Abstract
Objective: There is an increasing number of studies in the literature reporting that serum platelet/lymphocyte ratio (PLR) can provide useful prognostic data for various cancers. In the present study, the effects of platelet-lymphocyte ratio on survival in stage II/III colorectal cancers (CRC) were examined.
Material and Method:A total of 106 Stage II/III CRC patients who underwent curative surgery 2015-2020 were included in the study. Emergency cases and patients diagnosed with other than adenocarcinoma were excluded from the study. The demographic data of the patients, preoperative imaging and laboratory results, postoperative pathology reports, and patient follow-up examination data were obtained from hospital records. The relations between demographic, histopathological, hematological values and the prognosis was analyzed in terms of statistical significance.
Results:Among the 106 patients, 62 (58.5%) were male and 44 (41.5%) were female. The mean age was 64.3±12.01 (23-89). The mean follow-up period was calculated as 24.6±15.8 (2-63) months. When the pathology reports were reviewed, it was found that the mean tumor diameter was 5.3±2.33 cm (2-17) and the mean metastatic lymph node was 1.8±2.4 (0-10). The PLR ratio was determined as a poor prognostic factor affecting survival in the cox regression analysis, in which preoperative complete blood count, c-reactive protein and albumin values, neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), and PLR were compared, and was separated from other variables (P=0.002 CI= 95%). When variables such as age, clinical stage, and tumor diameter were included in the model, PLR was similarly found to be an important predictive variable (P= 0.002). When only NLR, LMR, and PLR were evaluated, PLR again came to the forefront with a significance value of P=0.01. Also, high neutrophil count, increased platelet distribution volume (PDW), advanced age, and perineural invasion (PNI) were found to be significant factors in predicting poor prognosis.
Conclusions: High PLR is a poor prognostic factor for CRC patients. For this reason, it may be necessary to follow a more aggressive strategy in the management of postoperative treatment in patients who have high PLR.
Keywords
Platelet/Lymphocyte Ratio adjuvant chemotherapy colorectal cancer Stage II/III prognostic factor.
Project Number
2021.12404.19
References
- Siegel R, Naishadham D, Jemal A. Cancerstatistics. CA Cancer J Clin2012; 62: 10-29.
- Ferlay J, Parkin DM, Steliarova-Foucher E. Estimates of cancer incidence and mortality in Europe in 2008 Eur J Cancer 2010; 46: 765-81.
- O'Connell JB, Maggard MA, Ko CY, Colon cancer survival rates with the new American Joint Committee on Cancer sixth editions taging. J Natl Cancer Inst 2004; 96: 1420-5.
- Morris M, Platell C, de Boer B, et al. Population-based study of prognostic factors in stage II colonic cancer, Br J Surg 2006; 93: 866-71.
- Gill S, Loprinzi CL, Sargent DJ, et al. Pooled analysis of fluorouracil-based adjuvant therapy for stage II and III colon cancer: who benefits and by how much? J Clin Oncol 2004; 22: 1797-806.
- Le Voyer TE, Sigurdson ER, Hanlon AL, et al. Colon cancer survival is associated within creasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089 J Clin Oncol 2003; 21: 2912-9.
- Quah H.M, Chou J.F, Gonen M, et al. Identification of patients with high-risk stage II colon cancer for adjuvant therapy. Dis Colon Rectum 2008; 51: 503-7.
- 8.HariDM, Leung AM, Lee JH, et al. AJCC Cancer Staging Manual 7th edition criteria for colon cancer: do the complex modifications improve prognostic assessment? J Am Coll Surg 2013; 217: 181–90.
- Benson AB, 3rd, Schrag D, Somerfield MR, et al. American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol 2004; 22: 3408–19.
- International Multicentre Pooled Analysis of Colon Cancer Trials (IMPACT) investigators. Efficacy of adjuvant fluorouracil and folinicacid in colon cancer. Lancet 1995; 345: 939-44.
