Clinical Significance Of Circulating Tumor Cells And Inflammatory Parameters In Patients With Colorectal Cancer

OBJECTIVE: To investigate the association between CTC and clinical information,NLR and PLR in colorectal cancer,and to evaluate the prognostic value of CTC,NLR and PLR levels in colorectal cancer patients.METHODS: 118 cases of colorectal cancer patients who were diagnosed and treated in the department of general surgery and oncology of Affiliated Zhongshan hospital of Dalian University from January 1,2014 to December 31,2017 were collected for retrospective analysis.Including 72 patients after radical surgery of stageⅠ-Ⅲ and 46 cases of patients with advanced first-line chemotherapy.Blood samples were collected on an empty stomach after admission,CTCs of patients were detected by Cell Search technology,meanwhile,neutrophils,lymphocytes and platelets counts of each patient were detected by the automatic blood routine detector,and then calculate the NLR and PLR values.CTC counts≥1 was defined as CTC positive,CTC counts=0 as CTC negative,and the median value of NLR and PLR was taken as the cutoff value for grouping.Statistical analysis was performed using SPSS19.0 software,and the difference was statistically significant when P < 0.05.Analyze the correlation between CTC counts and clinical parameters,NLR,PLR,as well as the relationship between CTC,NLR and PLR levels and prognosis of the patients suffering colorectal cancer.RESULTS: The median NLR of the118 patients was 2.02(0.89-8.70),the median PLR was 117.81(44.71-325.71),the CTC value was(2.2±6.76)/7.5ml,and the CTC positive rate was 33.05%(39/118).The CTC value of 72 patients after radical resection was(1.29±6.22)/7.5ml,and the positive rate was 23.61%(17/72),the patients’ CTC levels were not related to age,gender,tumor location,T stage,NLR,PLR(P>0.05)but related to tumor stage,N stage,the differences were statistically significant(P=0.035,P=0.025).In addition,the median DFS(disease-free survival time)of patients in the CTC negative group,the low NLR group and the low PLR group after the radical resection of stageⅠ-Ⅲ patients were respectively longer than those in the CTC positive group,the high NLR group and the high PLR group,but the differences were not statistically significant(P=0.258,P=0.073,P=0.166).A total of 46 patients with advanced colorectal cancer and their CTC value was(3.63±7.38)/7.5ml,and the positive rate was 47.83%(22/46),the CTC levels of patients with advanced colorectal cancer were related to the NLR and PLR(P=0.008,P=0.034);It was not related to age,gender,tumor location and presence or absence of liver metastasis(P>0.05).The median PFS(progression-free survival time)of CTC negative group,low NLR group and low PLR group were significantly longer than that of CTC positive group,high NLR group and high PLR group,(P=0.011,P=0.005,P=0.027).COX regression analysis showed that CTC(HR=1.925,95%CI:1.008-3.676,P=0.047)and NLR level(HR=0.503,95%CI:0.257-0.981,P=0.044)were independent factors affecting the prognosis of patients with advanced first-line chemotherapy for colorectal cancer.According to different chemotherapy regimens,46 patients with advanced colorectal cancer were further divided into three groups: 13 patients with FOLFOX regimen,18 patients with FOLFORI regimen,and 15 patients with other chemotherapy regimens.In the subgroup analysis of three different chemotherapy regimens,the median PFS of the CTC negative group,the low NLR group and the low PLR group were all longer than those of the CTC positive group,the high NLR group and the high PLR group,and some of the differences were statistically significant.In the correlation analysis of CTC counts with NLR and PLR,the CTC counts was not related to NLR(P=0.079),but related to PLR(P=0.011)in the patients after radical resection.but in the patients with advanced colorectal cancer,CTC counts was significantly correlated with NLR and PLR(P=0.001,P<0.001).CONCLUSIONS: In the patients after radical resection of stageⅠ-Ⅲwith colorectal cancer,the CTC levels was related to tumor stage and N stage,has nothing to do with the other clinical parameters.CTC counts was correlated with NLR and PLR.The levels of CTC,NLR and PLR are of certain value in the prognosis evaluation of colorectal cancer patients,besides CTC and NLR levels are independent factors affecting the prognosis of patients with advanced colorectal cancer.