Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2024; 16(2): 438-450
Published online Feb 27, 2024. doi: 10.4240/wjgs.v16.i2.438
Preoperative neutrophil-to-lymphocyte ratio predicts symptomatic anastomotic leakage in elderly colon cancer patients: Multicenter propensity score-matched analysis
Chao-Yang Wang, Xiao-Long Li, Xiao-Long Ma, Xiong-Fei Yang, Yong-Yong Liu, Yong-Jiang Yu
Chao-Yang Wang, Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou 730000, Gansu Province, China
Xiao-Long Li, Yong-Jiang Yu, Department of Gastrointestinal Surgery, First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
Xiao-Long Ma, Department of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu Province, China
Xiong-Fei Yang, Department of Anorectology, Gansu Provincial People’s Hospital, Lanzhou 730000, Gansu Province, China
Yong-Yong Liu, Department of General Surgery, The Second Hospital Affiliated to Lanzhou University, Lanzhou 730000, Gansu Province, China
Author contributions: Wang CY and Li XL performed the study conceptualization and design, statistical analysis, and manuscript preparation; Wang CY, Ma XL, and Liu YY contributed to data acquisition; Yang XF, Liu YY, and Yu YJ contributed to data quality assessment; Li XL contributed to data interpretation; Wang CY drafted the initial manuscript; Yu YJ reviewed and revised the paper; and all authors have read and agreed to the published version of the manuscript.
Supported by the Natural Science Foundation of Gansu Province, China, No. 21JR1RA075 and No. 22JR5RA895; and Lanzhou Science and Technology Program, China, No. 2021-1-109.
Institutional review board statement: The study was reviewed and approved by the Medical Ethics Committee of the First Hospital of Lanzhou University (leading center of the study, approval No. LDYYLL-2023-363).
Informed consent statement: The requirement of informed consent was waived by the Medical Ethics Committee of the First Hospital of Lanzhou University due to the retrospective nature of the study and the absence of any risk.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data analyzed in this study is available from the corresponding author upon reasonable request.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong-Jiang Yu, Doctor, MD, Academic Editor, Adjunct Professor, Chief Doctor, Professor, Department of Gastrointestinal Surgery, First Hospital of Lanzhou University, No. 1 Donggang West Road, Lanzhou 730000, Gansu Province, China. ylongy@163.com
Received: October 15, 2023
Peer-review started: October 15, 2023
First decision: December 6, 2023
Revised: December 18, 2023
Accepted: January 15, 2024
Article in press: January 15, 2024
Published online: February 27, 2024
ARTICLE HIGHLIGHTS
Research background

The neutrophil-to-lymphocyte ratio (NLR) is a complex inflammatory biomarker that is associated with prognosis in patients with colorectal tumors. However, it is unclear whether NLR can be used as a predictor of postoperative symptomatic anastomotic leakage (AL) in elderly colon cancer patients.

Research motivation

The discovery of biomarkers able to predict AL early after colorectal surgery would bring consistent advantages in the management and outcomes of this complication. NLR is a low-cost, easy-to-perform, and widely available index. Here, we aimed to investigate the NLR as an early available predictive marker for AL.

Research objectives

To assess the role of preoperative NLR in predicting the development of symptomatic AL after surgery in elderly patients with colon cancer by using propensity score matched (PSM) analysis.

Research methods

We used a retrospective analysis to examine data from elderly colon cancer patients admitted between January 2018 and December 2022 at three large medical centers. The best predictive cutoff value for NLR was determined using the receiver operating characteristic curve. All covariates were matched using a 1:1 PSM method, and finally, all variables were analyzed using univariate and multivariate logistic regression analyses to determine the correlation between NLR and the occurrence of postoperative AL and other associated risk factors.

Research results

Among 577 patients, 36 (6.2%) experienced symptomatic AL. The optimal NLR cutoff for predicting AL was 2.66. After propensity score matching, the incidence of AL was significantly higher in the NLR ≥ 2.66 subgroup compared to the NLR < 2.66 subgroup (11.5% vs 2.5%; P = 0.012). Univariate logistic regression analysis showed significant differences in blood transfusion intraoperatively and within 2 d postoperatively, preoperative albumin concentration, preoperative prognostic nutritional index, and preoperative NLR regarding AL occurrence (P < 0.05); multivariate logistic regression analysis identified NLR ≥ 2.66 [odds ratio (OR) = 5.51; 95% confidence interval (CI): 1.50-20.26; P = 0.010] and blood transfusion intraoperatively and within 2 d postoperatively (OR = 2.52; 95%CI: 0.88-7.25; P = 0.049) as risk factors for symptomatic AL occurrence.

Research conclusions

High preoperative NLR (≥ 2.66) and intraoperative, as well as postoperative (within 2 d), blood transfusions are associated with increased postoperative symptomatic AL in elderly colon cancer patients. Preoperative NLR serves as a predictor for postoperative symptomatic AL after elective surgery for elderly colon cancer patients.

Research perspectives

In the future, we plan to further confirm the clinical applicability of NLR using a prospective randomized controlled trial approach.