- Figueredo A, CharetteML, Maroun J, et al. Adjuvant therapy for stage II colon cancer: a systematic review from the Cancer Care Ontario Program in evidence-based care's gastrointestinal cancer disease site group J Clin Oncol 2004; 22: 3395-407.
- Benson AB, Schrag B, Somerfield MR, et al. American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer J Clin Oncol 2004;22: 3408-19.
- Van Cutsem E, Dicato M, Wils J, et al. Adjuvant treatment of colorectal cancer (current expert opinion derived from the Third International Conference: Perspectives in Colorectal Cancer, Dublin, 2001) Eur J Cancer 2002; 38: 1429-36.
- Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-relatedinflammation. Nature 2008; 454: 436– 44.
- Balkwill F, Mantovani A. Inflammation and cancer: back to Virchow? The Lancet 2001; 357:539-45
- Martin HL, Ohara K, Kiberu A, Van Hagen T, Davidson A, Khattak MA, Prognostic value of systemic inflammation-based markers in advanced pancreatic cancer, Intern Med J 2014; 676-82.
- Raungkaewmanee S, Tangjitgamol S, Manusirivithaya S, et al. Platelet to lymphocyte ratio as a prognostic factor for epithelial ovarian cancer J Gynecol Oncol 2012; 23: 265-73.
- Asher V, Lee J, Innamaa A, et al. Pre operative platelet lymphocyte ratio as an independent prognostic marker in ovarian cancer. Clin Transl Oncol 2011;13: 499-503.
- Smith R.A, Bosonnet L, Raraty M, et al. Preoperative platelet-lymphocyte ratio is an independent significant prognostic marker in resected pancreatic ductaladeno carcinoma. Am J Surg 2009;197: 466-72.
- Kwon H.C, Kim S.H, OhS.Y.et al. Clinical significance of preoperative neutrophil-lymphocyt ever susplatelet-lymphocyte ratio in patients with operable colorectal cancer. Biomarkers 2012; 17: 216-22
- Itzkowitz SH, Rochester J. Colonic polypsand polyposis syndromes. In: Feldman M, Fiedman LS, Brandt LJ (Eds.) Gastrointestinal and Liver Disease. 8th Ed. 2713-2757, Saunders Elsevier, Philadelphia, 2006
- Fry RD, Mahmoud N, Maron DJ, Ross HM. Colonand Rectum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL (Eds.) Sabiston Textbook of Surgery. 18th Ed. 1348-1432, Saunders Elsevier, Philadelphia, 2008
- Edwards BK, Howe HL, Ries LAG et al. Annual report to the nation on the status of cancer, 1973-1999, featuring implications of age and aging on US cancer burden. Cancer 2002; 94: 2766-92
- de Visser KE, Eichten A, Coussens LM. Paradoxical roles of the immune system during cancer development. Nat Rev Cancer 2006; 6: 24–37.
- Lin WW, Karin M. A cytokine-mediated link between innate immunity, inflammation, and cancer. J Clin Invest 2007; 117: 1175–83.
- Hoffmann TK, Dworacki G, Tsukihiro T, Meidenbauer N, Gooding W, Johnson JT, Whiteside TL. Spontaneous apoptosis of circulating T lymphocytes in patients with head and neck cancer and its clinical importance. Clin Cancer Res 2002; 8: 2553–62.
- Ownby HE, Roi LD, Isenberg RR, Brennan MJ. Peripheral lymphocyte and eosinophil counts as indicators of prognosis in primary breast cancer. Cancer. 1983; 52:126–30.
- Ray-Coquard I, Cropet C, Van Glabbeke M, et al. Lymphopenia as a prognostic factor for overall lsurvival in advanced carcinomas, sarcomas, and lymphomas. Cancer Res 2009: 69: 5383– 91.
