Postoperative, but not preoperative, inflammation-based prognostic markers are prognostic factors in stage III colorectal cancer patients

Yasui, Kohei; Shida, Dai; Nakamura, Yuya; Ahiko, Yuka; Tsukamoto, Shunsuke; Kanemitsu, Yukihide

doi:10.1038/s41416-020-01189-6

Cited by 51 publications

(52 citation statements)

References 32 publications

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“…Most of the papers evaluated “preoperative NLR”, while some assessed NLR in a different way. Yasui et al stratified 568 CRC patients into three groups depending on inflammation status: preoperatively low (normal group), preoperatively high but postoperatively low (normalized group), and persistently high (elevated group) [ 52 ]. They indicated that the normal group showed a better prognosis than the elevated group regarding several inflammation-related markers, including NLR.…”

Section: Neutrophil-related Markersmentioning

confidence: 99%

“…Most of the studies about CRP-related makers adopted preoperative parameters. However, as mentioned above, Yasui et al analyzed the inflammation status between before and after surgery, and showed that postoperative, but not preoperative, inflammation-based markers (i.e., CAR, LCR, and NLR) were significantly associated with OS and RFS [ 52 ]. The best timing for the evaluation of CRP-related markers remains to be elucidated.…”

Section: Crp-related Markersmentioning

confidence: 99%

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Inflammation-Related Biomarkers for the Prediction of Prognosis in Colorectal Cancer Patients

Yamamoto

Kawada

Obama

2021

IJMS

235

140

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Colorectal cancer (CRC) is the leading cause of cancer deaths around the world. It is necessary to identify patients with poor prognosis or with high risk for recurrence so that we can selectively perform intensive treatments such as preoperative and/or postoperative chemotherapy and extended surgery. The clinical usefulness of inflammation-related prognostic biomarkers available from routine blood examination has been reported in many types of cancer, e.g., neutrophil–lymphocyte ratio (NLR), lymphocyte–C-reactive protein ratio (LCR), platelet–lymphocyte ratio (PLR), lymphocyte–monocyte ratio (LMR), and so on. Moreover, some scoring systems based on circulating blood cell counts and albumin concentration have been also reported to predict cancer patients’ prognosis, such as the Glasgow prognostic score (GPS), systemic inflammation score (SIS), and prognostic nutritional index (PNI). The optimal biomarker and optimal cutoff value of the markers can be different depending on the cancer type. In this review, we summarize the prognostic impact of each inflammation-related marker in CRC.

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Section: Neutrophil-related Markersmentioning

confidence: 99%

Section: Crp-related Markersmentioning

confidence: 99%

Inflammation-Related Biomarkers for the Prediction of Prognosis in Colorectal Cancer Patients

Yamamoto

Kawada

Obama

2021

IJMS

235

140

View full text Add to dashboard Cite

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“…10 However, another study by Yasui and colleagues reported that the persistently low NLR group and exacerbation group (preoperative low to postoperative high NLR) showed no difference in survival in patients with stage III CRC. 9 To the best of our knowledge, the prognostic impact of NLR-delta and NLR-trend has been investigated in a limited manner. Cui et al analyzed both NLR-delta and…”

Section: Discussionmentioning

confidence: 99%

“…NLR-delta has been demonstrated as an alternative prognostic factor in patients with non-small cell lung cancer, hepatocellular carcinoma, gastric cancer, and anaplastic thyroid cancer. [11][12][13][14][15][16] However, there are still some discrepancies in the clinical significance of grouping the NLR-pre and NLP-post 9,10 and the clinical significance of NLR-delta in patients with CRC also showed conflicting results. 17,18 In addition, the significance of combining pre-and post-operative NLR (NLR-trend) and NLR-delta has rarely been evaluated simultaneously, and it remains unclear whether there is a difference in the strength of association with survival between the two dynamic matrices.…”

Section: Introductionmentioning

confidence: 99%

Elevated Neutrophil-to-Lymphocyte Ratio in Perioperative Periods is Suggestive of Poor Prognosis in Patients with Colorectal Cancer

