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. 2021 Dec;51(12):1906-1917.
doi: 10.1007/s00595-021-02291-9. Epub 2021 May 5.

Cumulative perioperative lymphocyte/C-reactive protein ratio as a predictor of the long-term outcomes of patients with colorectal cancer

Yoshinaga Okugawa  1   2 , Yuji Toiyama  3 , Hiroyuki Fujikawa  3 , Mikio Kawamura  3 , Hiromi Yasuda  3 , Takeshi Yokoe  3 , Ikuyo Mochiki  4 , Yoshiki Okita  3 , Masaki Ohi  3 , Kaname Nakatani  4
Affiliations

Cumulative perioperative lymphocyte/C-reactive protein ratio as a predictor of the long-term outcomes of patients with colorectal cancer

Yoshinaga Okugawa et al. Surg Today. 2021 Dec.

Abstract

Purpose: Systemic inflammatory response influences cancer development and perioperative surgical stress can affect the survival of patients with colorectal cancer (CRC). We developed a system to cumulatively assess perioperative inflammatory response and compare the prognostic value of various cumulative inflammatory and nutritional markers in patients with CRC.

Methods: We assessed perioperative cumulative markers using the trapezoidal area method in 307 patients who underwent surgery for CRC and analyzed the results statistically.

Results: The cumulative lymphocyte to C-reactive protein (CRP) ratio (LCR) predicted survival more accurately than other well-established markers (sensitivity: 80.0%, specificity: 69.3%; area under the curve (AUC): 0.779; P < 0.001). A low cumulative LCR was correlated with factors associated with disease development, including undifferentiated histology, advanced T stage, lymph node metastasis, distant metastasis, and advanced TNM stage classification. A decreased cumulative LCR was an independent prognostic factor for both overall survival (OS) (Hazard Ratio (HR):5.21, 95% confidence interval [CI] 2.42-11.2; P < 0.0001) and disease-free survival (DFS) (HR: 1.88, 95% CI 1.07-3.31; P = 0.02), and its prognostic significance was verified in a different clinical setting. The cumulative LCR was correlated negatively with the intraoperative bleeding volume (P < 0.0001, R = -0.4). Combined analysis of cumulative and preoperative LCR could help stratify risk for the oncological outcomes of CRC patients.

Conclusions: The findings of this study demonstrate the value of the cumulative LCR in the postoperative management of patients with CRC.

Keywords: Colorectal cancer; Lymphocyte-C-reactive protein ratio; Perioperative cumulating of systemic inflammation; Prognosis.

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