- Ku GY, Yuan J, Page DB, et al. Single-institution experience with ipilimumab in advanced melanoma patients in the compassionate use setting: lymphocyte count after 2 doses correlates with survival. cancer 2010; 116: 1767–75.
- Zhang GQ, Zhao H, Wu JY, et al. Prolonged overall lsurvival in gastric cancer patients after adoptive immunotherapy. World J Gastroenterol 2015; 21:2777-85.
- Naschitz JE, Yeshurun D, Eldar S, Lev LM. Diagnosis of cancer-associated vascular disorders. cancer. 1996; 77: 1759–67.
- Ishizuka M, Nagata H, Takagi K, Iwasaki Y, Kubota K. Preoperative thrombocytosis is associated with survival after surgery for colorectal cancer. J Surg Oncol 2012; 106: 887–91.
- Fidler IJ. The pathogenesis of cancer metastasis: the 'seed and soil' hypothesis revisited. Nat Rev Cancer 2003; 3: 453-8.
- Grignani G, Falanga A, Pacchiarini L, et al. Human breast and colon carcinomas Express cysteine protein a seactivities with pro-aggregating and pro-coagulant properties. Int J Cancer 1988; 42: 554-7.
- Orellana R. Kato S. Erices R, et al. Platelets enhance tissue factor protein and metastasis initiating cell markers, and act as chemoattractants increasing the migration of ovarian cancer cells. BMC Cancer2015; 15: 290
- Templeton AJ, Ace O, McNamara MG, et al. Prognostic role of platelet to lymphocyte ratio in solid tumors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev 2014; 23:1204-12.
- Mahdavi-Zafarghandi R, Shakiba B, Keramati MR, Tavakkoli M. Platelet volume indices in patients with varicocele. Clin Exp Reprod Med 2014; 41:92-95
- Aliustaoglu M, Bilici A, Ustaalioglu BBO, et al. Theeffect of peripheral blood values on prognosis of patients with locally advanced gastric cancer before treatment. Med Oncol 2010; 27:1060–5.
- Huang Y, Cui MM, Huang YX, et al. Pre operative platelet distribution width predicts breast cancer survival. Cancer Biomark 2018; 23: 205-11.
- Zhang H, Liu L, Fu S Et al. Higher platelet distribution width predicts poor prognosis in laryngeal cancer. Oncotarget 2017; 8: 48138-44.
- Cheng S, Han F, Wang Y Et al. The redistribution width and the platelet distribution width as prognostic predictors in gastric cancer. BMC Gastroenterol 2017; 17: 163.
- Cui MM, Li N, Liu X, et al. Platelet distribution width correlates with prognosis of non-small cell lung cancer. SciRep 2017; 7: 3456.
- Gunaldi M, Erdem D, Goksu S, et al. Platelet distribution width as a predictor of metastasis in gastric cancer patients. J Gastrointest Canc 2017; 48, 341–346.
- Kemal Y, Yucel I, Ekiz K, Demirag G, et al. Elevated serum neutrophil to lymphocyte and platelet to lymphocyte ratios could be useful in lung cancer diagnosis. Asian Pac J Cancer Prev 2014; 15:2651-4.
- Bilici A, Seker M, Ustaalioglu BB, et al. Prognostic significance of perineural invasion in patients with gastric cancer who underwent curative resection. Ann Surg Oncol 2010; 17: 2037-44.
- Chatterjee D, Katz MH, RashidA, et al. Perineural and intraneural invasion in post therapy pancreatic oduodenectomy specimens predicts poor prognosis in patients with pancreatic ductal adenocarcinoma Am J Surg Pathol 2012; 36: 409-17
- Poeschl EM, Pollheimer MJ, Kornprat P, et al. Perineural invasion: correlation with aggressive pheno type and independent prognostic variable in both colon and rectum cancer J Clin Oncol 2010; 28: 358-60.
- Liebig C, AyalaG, Wilks J, et al. Perineural invasion is an independent predictor of outcome in colorectal cancer. J Clin Oncol 2009; 27: 5131-7.
