PLR were introduced as prognostic scoring systems for operable CRC, PLR which is constructed of platelet/lymphocyte count may represent a useful prognostic index for the prediction of PFS and OS in operable CRC. No significant financial relationships to disclose.

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The Prognostic Value of Modified Glasgow Prognostic Score in Pancreatic Cancer: A Meta-analysis

10.21203/rs.3.rs-47891/v2 ◽

2020 ◽

Author(s):

Huan Zhang ◽

Dianyun Ren ◽

Xin Jin ◽

Heshui Wu

Keyword(s):

Pancreatic Cancer ◽

Prognostic Value ◽

Close Association ◽

Meta Analysis ◽

Prognostic Score ◽

Prognostic Significance ◽

Glasgow Prognostic Score ◽

Cochrane Library ◽

Modified Glasgow Prognostic Score ◽

High Level

Abstract Background: Several studies were conducted to explore the prognostic value of modified Glasgow Prognostic Score (mGPS) in pancreatic cancer, which reported contradictory results. The purpose of this meta-analysis was to summarize and further investigate the correlation between mGPS and overall survival (OS) in pancreatic cancer.Methods: A systematic literature search was performed in PubMed, EMBASE, ISI Web of Science, Cochrane library databases and OVID to identify eligible studies published from Jan 1, 2011 to June 20, 2020. Pooled hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) were used to detect the prognostic significance of mGPS in patients with pancreatic cancer.Results: A total of 222 non-repetitive studies were identified, and 20 related studies that explored the association between survival outcomes and mGPS in pancreatic cancer patients were finally enrolled in this meta-analysis. The results showed a significant correlation between high level of mGPS and poor OS (HR=1.50, 95% CI=1.20-1.89, P<0.0001). Similar results were observed in the subgroup analyses based on the treatment regimen and research region.Conclusions: Our study suggested the close association between poor prognosis and high level of mGPS, which will be helpful for future clinical applications in patients with pancreatic cancer.

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The lymphocyte-to-monocyte ratio as a predictor of overall survival in comparison to established systemic markers of inflammation in resectable colorectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.593 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 593-593 ◽

Cited By ~ 1

Author(s):

Joseph Chan ◽

Connie Irene Diakos ◽

David Chan ◽

Anthony J Gill ◽

Alexander Engel ◽

...

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Cox Regression ◽

Prognostic Score ◽

Prognostic Significance ◽

Glasgow Prognostic Score ◽

Local Health ◽

Lymphocyte Ratio ◽

Lymphocyte To Monocyte Ratio ◽

Markers Of Inflammation

593 Background: The prognostic significance of systemic inflammatory markers in colorectal cancer (CRC) such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and modified Glasgow prognostic score (mGPS) have been well defined in literature. In addition, commonly utilized genetic markers such as combined BRAF-MMR status have also been found to be prognostic. Recent evidence suggests that the lymphocyte-to-monocyte ratio (LMR) may hold prognostic utility in CRC. However the LMR has still not been clearly defined in either its clinical utility or in comparsion to other established biomarkers. Methods: Consecutive patients from the Northern Sydney Local Health District undergoing curative surgical resection for colorectal cancer from January 1998 to December 2012 were collated. Of the 3281 patients identified, 1623 patients with complete pre-operative blood counts, BRAF-MMR IHC and clinicopathologic data were further analysed. Variables were analysed in univariate and then a multivariate cox regression model using forwards conditional method looking for association with overall survival (OS). Results: In multivariate analysis of 1623 patients, elevated LMR was associated with better overall survival (OS) (HR 0.565, 95% CI: 0.475-0.672, P < 0.001) independent of age (P < 0.001), T stage (P < 0.001), N stage (P < 0.001) and grade (P = 0.049). Other biomarkers such as NLR, PLR and combined BRAF-MMR status were not significantly associated with OS. In multivariate subgroup analysis of 389 patients with available mGPS data, LMR remained the only independently prognostic biomarker (HR 0.620, 95% CI: 0.437-0.880, p = 0.007). Conclusions: The LMR is an independent predictor of OS in CRC patients undergoing curative resection. Furthermore, the LMR appears to be superior to previously established biomarkers.

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