Nomograms for predicting prognostic value of inflammatory biomarkers in colorectal cancer patients after radical resection

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Increasing evidence indicates that inflammation plays a vital role in tumorigenesis and progression. However, the prognostic value of inflammatory biomarkers in colorectal cancer (CRC) has not been established. In this study, a retrospective analysis was conducted in patients with CRC in Fudan University Shanghai Cancer Center (FUSCC) between April 1, 2007 and April 30, 2014, and 5,336 patients were identified eligible. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and albumin/globulin ratio (AGR) were analyzed. Kaplan-Meier analysis was used to calculate the 5-year overall survival (OS) and disease-free survival (DFS). Cox regression analysis was performed to assess the prognostic factors. Nomograms were established to predict OS and DFS, and Harrell's concordance index (c-index) was adopted to evaluate prediction accuracy. As results, the 5-year OS was 79.2% and the 5-year DFS was 56.0% in the cohort. Patients were stratified into 2 groups by NLR (≤2.72 and >2.72), PLR (≤219.00 and >219.00), LMR (≤2.83 and >2.83) and AGR (<1.50 and ≥1.50). Patients with NLR>2.72, PLR>219.00, LMR≤2.83 and AGR<1.50 were significantly associated with decreased OS and DFS (p<0.001). Multivariate analysis indicated that NLR, LMR and AGR were independent factors of OS (p=0.047, p=0.008 and p<0.001, respectively) and DFS (p=0.009, p<0.001 and p=0.008, respectively). In addition, nomograms on OS and DFS were established according to all significant factors, and c-indexes were 0.765 (95% CI: 0.744–0.785) and 0.735 (95% CI: 0.721–0.749), respectively. Nomograms based on OS and DFS can be recommended as practical models to evaluate prognosis for CRC patients.

What's new?

Host inflammatory response plays a critical role in the development and progression of colorectal cancer (CRC). Hence, inflammatory biomarkers, such as neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio and albumin/globulin ratio, are potentially able to predict patient outcome in CRC. In this study, pretreatment serum levels of inflammatory biomarkers were found to predict overall survival and disease-free survival in CRC, based on retrospective analysis of 5,336 CRC patients admitted to China's Fudan University Shanghai Cancer Center between 2007 and 2014. Nomograms incorporating the inflammatory markers were successfully established and could be used to refine predictions of CRC outcome.

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