Citation Information :
Ramesh SK, Swain SK, Munikrishnan V, Jameel JK. Can the Inflammatory Cell Ratio NLR and PLR be Used as a Reliable Marker in Colon Cancer? A Prospective Study. Euroasian J Hepatogastroenterol 2023; 13 (2):61-65.
Background: Simple approaches for detecting the tumor stage of colon cancer patients are required during the preoperative period. In recent years, the neutrophil-lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) have been employed as predictive parameters for systemic inflammatory response and long-term prognosis in a variety of malignancies. The purpose of this study was to determine whether the NLR and PLR correspond with tumor characteristics in colon cancer patients.
Materials and methods: About 90 patients with colon cancer who reported to our institute during the time interval July 2021 to December 2022 were included in the study. The NLR and PLR were calculated using data obtained from a complete blood count evaluation. The relationship between inflammatory cell ratio and tumor-specific characteristics were analyzed.
Results: Neutrophil–lymphocyte ratio and PLR correlated with pTNM staging in 88 patients. Two patients exhibited diffuse peritoneal metastasis. A significant association was found between PLR and early (Tis + T1 + T2) and advanced (T3 + T4) groups. Although the difference was not statistically significant, patients with lymphovascular invasion (LVI) and perineural invasion (PNI) had greater mean NLR and PLR.
Conclusion: Platelet–lymphocyte ratio was found to be more accurate than NLR in predicting colon cancer tumor depth/invasion. A high PLR value aids in prognosticating advanced T-stage colon cancer patients and can be used as a valuable tool for preoperative counseling, but it must be validated with a survival analysis.
Clinical practice points: The tumor microenvironment contains a variety of inflammatory cells that contribute to the growth and spread of the neoplasm. The NLR and PLR have been shown to be clinically and prognostically important in a variety of gastrointestinal cancers. The results of this study demonstrate that PLR was more accurate than NLR in predicting colon cancer tumor depth/invasion. Also, a high PLR value aids in prognosticating advanced T-stage colon cancer patients and may be used as a valuable tool for preoperative counseling.
Mathew A, Baby B, Wang K, et al. Colorectal cancer incidence in younger adults in India. Gut 2020;69(10):1899–1900. DOI: 10.1136/gutjnl-2019-320271.
Balkwill F, Mantovani A. Inflammation and cancer: back to Virchow? Lancet 2001;357(9255):539–545. DOI: 10.1016/S0140-6736(00)04046-0.
Michalaki V, Syrigos K, Charles P, et al. Serum levels of IL-6 and TNF-alpha correlate with clinicopathological features and patient survival in patients with prostate cancer [published correction appears in Br J Cancer. 2004;91(6):1227]. Br J Cancer 2004;90(12):2312–2316. DOI: 10.1038/sj.bjc.6601814.
Pine SR, Mechanic LE, Enewold L, et al. Increased levels of circulating interleukin 6, interleukin 8, C-reactive protein, and risk of lung cancer. J Natl Cancer Inst 2011;103(14):1112–1122. DOI: 10.1093/jnci/djr216.
Spolverato G, Maqsood H, Kim Y, et al. Neutrophil-lymphocyte and platelet-lymphocyte ratio in patients after resection for hepato-pancreatico-biliary malignancies. J Surg Oncol. 2015;111(7):868–874. DOI: 10.1002/jso.23900.
Xie X, Luo KJ, Hu Y, et al. Prognostic value of preoperative platelet-lymphocyte and neutrophil-lymphocyte ratio in patients undergoing surgery for esophageal squamous cell cancer. Dis Esophagus. 2016;29(1):79–85. DOI: 10.1111/dote.12296.
Hirahara T, Arigami T, Yanagita S, et al. Combined neutrophil-lymphocyte ratio and platelet-lymphocyte ratio predicts chemotherapy response and prognosis in patients with advanced gastric cancer. BMC Cancer. 2019;19(1):672. DOI: 10.1186/s12885-019-5903-y.
Jia J, Zheng X, Chen Y, et al. Stage-dependent changes of preoperative neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in colorectal cancer. Tumour Biol 2015;36(12):9319–9325. DOI: 10.1007/s13277-015-3667-9.