- Park JH, Watt DG, Roxburgh CS, Horgan PG, McMillan DC. Colorectal Cancer, systemic inflammation and outcome: tumors taging and host staging. Ann Surg 2016; 263: 326–36.
- Suzuki Y, Okabayashi K, Hasegawa H, et al. Comparison of prognostic scores based on preoperative inflammation in patients with Colorectal Cancer. Ann Surg 2016; 267: 52531
- Nozoe T, Kohno M, Iguchi T, et al. The prognostic nutritional index can be a prognostic indicator in colorectal carcinoma. Surgery Today 2012; 42: 532-5.
- Wang, F. He, W. Jiang, C. et al. Prognostic value of inflammation-based scores in patients undergoing radical resection for colorectal cancer. BMC Kanser 2018; 1102.
Abstract
Supporting Institution
yok
Project Number
2021.12404.19
References
- Siegel R, Naishadham D, Jemal A. Cancerstatistics. CA Cancer J Clin2012; 62: 10-29.
- Ferlay J, Parkin DM, Steliarova-Foucher E. Estimates of cancer incidence and mortality in Europe in 2008 Eur J Cancer 2010; 46: 765-81.
- O'Connell JB, Maggard MA, Ko CY, Colon cancer survival rates with the new American Joint Committee on Cancer sixth editions taging. J Natl Cancer Inst 2004; 96: 1420-5.
- Morris M, Platell C, de Boer B, et al. Population-based study of prognostic factors in stage II colonic cancer, Br J Surg 2006; 93: 866-71.
- Gill S, Loprinzi CL, Sargent DJ, et al. Pooled analysis of fluorouracil-based adjuvant therapy for stage II and III colon cancer: who benefits and by how much? J Clin Oncol 2004; 22: 1797-806.
- Le Voyer TE, Sigurdson ER, Hanlon AL, et al. Colon cancer survival is associated within creasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089 J Clin Oncol 2003; 21: 2912-9.
- Quah H.M, Chou J.F, Gonen M, et al. Identification of patients with high-risk stage II colon cancer for adjuvant therapy. Dis Colon Rectum 2008; 51: 503-7.
- 8.HariDM, Leung AM, Lee JH, et al. AJCC Cancer Staging Manual 7th edition criteria for colon cancer: do the complex modifications improve prognostic assessment? J Am Coll Surg 2013; 217: 181–90.
- Benson AB, 3rd, Schrag D, Somerfield MR, et al. American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol 2004; 22: 3408–19.
- International Multicentre Pooled Analysis of Colon Cancer Trials (IMPACT) investigators. Efficacy of adjuvant fluorouracil and folinicacid in colon cancer. Lancet 1995; 345: 939-44.
- Figueredo A, CharetteML, Maroun J, et al. Adjuvant therapy for stage II colon cancer: a systematic review from the Cancer Care Ontario Program in evidence-based care's gastrointestinal cancer disease site group J Clin Oncol 2004; 22: 3395-407.
- Benson AB, Schrag B, Somerfield MR, et al. American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer J Clin Oncol 2004;22: 3408-19.
- Van Cutsem E, Dicato M, Wils J, et al. Adjuvant treatment of colorectal cancer (current expert opinion derived from the Third International Conference: Perspectives in Colorectal Cancer, Dublin, 2001) Eur J Cancer 2002; 38: 1429-36.
- Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-relatedinflammation. Nature 2008; 454: 436– 44.
- Balkwill F, Mantovani A. Inflammation and cancer: back to Virchow? The Lancet 2001; 357:539-45
- Martin HL, Ohara K, Kiberu A, Van Hagen T, Davidson A, Khattak MA, Prognostic value of systemic inflammation-based markers in advanced pancreatic cancer, Intern Med J 2014; 676-82.
