Prognostic Significance of Preoperative Lymphocyte-to-C-Reactive Protein Ratio in Patients with Non-Metastatic Colorectal Cancer

BACKGROUND: Lymphocyte-to-C-reactive protein ratio (LCR) has been used as a post-surgical prognostic biomarker in patients with gastric and colorectal cancer. However, its relationship with early postoperative complications in these patients is unknown. In this study, we aimed to reveal the relationship between LCR and postoperative complications. METHODS: Eighty-one patients operated for stomach and colorectal cancer between January 2020 and August 2020 were prospectively analyzed. On preoperative and postoperative days 1, 3 and 5, other inflammatory parameters, mainly LCR, neutrophil lymphocyte ratio (NLR), were recorded. The patients were divided into two groups according to Clavien-Dindo classification as stage III and higher complications major, stage I-II/non-complication minor. RESULTS: Fifty seven patients were operated for colorectal cancer, 24 patients for gastric cancer. The mean age of the patients was 65.6 ± 12.6, 34.6% of them was women. Age, operation time and hospital stay were significantly different between the groups (p= 0.004, p= 0.002, p< 0.001). Major complications developed in 18 patients. On postoperative day 5, LCR found superior diagnostic accuracy in predicting major postoperative complications compared to other inflammatory markers. On the postoperative 5th day, the cut-off value of LCR was 0.0034, 88.8% (71.9–94.8) sensitivity, and 85.7% (73.6–95.4) selectivity. CONCLUSION: Among different inflammatory markers, postoperative LCR is a safe and effective predictor of postoperative complications, especially after gastric and colorectal cancer surgery on day 5.

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Response to the Comment on “Lymphocyte-C-reactive Protein Ratio as Promising New Marker for Predicting Surgical and Oncological Outcomes in Colorectal Cancer”

Annals of Surgery ◽

10.1097/sla.0000000000003860 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Yoshinaga Okugawa ◽

Yuji Toiyama ◽

Masaki Ohi ◽

Masato Kusunoki

Keyword(s):

Colorectal Cancer ◽

C Reactive Protein ◽

Protein Ratio ◽

Reactive Protein ◽

Oncological Outcomes

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Comment on “Lymphocyte-C-reactive Protein Ratio as Promising New Marker for Predicting Surgical and Oncological Outcomes in Colorectal Cancer”

Annals of Surgery ◽

10.1097/sla.0000000000003856 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Qu-xia Zhang ◽

Bin-bin Xu ◽

Zhen Xue

Keyword(s):

Colorectal Cancer ◽

C Reactive Protein ◽

Protein Ratio ◽

Reactive Protein ◽

Oncological Outcomes

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Prognostic significance of the preoperative serum C-reactive protein level in patients with stage IV colorectal cancer

Surgery Today ◽

10.1007/s00595-014-0909-1 ◽

2014 ◽

Vol 45 (3) ◽

pp. 315-321 ◽

Cited By ~ 9

Author(s):

Masatsune Shibutani ◽

Kiyoshi Maeda ◽

Hisashi Nagahara ◽

Eiji Noda ◽

Hiroshi Ohtani ◽

...

Keyword(s):

Colorectal Cancer ◽

Protein Level ◽

Prognostic Significance ◽

Stage Iv ◽

C Reactive Protein ◽

Reactive Protein ◽

Stage Iv Colorectal Cancer ◽

Preoperative Serum

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Total cell-free DNA, carcinoembryonic antigen, and C-reactive protein for assessment of prognosis in patients with metastatic colorectal cancer

Tumor Biology ◽

10.1177/1010428318811207 ◽

2018 ◽

Vol 40 (11) ◽

pp. 101042831881120 ◽

Cited By ~ 2

Author(s):

Karen-Lise Garm Spindler ◽

Christina Demuth ◽

Boe Sandahl Sorensen ◽

Julia S Johansen ◽

Dorte Nielsen ◽

...

