Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2022; 10(20): 6825-6844
Published online Jul 16, 2022. doi: 10.12998/wjcc.v10.i20.6825
Longitudinal changes in personalized platelet count metrics are good indicators of initial 3-year outcome in colorectal cancer
Zoltan Herold, Magdolna Herold, Julia Lohinszky, Attila Marcell Szasz, Magdolna Dank, Aniko Somogyi
Zoltan Herold, Attila Marcell Szasz, Magdolna Dank, Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, Budapest 1083, Hungary
Zoltan Herold, Magdolna Herold, Julia Lohinszky, Aniko Somogyi, Department of Internal Medicine and Hematology, Semmelweis University, Budapest 1088, Hungary
Author contributions: Herold Z, Somogyi A, and Dank M built the study design; Herold Z and Herold M were involved in the collection of patient data; Herold Z performed the statistical analysis of data; Herold Z, Herold M, and Szasz AM interpreted the data; Lohinszky J and Dank M were involved in patient selection; Herold Z prepared the draft of the manuscript; all authors were involved in manuscript editing and reviewing; Herold Z and Dank M received funding; Somogyi A supervised the study; all authors have read and agreed to the published version of the manuscript.
Supported by the New National Excellence Program of the Hungarian Ministry for Innovation and Technology from the source of the National Research, Development and Innovation Fund, No. UNKP-20-4-I; and the Hungarian National Research, Development and Innovation Office, No. NVKP_16-1-2016-0042.
Institutional review board statement: The study was approved by the Regional and Institutional Committee of Science and Research Ethics, Semmelweis University (SE TUKEB 21-14/1994, approval date of latest modification: February 23, 2021).
Informed consent statement: Patient data was retrieved anonymously from the medical database of Semmelweis University in a retrospective manner. A general consent form for academic assessment studies of all admitted patients was signed upon their treatment back in those years. Signed patient informed consent for further research at that time was not required given the anonymized, de-identified data.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on 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: Zoltan Herold, MSc, PhD, Research Scientist, Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, Tomo u. 25-29, Budapest 1083, Hungary. herold.zoltan@med.semmelweis-univ.hu
Received: October 15, 2021
Peer-review started: October 15, 2021
First decision: December 12, 2021
Revised: December 23, 2021
Accepted: May 22, 2022
Article in press: May 22, 2022
Published online: July 16, 2022
Processing time: 262 Days and 16.6 Hours
Abstract
BACKGROUND

Platelet count or complete blood count (CBC)-based ratios including lymphocyte-to-monocyte (LMR), neutrophil-to-lymphocyte (NLR), hemoglobin-to-platelet (HPR), red blood cell count distribution width-to-platelet (RPR), and platelet-to-lymphocyte (PLR) ratio are good predictors of colorectal cancer (CRC) survival. Their change in time is not well documented, however.

AIM

To investigate the effect of longitudinal CBC ratio changes on CRC survival and their possible associations with clinicopathological properties, comorbidities, and anamnestic data.

METHODS

A retrospective longitudinal observational study was conducted with the inclusion of 835 CRC patients, who attended at Semmelweis University, Budapest. CBC ratios and two additional newly defined personalized platelet count metrics (pPLTD and pPLTS, the platelet counts relative to the measurement at the time of CRC diagnosis and to the one 4-6 wk after tumor removal surgery, respectively) were recorded.

RESULTS

The 835 CRC patients had a total of 4608 measurements (5.52 visits/patient, in average). Longitudinal survival models revealed that the increases/decreases in LMR [hazard ratio (HR): 0.4989, P < 0.0001], NLR (HR: 1.0819, P < 0.0001), HPR (HR: 0.0533, P = 0.0038), pPLTD (HR: 4.9229, P < 0.0001), and pPLTS (HR: 4.7568, P < 0.0001) values were poor prognostic signs of disease-specific survival. The same was obtained for all-cause mortality. Most abnormal changes occurred within the first 3 years after the diagnosis of CRC. RPR and PLR had an only marginal effect on disease-specific (P = 0.0675) and all-cause mortality (Bayesian 95% credible interval: 0.90–186.05), respectively.

CONCLUSION

LMR, NLR, and HPR are good metrics to follow the prognosis of the disease. pPLTD and pPLTS perform just as well as the former, while the use of RPR and PLR with the course of the disease is not recommended. Early detection of the abnormal changes in pPLTD, pPLTS, LMR, NLR, or HPR may alert the practicing oncologist for further therapy decisions in a timely manner.

Keywords: Personalized platelet count; Lymphocyte-to-monocyte ratio; Neutrophil-to-lymphocyte ratio; Hemoglobin-to-platelet ratio; Platelet-to-lymphocyte ratio; Colorectal neoplasms

Core Tip: While the ability of various pre- and post-operative parameters of ratios from complete blood count to predict colorectal cancer (CRC) patient survival is known, their longitudinal changes with the course of the disease are not well documented. Temporal changes of complete blood count ratios of 835 CRC patients were investigated in this retrospective analysis. Two newly defined personalized platelet count metrics were introduced, and two distinct patterns were identified within the parameters examined. Most abnormal changes of the parameters occurred within the first 3 years after the diagnosis of CRC, which coincided with most of the CRC-related deaths.