Preoperative neutrophil-lymphocyte ratio and CEA is associated with poor prognosis in patients with synchronous colorectal cancer liver metastasis

Abstract

Purpose: Recently, the neutrophil-to-lymphocyte ratio (NLR), an inflammatory response marker, has been reported to be associated with the prognosis in patients with various type of cancer. However, there have been no studies until now that have explored the prognostic role of combined detection of NLR and CEA in patients with synchronous liver-limited colorectal metastases (sCRLM).

Methods: Eighty-three patients who histologically diagnosed as sCRLM were selected. Their laboratory and clinical data were collected retrospectively. Using receiver operating characteristic curve analysis, the cutoff value of NLR was calculated based on which patients were assigned to a high NLR (more than 1.94) group and low NLR (less than 1.94) group. A cutoff value of 100 ng/mL for serum CEA level was used in light of the previous literature.

Results: CEA level and Poorly differentiated histology of colon cancer was significantly correlated with high NLR (P = 0.005 and P = 0.048, respectively). The multivariate analysis identified the high NLR as independent prognostic factors for OS and DFS in all patients (P = 0.010 and P = 0.006, respectively). Patients with both low levels of NLR and CEA had a significantly longer OS and DFS (P = 0.026 and P = 0.009, respectively).

Conclusion: In conclusion, elevated preoperative NLR is strongly correlated with both survival and recurrence in patients who have been diagnosed with resectable sCRLM. The combination of NLR and CEA level could be a more powerful prognostic marker than NLR alone.

Keywords: Carinoembryonic antigen; Colonic neoplasms; Liver; Metastasis; Neutrophils; Prognosis.

Fig. 1. Kaplan-Meier survival curves for overall survival (OS) and disease-free survival (DFS) in patients with synchronous liver-limited colorectal metastase according to their neutrophil-to-lymphocyte ratio (NLR) and CEA levels. (A) OS according to NLR, (B) DFS according to NLR, (C) OS according to CEA levels, (D) DFS according to CEA levels, (E) OS according to combination of NLR and CEA levels (group 1: both high, group 2: either high, group 3 both low), (F) DFS according to combination of NLR and CEA levels (group 1: both high, group 2: either high, group 3 both low).