Original StudyNeutrophil-related Variables Have Different Prognostic Effect Based on Primary Tumor Location in Patients With Metastatic Colorectal Cancer Receiving Chemotherapy
Introduction
Colorectal cancer (CRC) is the second leading cause of cancer death among men and the third among women in the European Union.1 About 15% to 25% of patients with CRC are diagnosed with synchronous metastases, and another 10% to 20% develop metastases later.2 A meta-analysis of 13 prospective trials concluded that the primary tumor localization along the colon is prognostic in metastatic colorectal cancer (mCRC), and was associated with a different activity of anti-neoplastic drugs.3
Systemic inflammation response (SIR) in CRC can play dual roles, contributing to anti-neoplastic response or promoting tumor cell proliferation and metastasis.4 Data from controlled clinical trials and retrospective studies reported a significant relationship between neutrophil-to-lymphocyte ratio (NLR) or derived neutrophil-to-lymphocyte ratio (dNLR) and outcome of patients with mCRC.5, 6, 7, 8, 9 Although inflammation plays a role in the development of metastases, many studies have not confirmed the relationship between NLR and overall survival (OS) in mCRC. Recently, however, one of these studies has reported a significant relationship between the platelet-to-lymphocyte ratio (PLR) and OS only among patients with left-sided mCRC.10 Finally, the neutrophil platelet score (NPS) has been studied in 308 patients with localized CRC, and this study concluded that NPS was able to predict prognosis within each stage of disease.11 In patients with other metastatic neoplasms, NPS was superior to NLR,12 but no data about NPS in mCRC are available.
The purpose of this study is to verify whether the neutrophil-related variables predict the outcome of patients with mCRC receiving a first-line chemotherapy (CHT), and whether there are differences by tumor location.
Section snippets
Patients and Treatments
Data of patients with a diagnosis of mCRC, registered in the database of the division of Medical Oncology of the Ospedale Civile di Sanremo, were analyzed, and those patients who received at least 1 cycle of first-line CHT between January 2010 and January 2013 were collected. Patients were included in the present analysis if they were diagnosed with TNM stage IV or a relapse of the CRC, had a censoring, and have signed an informed consent form. All the results of the complete blood counts
Results
Of 145 screened patents with mCRC receiving CHT, 140 received at least 1 complete cycle of first-line CHT and were eligible by the criteria of the current analysis. The characteristics of the 140 selected patients are reported in Table 1.
The median OS was 19.8 months (range, 2.2-106.9 months). NLR was available for 88 patients, and there was a high level of collinearity with dNLR (Pearson rho = 0.916; P-value < .001), thus NLR was excluded from the further analyses. After controlling for the
Discussion
The conclusion of the present study about the neutrophil-related variables in patients with mCRC receiving CHT is that an independent relationship with OS is evident for rectal tumors, whereas neutrophil-related variables have no prognostic role in right-sided and left-sided CRC. To date, this location-related difference has been demonstrated only for PLR,10 and not for the neutrophil count, the dNLR, or NPS. Although the prognostic relevance of tumor location along the colon-rectum is not
Disclosure
The authors have stated that they have no conflicts of interest.
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