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
ARTICLE HIGHLIGHTS
Research background

Colorectal cancer (CRC) 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. Recent studies showed that inflammation is a crucial issue in the pathogenesis and development of cancer, especially in tumour progression. However, little is known about the prognostic value of the 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 patients diagnosed with CRC.

Research motivation

Effective research on haematologic markers that can improve the diagnosis of colorectal cancer and establish patient prognosis.

Research objectives

The aim of the study was to evaluate the prognostic value of absolute monocyte count, MLR, the combination of NLR-PLR, and PLT-NLR in peripheral blood samples of patients with colorectal cancer undergoing surgery.

Research methods

We respectively enrolled CRC patients who undergone surgery between April 2014 and December 2016 in the Department of Oncological Surgery, Comprehensive Cancer Centre (Bialystok, Poland). 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 and were examined in correlation with various pathomorphological and clinical factors. Receiver operating characteristic curve analysis was used to investigate cut-off values for the pre- and postoperative haematologic factors examined. 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.

Research results

The analysis showed that 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 in the blood samples obtained after surgery were positively associated with the 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 in 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.

Research conclusions

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