Lymphocyte-to-monocyte ratio effectively predicts survival outcome of patients with obstructive colorectal cancer

Abstract

BACKGROUNDObstructive colorectal cancer (OCC) is always accompanied by severe complications, and the optimal strategy for patients with OCC remains undetermined. Different from emergency surgery (ES), self-expandable metal stents (SEMS) as a bridge to surgery (BTS), could increase the likelihood of primary anastomosis. However, the stent failure and related complications might give rise to a high recurrence rate. Few studies have focused on the indications for either method, and the relationship between preoperative inflammation indexes and the prognosis of OCC is still underestimated.AIMTo explore the indications for ES and BTS in OCCs based on preoperative inflammation indexes.METHODSOne hundred and twenty-eight patients who underwent ES or BTS from 2008 to 2015 were enrolled. Receiver operating characteristic (ROC) curve analysis was used to define the optimal preoperative inflammation index and its cutoff point. Kaplan–Meier analyses and Cox proportional hazards models were applied to assess the association between the preoperative inflammation indexes and the survival outcomes [overall survival (OS) and disease-free survival (DFS)]. Stratification analysis was performed to identify the subgroups that would benefit from ES or BTS.RESULTSOS and DFS were comparable between the ES and BTS groups (P > 0.05). ROC curve analysis showed derived neutrophil-to-lymphocyte ratio (dNLR) as the optimal biomarker for the prediction of DFS in ES (P < 0.05). Lymphocyte-to-monocyte ratio (LMR) was recommended for BTS with regard to OS and DFS (P < 0.05). dNLR was related to stoma construction (P = 0.001), pneumonia (P = 0.054), and DFS (P = 0.009) in ES. LMR was closely related to lymph node invasion (LVI) (P = 0.009), OS (P = 0.020), and DFS (P = 0.046) in the BTS group. dNLR was an independent risk factor for ES in both OS (P = 0.032) and DFS (P = 0.016). LMR affected OS (P = 0.053) and DFS (P = 0.052) in the BTS group. LMR could differentiate the OS between the ES and BTS groups (P < 0.05).CONCLUSIONPreoperative dNLR and LMR could predict OS and DFS in patients undergoing ES and BTS, respectively. For OCC, as the potential benefit group, patients with a low LMR might be preferred for BTS via SEMS insertion.

The Importance of Systemic Inflammation Markers in the Survival of Patients with Complicated Colorectal Cancer, Operated in Emergency

“…We have shown that the increased preoperative value of NLR was a risk factor for remote survival, as other authors have also found (39)(40)(41). In a single study conducted in 2018 at the University of Leeds in the UK, the authors reported that high NLR values were associated with a high risk of death in univariate but not multivariate analysis (42).…”

Laboratory features in severe vs. non-severe COVID-19 patients, a systematic review and meta-analysis

“…The NLR was a commonly used index for determining the bacterial infections severity and for the prognosis of pneumonia and tumor patients (32,33). The current study suggests the increased NLR and decreased LCR of severe COVID-19 patients in which been recently reported (34) but to the best of our knowledge our metaanalysis for the first time showed decrease in LeCR, and LeIR in severe COVID-19 patients compared to nonsevere, indicating the poor prognosis of this pneumonia.…”

Neutrophil-to-Lymphocyte Ratio Predicts Severe Illness Patients with 2019 Novel Coronavirus in the Early Stage

“…The increase of NLR indicated poor clinical prognosis. [8][9][10][11][12][13][14] The results indicated that 2019-nCoV may act on T lymphocytes, and T lymphocyte damage is an important factor that causes patients to deteriorate 13 . In addition, patients with severe illness might have bacterial infection due to low immune function.…”