Impact of preoperative white blood cell count on long-term outcome in patients undergoing surgery for colorectal cancer: A retrospective observational study of Chinese patients

Abstract

PurposeThe correlation between preoperative white blood cell (WBC) count and the outcome in patients who underwent surgery for colorectal cancer (CRC) was evaluated in present study.Patients and methods:A total of 8121 Chinese patients at Fudan University Shanghai Cancer Center (FUSCC) undergoing colectomy, Dixon’s or Mile’s, for CRC from January 2008 to December 2014 were enrolled in present study. Based on that the WBC optimal cut-off value was 7*109, the patients were divided into two groups, the moderate leukocytosis group (the leukocytosis group) and non-leukocytosis group. The impact of preoperative WBC count on disease-free survival (DFS) and overall survival (OS) was investigated using the Kaplan-Meier method and Cox proportional hazard models.ResultsModerate leukocytosis (≥7*109) was recognized as a prognostic factor for survival independently. Moderate leukocytosis was significantly associated with male sex (P＜0.001), advanced T stage (P＜0.001), TNM stage (P＜0.001), and no preoperative chemotherapy (P＜0.001). Moderate leukocytosis group was corelated with poorer overall survival (OS) (P＜0.001) and disease-free survival (DFS) (P = 0.024) than non-leukocytosis group. In the multivariate analysis, the moderate leukocytosis group had a 19.6% higher risk in OS (HR = 1.196, 95CI%:1.088–1.314, P < 0.001) and had a 13.1% higher risk in DFS (HR = 1.131, 95CI%:1.016–1.259, P = 0.024) than the non-leukocytosis group. We found that the association with preoperative moderate leukocytosis and poorer OS (P＜0.001) or DFS (P=0.001) in patients with no preoperative chemotherapy in subgroup analysis.ConclusionsPreoperative moderate leukocytosis is associated with shorter OS, DFS indicating poor outcome in CRC patients after surgery.