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Cumulative perioperative lymphocyte/C-reactive protein ratio as a predictor of the long-term outcomes of patients with colorectal cancer

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Abstract

Purpose

Systemic inflammatory response influences cancer development and perioperative surgical stress can affect the survival of patients with colorectal cancer (CRC). We developed a system to cumulatively assess perioperative inflammatory response and compare the prognostic value of various cumulative inflammatory and nutritional markers in patients with CRC.

Methods

We assessed perioperative cumulative markers using the trapezoidal area method in 307 patients who underwent surgery for CRC and analyzed the results statistically.

Results

The cumulative lymphocyte to C-reactive protein (CRP) ratio (LCR) predicted survival more accurately than other well-established markers (sensitivity: 80.0%, specificity: 69.3%; area under the curve (AUC): 0.779; P  <  0.001). A low cumulative LCR was correlated with factors associated with disease development, including undifferentiated histology, advanced T stage, lymph node metastasis, distant metastasis, and advanced TNM stage classification. A decreased cumulative LCR was an independent prognostic factor for both overall survival (OS) (Hazard Ratio (HR):5.21, 95% confidence interval [CI] 2.42–11.2; P  <  0.0001) and disease-free survival (DFS) (HR: 1.88, 95% CI 1.07–3.31; P  =  0.02), and its prognostic significance was verified in a different clinical setting. The cumulative LCR was correlated negatively with the intraoperative bleeding volume (P  <  0.0001, R  =  −0.4). Combined analysis of cumulative and preoperative LCR could help stratify risk for the oncological outcomes of CRC patients.

Conclusions

The findings of this study demonstrate the value of the cumulative LCR in the postoperative management of patients with CRC.

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Availability of data and materials

Primary research data are presented in a summative fashion. No publicly available datasets have been generated as part of this work.

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Funding

Source of financial support: None.

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Authors and Affiliations

  1. Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan

    Yoshinaga Okugawa, Yuji Toiyama, Hiroyuki Fujikawa, Mikio Kawamura, Hiromi Yasuda, Takeshi Yokoe, Yoshiki Okita & Masaki Ohi

  2. Department of Genomic Medicine, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Mie, Japan

    Yoshinaga Okugawa, Ikuyo Mochiki & Kaname Nakatani

Authors
  1. Yoshinaga Okugawa
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  2. Yuji Toiyama
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  3. Hiroyuki Fujikawa
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  4. Mikio Kawamura
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  5. Hiromi Yasuda
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  6. Takeshi Yokoe
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  8. Yoshiki Okita
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  9. Masaki Ohi
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  10. Kaname Nakatani
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Contributions

Study concept and design (YO, YT); provision of samples (HF, MK, HY, TY, YO, MO); acquisition of data (YO, YT, HF, MK, HY, TY, IM, YO, MO, KN); analysis and interpretation of data (YO, YT, MO, KN); statistical analysis (YO, YT); drafting of the manuscript (YO, YT, KN).

Corresponding author

Correspondence to Yoshinaga Okugawa.

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Conflict of interests

We have no conflict of interests to disclose for this study.

Ethics approval and consent to participate

This retrospective observational study was approved by the institutional review board of Mie University Hospital. We offered an opt-out for participants to provide the opportunity to decline participation in the study. This study was performed in accordance with the Declaration of Helsinki.

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Not applicable.

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Okugawa, Y., Toiyama, Y., Fujikawa, H. et al. Cumulative perioperative lymphocyte/C-reactive protein ratio as a predictor of the long-term outcomes of patients with colorectal cancer. Surg Today 51, 1906–1917 (2021). https://doi.org/10.1007/s00595-021-02291-9

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  • DOI: https://doi.org/10.1007/s00595-021-02291-9

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