- Raungkaewmanee S, Tangjitgamol S, Manusirivithaya S, et al. Platelet to lymphocyte ratio as a prognostic factor for epithelial ovarian cancer J Gynecol Oncol 2012; 23: 265-73.
- Asher V, Lee J, Innamaa A, et al. Pre operative platelet lymphocyte ratio as an independent prognostic marker in ovarian cancer. Clin Transl Oncol 2011;13: 499-503.
- Smith R.A, Bosonnet L, Raraty M, et al. Preoperative platelet-lymphocyte ratio is an independent significant prognostic marker in resected pancreatic ductaladeno carcinoma. Am J Surg 2009;197: 466-72.
- Kwon H.C, Kim S.H, OhS.Y.et al. Clinical significance of preoperative neutrophil-lymphocyt ever susplatelet-lymphocyte ratio in patients with operable colorectal cancer. Biomarkers 2012; 17: 216-22
- Itzkowitz SH, Rochester J. Colonic polypsand polyposis syndromes. In: Feldman M, Fiedman LS, Brandt LJ (Eds.) Gastrointestinal and Liver Disease. 8th Ed. 2713-2757, Saunders Elsevier, Philadelphia, 2006
- Fry RD, Mahmoud N, Maron DJ, Ross HM. Colonand Rectum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL (Eds.) Sabiston Textbook of Surgery. 18th Ed. 1348-1432, Saunders Elsevier, Philadelphia, 2008
- Edwards BK, Howe HL, Ries LAG et al. Annual report to the nation on the status of cancer, 1973-1999, featuring implications of age and aging on US cancer burden. Cancer 2002; 94: 2766-92
- de Visser KE, Eichten A, Coussens LM. Paradoxical roles of the immune system during cancer development. Nat Rev Cancer 2006; 6: 24–37.
- Lin WW, Karin M. A cytokine-mediated link between innate immunity, inflammation, and cancer. J Clin Invest 2007; 117: 1175–83.
- Hoffmann TK, Dworacki G, Tsukihiro T, Meidenbauer N, Gooding W, Johnson JT, Whiteside TL. Spontaneous apoptosis of circulating T lymphocytes in patients with head and neck cancer and its clinical importance. Clin Cancer Res 2002; 8: 2553–62.
- Ownby HE, Roi LD, Isenberg RR, Brennan MJ. Peripheral lymphocyte and eosinophil counts as indicators of prognosis in primary breast cancer. Cancer. 1983; 52:126–30.
- Ray-Coquard I, Cropet C, Van Glabbeke M, et al. Lymphopenia as a prognostic factor for overall lsurvival in advanced carcinomas, sarcomas, and lymphomas. Cancer Res 2009: 69: 5383– 91.
- Ku GY, Yuan J, Page DB, et al. Single-institution experience with ipilimumab in advanced melanoma patients in the compassionate use setting: lymphocyte count after 2 doses correlates with survival. cancer 2010; 116: 1767–75.
- Zhang GQ, Zhao H, Wu JY, et al. Prolonged overall lsurvival in gastric cancer patients after adoptive immunotherapy. World J Gastroenterol 2015; 21:2777-85.
- Naschitz JE, Yeshurun D, Eldar S, Lev LM. Diagnosis of cancer-associated vascular disorders. cancer. 1996; 77: 1759–67.
- Ishizuka M, Nagata H, Takagi K, Iwasaki Y, Kubota K. Preoperative thrombocytosis is associated with survival after surgery for colorectal cancer. J Surg Oncol 2012; 106: 887–91.
- Fidler IJ. The pathogenesis of cancer metastasis: the 'seed and soil' hypothesis revisited. Nat Rev Cancer 2003; 3: 453-8.
- Grignani G, Falanga A, Pacchiarini L, et al. Human breast and colon carcinomas Express cysteine protein a seactivities with pro-aggregating and pro-coagulant properties. Int J Cancer 1988; 42: 554-7.
