Predictive model using hemoglobin, albumin, fibrinogen, and neutrophil-to-lymphocyte ratio to distinguish patients with colorectal cancer from those with benign adenoma

Abstract

Colorectal cancer (CRC) is associated with inflammation, activation of coagulation, and mild anemia. Hematological parameters reflecting ongoing cancer may have the potency to be effective for early diagnostics of CRC. The aim of this study was to examine the validity and relationship between some biochemical and hematological parameters for the early diagnosis of CRC. We designed a prospective observational cohort study to analyze whether these laboratory markers have the potency to distinguish benign tumors from malignant before planned surgery. The clinical data were collected from 208 patients with suspected benign or malignant colorectal tumors who were eligible for elective surgery between September 2018 and January 2020. Blood samples were collected one day before surgery, examined parameters included: complete blood count, hemoglobin (HGB) concentration, albumin (ALB), C-reactive protein (CRP), interleukin-6 (IL-6), and fibrinogen (FG). Absolute neutrophil and lymphocyte counts were used for the calculation of the neutrophil-to-lymphocyte ratio (NLR). The diagnosis was confirmed by histopathological examination. The 197 patients were divided into the group of benign (B group = 52 patients) or malignant tumors (CRC group = 145 patients). ROC curves and cut-off values of NLR, HGB, FG, and ALB concentration, serum CRP and IL-6 levels. In the cohort of 197 adult patients submitted for the elective colorectal surgery the complete blood samples drawn one day before surgery showed significant differences between patients with benign tumors and colorectal carcinoma: HGB (mean 139.9 g/l vs. 129.9; P < 0.001), FG (mean 3.36 g/l vs. 3.94 g/l; P < 0.001), ALB (mean 43.4 g/l vs. 41.1 g/l; P = 0.001), NLR (mean 2.73 vs. 3.88; P = 0.016), respectively. CRP (mean 2.9 mg/l vs. 4.4 mg/l; P = 0.011), thrombocyte count (mean 235×109/l vs. 265×109/l; P < 0.029).Differences in IL-6 concentrations were not significant (2.9 pg/ml vs. 4.15 pg/ml; P = 0.052). Using multivariable logistic regression analysis four valid parameters (HGB, FG, ALB, and NLR) were suitable for the construction of a diagnostic predictive model for the identification of CRC. In conclusion, a panel of routinely examined blood parameters like HGB, FG, ALB, and NLR has the potency to distinguish patients with benign tumors from malignant by applying a diagnostic predictive model for early laboratory detection of CRC.

A Retrospective Study from a Single Center to Identify Hematological Factors that Distinguish Between Patients with Colorectal Carcinoma and Colorectal Adenoma

“…In the identification of CRC and colorectal adenoma patients, Roman et al [ 24 ] created a prediction model and nomogram using Hb, FIB, ALB, and NLR to predict the risk of CRC in patients, with an AUC value of 0.744. Another study showed that the diagnostic value of plateletcrit combined with CEA in the diagnosis of CRC was 0.835 (AUC), and the sensitivity was 0.700, while the specificity was 0.830 [ 22 ].…”

A predictive model for identifying patients with colorectal cancer from benign polyps based on the serum PLR and PLR-CEA-CA199 score

“…Ying et al demonstrated that brinogen-to-pre-albumin ratio (FPR) combined with CEA could effectively identify early-stage CRC from benign polyps, with an AUC, Sen, and Spe of 0.835, 68.30%, and 83.40 [9]. Furthermore, Roman et al showed that combining NLR and other blood parameters, such as HGB, FG and ALB, can distinguish CRC before planned surgery, and a predicted model based on above factors was created, whose AUC value was 0.744 [32]. In this study, multivariate logistic regression analysis reveled that high levels of age, maximum tumor size, WBC, and PCC score remained independent risk predictors.…”

Expression and Predictive Value of Serum NLR, PLR Combined with SAA in Patients with Different Stages of Colorectal Cancer

“…When the body suffers from severe immune dysfunction and immunosuppression, it will cause a series of pathophysiological changes ( 18 ). LYM can specifically recognize and directly kill tumors or release a series of cytokines to activate anti-tumor immunity, which plays a key role in the production of cytokines that inhibit tumor proliferation and metastasis ( 19 ). NEU and LYM are objective indicators reflecting the inflammatory response and immune status of the body.…”