Kim

Lee

et al. 2021

JIR

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Background: Recent data suggest that alterations in the neutrophil-to-lymphocyte ratio (NLR) in the perioperative periods can serve as prognostic factors. However, research on the clinical impact has been limited and even discordant in patients with colorectal cancer (CRC). Patients and Methods: The optimal cut-off value of preoperative NLR (NLR-pre), postoperative NLR (NLR-post), and its change (NLR-delta) were determined to maximize differences in overall survival (OS) between groups. Patients were categorized into four groups (NLR-trend) as follows: G1, low NLR-pre and NLR-post; G2, low NLR-pre and high NLR-post; G3, high NLR-pre and low NLR-post; and G4, high NLR-pre and NLR-post. Discriminatory performance was compared using integrated AUC (iAUC) between all indicators. Results: A total of 576 patients diagnosed with stage I-IV CRC were included. The cut-off points were determined as 2.33 for NLR-pre, 2.06 for NLR-post, and −1.08 for NLR-delta. Subgroup dichotomization using NLR-pre, NLR-post, NLR-delta and NLR-trend were all identified as significant prognostic factors by univariate analysis. However, NLR-trend was only remained as an independent prognostic factor in the multivariate analysis. The iAUC of the NLR-trend was superior to that of NLR-pre (bootstrap iAUC mean difference=0.036; 95% CI 0.013-0.073), NLR-post (bootstrap iAUC mean difference=0.045; 95% CI 0.019-0.081) and NLR-delta (bootstrap iAUC mean difference=0.061; 95% CI 0.025-0.104). Conclusion: Risk stratification and combining of preoperative and postoperative NLR (NLR-trend) can improve prognostic discrimination compared with single measurements or simple changes in NLR in patients with CRC.

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“…Various systemic reviews and meta analyses have shown that postoperative mGPS has a strong prognostic value in the overall survival and recurrence-free survival of patients with colorectal cancer. [23][24][25] While effort is directed towards following systemic in ammation postoperatively, one particular study by Moyes et al correlates preoperative mGPS and white cell count to postoperative complications in patients undergoing curative resection for colorectal cancer, as shown in Tables 1 and 2 in their paper. 26 Systemic in ammation, besides concomitant sepsis and in ammatory pathology, is independently associated with cancer.…”

Section: Discussionmentioning

confidence: 99%

Preoperative C-reactive protein and other inflammatory markers as predictors of postoperative complications in patients with colorectal neoplasia

Alsaif

Rogers

Pua

et al. 2021

Preprint

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Background: Inflammatory markers are measured following colorectal surgery to detect postoperative complications. However, the association of these markers preoperatively with subsequent postoperative course has not yet been usefully studied. Aim: The aim of this study is to assess the ability of preoperative C-reactive protein (CRP) and other inflammatory marker measurements in the prediction of postoperative morbidity after elective colorectal surgery. Methods: This retrospective study catalogues 218 patients undergoing elective, potentially-curative surgery for colorectal neoplasia. Preoperative laboratory results of the full blood count (FBC), C-reactive protein (CRP) and carcinoembryonic antigen (CEA) were recorded. Multivariable analysis was performed to examine preoperative variables against 30-day postoperative complications by type and grade (Clavien-Dindo (CD)), adjusting for age, sex, BMI, smoking status, medical history, open versus laparoscopic operation, and tumor characteristics. Results: Elevated preoperative CRP (≥ 5 mg/L) was significantly predictive of all-cause mortality, with an OR of 17.0 (p < 0.001) and was the strongest factor to predict a CD morbidity grade ≥ 3 (OR 41.9, p < 0.001). Other factors predictive of CD morbidity grade ≥ 3 included smoking, elevated preoperative platelet count and elevated preoperative neutrophil-lymphocyte ratio (OR 15.6, 8.6 and 6.3 respectively, all p < 0.05). CRP values above 5.5 mg/L were indicative of all-cause morbidity (AUC=0.871), and values above 17.5 mg/L predicted severe complications (AUC=0.934). Conclusions: Elevated preoperative CRP predicts increased postoperative morbidity in this patient cohort. The results herein aid risk and resource stratification and encourage preoperative assessment of inflammatory propensity besides simple sepsis exclusion.

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Postoperative, but not preoperative, inflammation-based prognostic markers are prognostic factors in stage III colorectal cancer patients

Cited by 51 publications

References 32 publications

Inflammation-Related Biomarkers for the Prediction of Prognosis in Colorectal Cancer Patients

Inflammation-Related Biomarkers for the Prediction of Prognosis in Colorectal Cancer Patients

Elevated Neutrophil-to-Lymphocyte Ratio in Perioperative Periods is Suggestive of Poor Prognosis in Patients with Colorectal Cancer

Preoperative C-reactive protein and other inflammatory markers as predictors of postoperative complications in patients with colorectal neoplasia

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