Sawada R, Akiyoshi T, Kitagawa Y, et al. Systemic inflammatory markers combined with tumor-infiltrating lymphocyte density for the improved prediction of response to neoadjuvant chemoradiotherapy in rectal cancer. Ann Surg Oncol 2021;28(11):6189–6198. DOI: 10.1245/s10434-021-09975-z.
Kwon HC, Kim SH, Oh SY, et al. Clinical significance of preoperative neutrophil-lymphocyte versus platelet-lymphocyte ratio in patients with operable colorectal cancer. Biomarkers 2012;17(3):216–222. DOI: 10.3109/1354750X.2012.656705.
Fang T, Wang Y, Yin X, et al. Diagnostic sensitivity of NLR and PLR in early diagnosis of gastric cancer. J Immunol Res 2020;2020:9146042. DOI: 10.1155/2020/9146042.
Stojkovic Lalosevic M, Pavlovic Markovic A, Stankovic S, et al. Combined diagnostic efficacy of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) as biomarkers of systemic inflammation in the diagnosis of colorectal cancer. Dis Markers 2019;2019:6036979. DOI: 10.1155/2019/6036979.
Naszai M, Kurjan A, Maughan TS. The prognostic utility of pre-treatment neutrophil-to-lymphocyte-ratio (NLR) in colorectal cancer: a systematic review and meta-analysis. Cancer Med 2021;10(17):5983–5997. DOI: 10.1002/cam4.4143.
Tan D, Fu Y, Su Q, et al. Prognostic role of platelet-lymphocyte ratio in colorectal cancer: A systematic review and meta-analysis. Medicine (Baltimore) 2016;95(24):e3837. DOI: 10.1097/MD.0000000000003837.
Pereira C, Mohan J, Gururaj S, et al. Predictive ability of neutrophil-lymphocyte ratio in determining tumor staging in colorectal cancer. Cureus 2021;13(10):e19025. DOI: 10.7759/cureus.19025.
Turhan VB, Ünsal A, Gök HF, et al. Predictive value of preoperative neutrophil-lymphocyte and platelet-lymphocyte ratio in determining the stage of colon tumors. Cureus 2021;13(9):e18381. DOI: 10.7759/cureus.18381.
He W, Wei M, Yang X, et al. Do inflammatory markers predict prognosis in patients with synchronous colorectal cancer?. Medicine (Baltimore). 2017;96(17):e6607. DOI: 10.1097/MD.0000000000006607.
Özgehan G, Kahramanca Ş, Kaya İO, et al. Neutrophil-lymphocyte ratio as a predictive factor for tumor staging in colorectal cancer. Turk J Med Sci 2014;44(3):365–368. DOI: 10.3906/sag-1305-33.
Li X, Guo D, Chu L, et al. Potential diagnostic value of combining inflammatory cell ratios with carcinoembryonic antigen for colorectal cancer. Cancer Manag Res 2019;11:9631–9640. DOI: 10.2147/CMAR.S222756.
Uludag SS, Sanli AN, Zengin AK, et al. Systemic inflammatory biomarkers as surrogate markers for stage in colon cancer. Am Surg 2022;88(6):1256–1262. DOI: 10.1177/0003134821995059.
Khan AA, Akritidis G, Pring T, et al. The neutrophil-to-lymphocyte ratio as a marker of lymph node status in patients with rectal cancer. Oncology 2016;91(2):69–77. DOI: 10.1159/000443504..
Kilincalp S, Çoban Ş, Akinci H, et al. Neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and mean platelet volume as potential biomarkers for early detection and monitoring of colorectal adenocarcinoma. Eur J Cancer Prev 2015;24(4):328–333. DOI: 10.1097/CEJ.0000000000000092.
Zou ZY, Liu HL, Ning N, et al. Clinical significance of pre-operative neutrophil lymphocyte ratio and platelet lymphocyte ratio as prognostic factors for patients with colorectal cancer. Oncol Lett 2016;11(3):2241–2248. DOI: 10.3892/ol.2016.4216.
Dimitriou N, Felekouras E, Karavokyros I, et al. Neutrophils to lymphocytes ratio as a useful prognosticator for stage II colorectal cancer patients. BMC Cancer 2018;18(1):1202. DOI: 10.1186/s12885-018-5042-x.