Combination Of Preoperative NLR With FAR To Evaluate The Prognosis Of Colorectal Cancer

Objective: To investigate the clinical significance of the combination of the preoperative neutrophil to lymphocyte ratio(NLR)with the preoperative fibrinogen to albumin ratio(FAR)in evaluating the prognosis of patients with colorectal cancer.Methods: A retrospective analysis of the clinical data of 137 patients with colorectal cancer who underwent surgery from March 2013 to December 2014 in the gastrointestinal/hernia surgery department of the First Affiliated Hospital of China Medical University,and then collected data.The cutoff value of NLR and FAR are 2.706 and 0.108 respectively determined by the ROC curve,,next,the 137 patients with colorectal cancer were divided into 4 groups.Patients with NLR <2.706 and FAR <0.108 were assigned to the 1st group.Patients with NLR <2.706 and FAR > 0.108 were assigned to 2nd group.Patients with NLR > 2.706 and FAR < 0.108 were assigned to 3rd group.Patients with NLR > 2.706 and FAR > 0.108 were assigned to 4th group.Analyse respectively the relationship between NLR,FAR and the pathological features of colorectal cancer.apply univariate analysis and multivariate analysis to the below pathological features:Gender,age,tumor location,tumor size,NLR,FAR,tumor differentiation,history of smoking,history of diabetes,postoperative complications,depth of tumor invasion,distant metastasis and Pathological stage.And then,the area under the ROC curve of NLR,FAR,NLR combine with FAR were compared to evaluate their ability for predicting the prognosis of colorectal cancer,respectively.Finally,a survival analysis of the groups was performed to compare the survival rates of the patients in each group.Results: The relationship between NLR and tumor location(p=0.033),tumor size(p=0.002),and distant metastasis(p=0.011)was statistically significant.FAR was statistically significant in relation to tumor location(p=0.013),tumor size(p<0.001),depth of invasion(p=0.009),and distant metastasis(p=0.011).Univariate analysis: NLR(p<0.001),FAR(p=0.001),postoperative complications(p=0.023),depth of tumor invasion(p<0.001),distant metastasis(p<0.001),and pathological staging(p=0.005)was statistically significant.Multivariate analysis: NLR(p=0.002),FAR(p=0.038),postoperative complications(p=0.008),and distant metastasis(p=0.044)wereindependent risk factors for prognosis.Comparing the AUC: the area under the curve of the NLR alone method is 0.701(P=0.003),the area under the curve of the FAR alone method is 0.068(P=0.006).The largest area under the ROC curve was the NLR combine with FAR method,which equals to 0.763(P < 0.001).Survival analysis: 1st group(3years OS = 93.8%)has the best prognosis,4th group(3 years OS = 42.1%)has the worst prognosis,and the difference among four groups were statistically significant(p <0.001).Conclusions: the elevated preoperative NLR and FAR are associated with the malignant behavior and poor prognosis of colorectal cancer,the combination of NLR with FAR comprehensively analyse the four preoperative hematological parameters-immunology(Lymphocyte),inflammation(Neutrophil),hemodynamics(Fibrinogen),nutrition(Albumin),which can more effectively assess the prognosis of patients with colorectal cancer.