Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2020; 26(31): 4639-4655
Published online Aug 21, 2020. doi: 10.3748/wjg.v26.i31.4639
Monocyte-to-lymphocyte ratio as a prognostic factor in peripheral whole blood samples of colorectal cancer patients
Katarzyna Jakubowska, Mariusz Koda, Małgorzata Grudzińska, Luiza Kańczuga-Koda, Waldemar Famulski
Katarzyna Jakubowska, Luiza Kańczuga-Koda, Department of Pathomorphology, Comprehensive Cancer Centre, Bialystok 15027, Poland
Mariusz Koda, Małgorzata Grudzińska, Department of General Pathomorphology, Medical University of Bialystok, Bialystok 15027, Poland
Waldemar Famulski, Department of Medical Pathomorphology, Medical University of Bialystok, Bialystok 15027, Poland
Author contributions: Jakubowska K collected and analysed the data, reviewed the literature, acquired the data and contributed to manuscript drafting; Koda M analysed and interpreted the pathological examinations; Famulski W and Kańczuga-Koda L collected data; Grudzińska M reviewed the literature, acquired the data and contributed to manuscript drafting; all authors issued final approval for the version to be submitted.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Medical University of Bialystok, Poland.
Informed consent statement: Written informed consent was not required, and informed consent included an opt-out clause approved by the Medical Ethics Committee.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Katarzyna Jakubowska, PhD, Academic Research, Department of Pathomorphology, Comprehensive Cancer Centre, 12 Ogrodowa Street, Bialystok 15027, Poland. kathian@wp.pl
Received: February 20, 2020
Peer-review started: February 20, 2020
First decision: March 24, 2020
Revised: April 9, 2020
Accepted: July 18, 2020
Article in press: July 18, 2020
Published online: August 21, 2020
Processing time: 182 Days and 20.1 Hours
Abstract
BACKGROUND

Colorectal cancer is the third most common malignancy worldwide. Therefore, it is critically important to identify new useful markers that can be easily obtained in routine practice. Inflammation is a crucial issue in the pathogenesis and development of cancer.

AIM

To evaluate the prognostic value of absolute monocyte count, monocyte to lymphocyte ratio (MLR), the combination of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio (NLR-PLR), and combined platelet and neutrophil-to-lymphocyte ratio (PLT-NLR) in peripheral blood samples of patients with colorectal cancer undergoing surgery.

METHODS

We conducted a retrospective study of 160 patients with colorectal cancer who underwent surgery, and 42 healthy controls. The status of absolute monocyte count, MLR, NLR-PLR and PLT-NLR was calculated on the basis of blood samples obtained before and after surgery. Haematologic factors were examined in correlation with the type of tumour growth, tumour size, histological type, percentage of mucinous component, grade of malignancy, Tumour-Node-Metastasis stage, venous, lymphatic and perineural invasion of cancer cells, status of lymph node invasion and the presence of cancer cell deposits. The Kaplan-Meier method and the long-rank test were used to compare survival curves. To determine independent prognostic factors, univariate and multivariate Cox proportional hazards regression models were applied.

RESULTS

The PLT-NLR status was correlated with tumour size and the presence of perineural invasion (P = 0.015; P = -0.174, P = 0.037). Moreover, high NLR-PLR and PLR-NLR ratios in the blood samples obtained after surgery were positively associated with histological type of cancer and percentage of the mucinous component (NLR-PLR: P = 0.002; P = 0.009; PLR-NLR status: P = 0.002; P = 0.007). The analysis of 5-year disease-free survival showed that the MLR of whole blood obtained after surgery [HR = 2.903, 95%CI: (1.368-6.158), P = 0.005] and the status of lymph node metastasis [HR = 0.813, 95%CI: (0.653-1.013), P = 0.050] were independent prognostic factors in colorectal cancer patients.

CONCLUSION

The postoperative MLR in whole blood samples can be used as an independent prognostic factor in patients diagnosed with colorectal cancer.

Keywords: Monocyte count; Monocyte to lymphocyte ratio; Platelet; Neutrophil-to-lymphocyte ratio; Colorectal cancer; Prognosis

Core tip: This is a retrospective study evaluating the monocyte-to-lymphocyte ratio in peripheral whole blood samples of colorectal cancer patients. Haematologic parameters can be useful in the diagnosis and prognosis of colorectal cancer. The monocyte-to-lymphocyte ratio of whole blood obtained after surgery was an independent factor in the 5-year disease-free survival time of colorectal cancer patients.