- Orellana R. Kato S. Erices R, et al. Platelets enhance tissue factor protein and metastasis initiating cell markers, and act as chemoattractants increasing the migration of ovarian cancer cells. BMC Cancer2015; 15: 290
- Templeton AJ, Ace O, McNamara MG, et al. Prognostic role of platelet to lymphocyte ratio in solid tumors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev 2014; 23:1204-12.
- Mahdavi-Zafarghandi R, Shakiba B, Keramati MR, Tavakkoli M. Platelet volume indices in patients with varicocele. Clin Exp Reprod Med 2014; 41:92-95
- Aliustaoglu M, Bilici A, Ustaalioglu BBO, et al. Theeffect of peripheral blood values on prognosis of patients with locally advanced gastric cancer before treatment. Med Oncol 2010; 27:1060–5.
- Huang Y, Cui MM, Huang YX, et al. Pre operative platelet distribution width predicts breast cancer survival. Cancer Biomark 2018; 23: 205-11.
- Zhang H, Liu L, Fu S Et al. Higher platelet distribution width predicts poor prognosis in laryngeal cancer. Oncotarget 2017; 8: 48138-44.
- Cheng S, Han F, Wang Y Et al. The redistribution width and the platelet distribution width as prognostic predictors in gastric cancer. BMC Gastroenterol 2017; 17: 163.
- Cui MM, Li N, Liu X, et al. Platelet distribution width correlates with prognosis of non-small cell lung cancer. SciRep 2017; 7: 3456.
- Gunaldi M, Erdem D, Goksu S, et al. Platelet distribution width as a predictor of metastasis in gastric cancer patients. J Gastrointest Canc 2017; 48, 341–346.
- Kemal Y, Yucel I, Ekiz K, Demirag G, et al. Elevated serum neutrophil to lymphocyte and platelet to lymphocyte ratios could be useful in lung cancer diagnosis. Asian Pac J Cancer Prev 2014; 15:2651-4.
- Bilici A, Seker M, Ustaalioglu BB, et al. Prognostic significance of perineural invasion in patients with gastric cancer who underwent curative resection. Ann Surg Oncol 2010; 17: 2037-44.
- Chatterjee D, Katz MH, RashidA, et al. Perineural and intraneural invasion in post therapy pancreatic oduodenectomy specimens predicts poor prognosis in patients with pancreatic ductal adenocarcinoma Am J Surg Pathol 2012; 36: 409-17
- Poeschl EM, Pollheimer MJ, Kornprat P, et al. Perineural invasion: correlation with aggressive pheno type and independent prognostic variable in both colon and rectum cancer J Clin Oncol 2010; 28: 358-60.
- Liebig C, AyalaG, Wilks J, et al. Perineural invasion is an independent predictor of outcome in colorectal cancer. J Clin Oncol 2009; 27: 5131-7.
- Park JH, Watt DG, Roxburgh CS, Horgan PG, McMillan DC. Colorectal Cancer, systemic inflammation and outcome: tumors taging and host staging. Ann Surg 2016; 263: 326–36.
- Suzuki Y, Okabayashi K, Hasegawa H, et al. Comparison of prognostic scores based on preoperative inflammation in patients with Colorectal Cancer. Ann Surg 2016; 267: 52531
- Nozoe T, Kohno M, Iguchi T, et al. The prognostic nutritional index can be a prognostic indicator in colorectal carcinoma. Surgery Today 2012; 42: 532-5.
- Wang, F. He, W. Jiang, C. et al. Prognostic value of inflammation-based scores in patients undergoing radical resection for colorectal cancer. BMC Kanser 2018; 1102.
Details
| Primary Language | English |
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| Subjects | Health Care Administration |
| Journal Section | Original Article |
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| Project Number | 2021.12404.19 |
| Publication Date | March 15, 2022 |
| Published in Issue | Year 2022 Volume: 5 Issue: 2 |
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