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Colorectal cancer (CRC) is the third most common cancer in men and second in women with 1.8 million new cases (1,026,000 men and 823, 3 women) and almost 881.000 deaths (Fitzmaurice et al, 2017). Rates are substantially higher in males than in females Worldwide in 2018.
It’s increasingly recognized that variations in outcome in cancer patients are not solely determined by the characteristics of the tumor, but also by the host response factors and systemic inflammatory response. The tumor microenvironment, particularly the inflammatory response, proven to play an important role in in cancer development and progression especially neutrophil to lymphocyte ratio (NLR) and platelet count.
Aim of study:
In this retrospective study we aimed to evaluate the prognostic impact of baseline NLR and platelet count on the clinicopathological factors and outcome in patients of all stages Colorectal cancer treated from 1st of January 2014 to30 December 2016 in Department of Clinical Oncology and Nuclear Medicine, Ain Shams University hospitals, Cairo, Egypt.
Patients and methods:
Out of 409 patient’s medical records in the GI oncology unit, Ain Shams Clinical Oncology Department were reviewed from the period between 1st of January 2014 to 30 December 2016. Total neutrophils, lymphocytic, and platelets’ counts were available for only 169 patients. Study ended in 1st of August 2018 with median period of follow up of 27.5 month, ranging between 1/1/2014 to 1/8/2018.
All patients (169) were pathologically proven colorectal adenocarcinoma, with age ranging from 18-75 years old (median age: 55.5 yrs.)
The median age of patients was 55 years old, females were more affected than males, 66 (39.1%) males and 103 (60.9%) female.
Urban residents constituted 52.7% of cases, while rural residents constituted 13% of cases, this finding is similar to that reported from developed countries
Positive family history found in 18.9% of patients in this study.
Median of disease free survival was 19.8 month and median of PFS was 15 month in the metastatic group from the start.
Out of 169 patients enrolled in this study, 124 patients were resectable and underwent curative surgeries (right hemicolectomy, left hemicolectomy, APR and LAR), 44 patients tumour was right located and 80 patient’s tumour located in the left sided colon. 45 patients were metastatic from the start, at the end of this study, fifty patients (29.6%) died
Inadequate lymph node dissection (less than 12 lymph node) was noted in 41 (33.1%) patients in resected patients and it was statistically significant for both DFS and OAS by (P Value= .003) and (P Value= .002) respectively, this met the western literature that recommended that the larger number of nodes may reflect the quality of the surgery and a more complete resection of the mesenteric pedicle.
(ROC) curve was used to define the best cut off value of all laboratory data needed in this study.
CEA cutoff was ≥5 and it was statistically significant between early and advanced cancer patients in our study (P Value = .04).
Platelets cutoff was ≥ 310 in our study
OS, PFS and DFS were shorter in patients with elevated platelet counts than in patients with normal counts with significance statistically, (P values <.001, <.001 and 0.007) respectively.
Pre-treatment platelet revealed more frequent thrombocytosis in metastatic group than locally advanced group, yet statistically was not significant (P Value= .066).
NLR cut-off was ≥2, among 169 enrolled patients, OS, PFS and DFS were shorter in patients with elevated NLR ratio than in patients with normalized ratio with significance statistically. (P values <.001, .002 and <.001) respectively, which met end point of many international studies.
Binary Logestic Multi-Regression analysis was done for both platelet count and NLR with variables that showed significance statistically.
Showed that NLR is both independent prognostic and predictor factor for DFS, PFS and OAS. (sig. = .03, .03, ≤0.001 respectively).
And platelet count is both independent prognostic factor and predictor for both PFS, OS with significance = .04, =.03 respectively).
This study showed that abnormal NLR ratio (≥2) acting as a prognostic and predictor of decrease in DFS, PFS and OS in all patients groups.
It also showed that abnormal platelet count (≥310) is prognostic and predictor of significant decrease in PFS and OS.
Multidisciplinary management is needed to aware surgeons about importance of adequate lymph node dissection, our study showed a statistically significant decrease in OAS in patients underwent inadequate LNs dissection.