Correlation Of Neutrophil To Lymphocyte Ratio,Platelet To Lymphocyte Ratio And Systemic Immune-inflammation Index With Prognosis Of Metastatic Right-and Left-sided Colorectal Cancer

Objective The study aims to evaluate the correlation between inflammatory markers such as neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR)and systemic immune-inflammation index(SII)with prognosis of metastatic colorectal cancer(mCRC),and to explore the differences of prognostic value of inflammatory markers on patients with right-sided colon cancer(RCC)and left-sided colon cancer(LCC).Methods 92 previously untreated patients with metastatic colorectal cancer(mCRC)were divided into RCC group and LCC group,RCC were defined as primary tumors from cecum to transverse colon,while tumors from rectum to splenic flexure were regarded left sided.the clinical and laboratory data of all patients were retrospectively analyzed.Checked the blood routine examination in a week pretreatment,and work out the NLR,PLR and SII by collected the neutrophils count,platelet count and lymphocyte count.We analyzed the relationship between primary tumor location and inflammatory indexes.Further more,the differences of prognostic role of inflammatory markers on patients with RCC and LCC were compared using statistical methods.Results A total of 92 patients diagnosed with untreated RCC and LCC(46 and 46 respectively)were included in the study,and the median age was 62 years(range from 23 to 88 years).There were 49 males(52.3%)and 43 females(46.7%).1.Of all patients with mCRC,46 had high NLR values,49 had high PLR values and 45 had high SII values.There were differences in gender,ECOG performance status,Number of metastatic sites,Inflammatory indexes(peripheral neutrophil count,platelet count,lymphocyte counts,NLR,PLR and SII)between RCC and LCC(P﹤0.05).2.Patients with NLR﹥3,PLR﹥150 and SII﹥650 were all associated with ECOG performance status,Albumin and Number of metastatic sites,were also correlated with primary tumor location and more often seen in RCC.3.The median OS of all patients was 16.3 months,the median OS was 13.9 months and 18.7 months in RCC and LCC respectively(P﹤0.05).Primary tumor location was not an independent factor of OS(HR=1.166,95% CI 0.709-1.917,P=0.545).4.Univariate analysis found ECOG performance status,Albumin,Number of metastatic sites,NLR,PLR and SII were significant predictors of OS in RCC patients and all patients.ECOG performance status,Albumin,Number of metastatic sites,NLR were significantly associated with OS in patients with LCC.In multivariate analysis,The ECOG performance status≥1,hypoalbuminaemia,number of metastatic sites﹥1 and NLR﹥3 were associated with worse OS in RCC,LCC and all patients.Conclusion Our results demonstrate that pretreatment NLR is a reliable prognostic predictor for patients with mCRC,especially for RCC.Patients with LCC have superior OS compared with RCC,but primary tumor location was not an independent factor.