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Confidence Interval ◽

Metastatic Colorectal Cancer ◽

Carcinoembryonic Antigen ◽

Total Cell ◽

C Reactive Protein ◽

Cell Free Dna ◽

Reactive Protein ◽

Free Dna

In late-stage metastatic colorectal cancer, difficult treatment decisions should incorporate a thorough evaluation of the patient’s general condition and subject for shared decision making. Assessment of the individual patients’ prognosis is valuable in this setting. The aim was to analyze the prognostic value of plasma levels of total cell-free DNA, carcinoembryonic antigen and C-reactive protein in 97 heavily pretreated patients with metastatic colorectal cancer. Patients received irinotecan, cetuximab, and everolimus in a phase-2 clinical trial ( clinicaltrials.gov NCT01387880). Plasma samples were used for DNA purification and quantification of total cell-free DNA by droplet digital polymerase chain reaction. Serum carcinoembryonic antigen and C-reactive protein were analyzed by routine methods. Clinical endpoints were overall survival and progression-free survival. A total of 82 patients had blood samples available for quantification of total cell-free DNA. Patients with pre-treatment cell-free DNA levels higher than the median total cell-free DNA (9800 alleles per milliliter plasma) had a significantly shorter overall survival of 4.3 months (95% confidence interval: 3.6–5.8) compared to patients with cell-free DNA levels below the median with an overall survival of 11.3 months (95% confidence interval: 8.0–14.8, p < 0.0001). When using the upper normal limit from a previously analyzed normal control group, the median overall survival was 11.3 (95% confidence interval: 7.3–14.8) and 4.3 (95% confidence interval: 3.7–6.1) months, respectively (p < 0.0001). Serum carcinoembryonic antigen and C-reactive protein had similar prognostic value with short overall survival and progression-free survival in patients with elevated levels compared to those within normal range. A high-risk profile of elevated cell-free DNA, carcinoembryonic antigen, and C-reactive protein was described, but in combined Cox regression multivariate analysis, only total cell-free DNA preserved a strong prognostic value. In conclusion, total cell-free DNA in plasma, carcinoembryonic antigen, and C-reactive protein could all contribute to assessment of patients’ prognosis and potentially aid in clinical decision making in patients with metastatic colorectal cancer.

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Lymphocyte to C-reactive protein ratio predicts long-term outcomes for patients with lower rectal cancer

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02319-x ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Masaaki Nishi ◽

Mistuo Shimada ◽

Takuya Tokunaga ◽

Jun Higashijima ◽

Kozo Yoshikawa ◽

...

Keyword(s):

Rectal Cancer ◽

Overall Survival ◽

Univariate Analysis ◽

Prognostic Significance ◽

Lower Rectal Cancer ◽

Significant Prognostic Factor ◽

C Reactive Protein ◽

Curative Surgery ◽

Protein Ratio ◽

Reactive Protein

Abstract Backgrounds The lymphocyte to C-reactive protein (CRP) ratio (LCR) is an indicator of systemic inflammation and host–tumor cell interactions. The aim of this study was to investigate the prognostic significance of LCR in lower rectal cancer patients who received preoperative chemo-radiotherapy (CRT). Methods Forty-eight patients with lower rectal cancer who underwent CRT followed by curative surgery were enrolled in this study. Routine blood examinations were performed before and after CRT were used to calculate pre-CRT LCR and post-CRT LCR. The median LCR was used to stratify patients into low and high LCR groups for analysis. The correlation between pre- and post-CRT LCR and clinical outcomes was retrospectively investigated. Results The pre-CRT LCR was significantly higher than the post-CRT LCR (11,765 and 6780, respectively, P < 0.05). The 5-year overall survival rate was significantly higher for patients with high post-CRT LCR compared with low post-CRT LCR (90.6% and 65.5%, respectively, P < 0.05). In univariate analysis, post-CRT LCR, post-CRT neutrophil to lymphocyte ratio, and fStage were significant prognostic factors for overall survival. In multivariate analysis, post-CRT LCR, but not other clinicopathological factors or prognostic indexes, was a significant prognostic factor for overall survival (P < 0.05). Conclusions Post-CRT LCR could be a prognostic biomarker for patients with lower rectal cancer.

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