Pre‑operative granulocyte/lymphocyte ratio as a predictive marker of post‑operative complications in patients with colorectal cancer

Shimazaki,Jiro; Tabuchi,Takanobu; Nakachi,Takeshi; Motohashi,Gyo; Nishida,Kiyotaka; Ubukata,Hideyuki; Tabuchi,Takafumi

doi:10.3892/ol.2014.2669

Pre‑operative granulocyte/lymphocyte ratio as a predictive marker of post‑operative complications in patients with colorectal cancer

Authors:
- Jiro Shimazaki
- Takanobu Tabuchi
- Takeshi Nakachi
- Gyo Motohashi
- Kiyotaka Nishida
- Hideyuki Ubukata
- Takafumi Tabuchi
View Affiliations

Affiliations: Department of Gastrointestinal Surgery, Ibaraki Medical Center, Tokyo Medical University, Ami, Ibaraki 300‑0395, Japan
Published online on: November 4, 2014 https://doi.org/10.3892/ol.2014.2669
Pages: 425-429

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The aim of the present study was to assess the clinical relevance of the pre‑operative granulocyte/lymphocyte (G/L) ratio as a predictive marker of post‑operative complications in patients with colorectal cancer. In total, 85 patients (59 males and 26 females; mean age, 68.9 years) underwent surgery for colorectal cancer at the Department of Surgery, Ibraki Medical Center, Tokyo Medical University (Ami, Japan), and were divided into post‑operative complication and non‑complication groups. Clinical data, including age, gender, body mass index, tumor localization, tumor pathological type, cancer staging, surgery time, volume of surgical bleeding, pre‑operative G/L ratio and further pre‑operative laboratory data, including levels of albumin and C‑reactive protein, Glasgow Prognostic Score, white blood cell count and levels of hemoglobin, creatine kinase, lactate dehydrogenase, carcinoembryonic antigen and carbohydrate antigen 19‑9 were analyzed between these groups. The total post‑operative complication rate was 18.8%. On univariate analysis, the amount of surgical bleeding and the pre‑operative G/L ratio were significantly higher in the complication group than in the non‑complication group (299.8±361.7 vs. 155.6±268.6 ml, P<0.05; and 6.73±10.38 vs. 3.49±2.78, P<0.05, respectively). Multivariate logistic regression analysis for the risk factors of post‑operative complications, determined using univariate analysis, demonstrated that the amount of surgical bleeding and the pre‑operative G/L ratio were independent risk factors of post‑operative complications in patients with colorectal cancer. In conclusion, the G/L ratio may be a clinically relevant pre‑operative predictive marker for post‑operative complications.

View Figures

View References

1	Whistance RN, Forsythe RO, McNair AG, et al; Core Outcomes and iNformation SEts iN SUrgical Studies-ColoRectal Cancer Working Group. A systematic review of outcome reporting in colorectal cancer surgery. Colorectal Dis. 15:e548–e560. 2013. View Article : Google Scholar : PubMed/NCBI
2	Coussens LM and Werb Z: Inflammation and cancer. Nature. 420:860–867. 2002. View Article : Google Scholar : PubMed/NCBI
3	Walsh SR, Cook EJ, Goulder F, Justin TA and Keeling NJ: Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol. 91:181–184. 2005. View Article : Google Scholar : PubMed/NCBI
4	Halazun KJ, Aldoori A, Malik HZ, et al: Elevated preoperative neutrophil to lymphocyte ratio predicts survival following hepatic resection for colorectal liver metastases. Eur J Surg Oncol. 34:55–60. 2008. View Article : Google Scholar
5	Chua W, Charles KA, Baracos VE and Clarke SJ: Neutrophil/lymphocyte ratio predicts chemotherapy outcomes in patients with advanced colorectal cancer. Br J Cancer. 104:1288–1295. 2011. View Article : Google Scholar : PubMed/NCBI
6	Ding PR, An X, Zhang RX, et al: Elevated preoperative neutrophil to lymphocyte ratio predicts risk of recurrence following curative resection for stage IIA colon cancer. Int J Colorectal Dis. 25:1427–1433. 2010. View Article : Google Scholar : PubMed/NCBI
7	Hung HY, Chen JS, Yeh CY, et al: Effect of preoperative neutrophil-lymphocyte ratio on the surgical outcomes of stage II colon cancer patients who do not receive adjuvant chemotherapy. Int J Colorectal Dis. 26:1059–1065. 2011. View Article : Google Scholar : PubMed/NCBI
8	Shimazaki J, Goto Y, Nishida K, et al: In patients with colorectal cancer, preoperative serum interleukin-6 level and granulocyte/lymphocyte ratio are clinically relevant biomarkers of long-term cancer progression. Oncology. 84:356–361. 2013. View Article : Google Scholar : PubMed/NCBI
9	Sobin LH, Gospodarowicz MK and Wittekind C: TNM Classification of Malignant Tumors. 7th edition. Wiley-Blackwell; Oxford: 2009
10	Forrest LM, McMillan DC, McArdle CS, Angerson WJ and Dunlop DL: Evaluation of cumulative prognostic scores based on the systemic inflammatory response in patients with inoperable non-small-cell lung cancer. Br J Cancer. 89:1028–1030. 2003. View Article : Google Scholar : PubMed/NCBI
11	Jean-Claude M, Emmanuelle P, Juliette H, et al: Clinical and economic impact of malnutrition per se on the postoperative course of colorectal cancer patients. Clin Nutr. 31:896–902. 2012. View Article : Google Scholar : PubMed/NCBI
12	Lee L, Li C, Landry T, Latimer E, Carli F, Fried GM and Feldman LS: A systematic review of economic evaluations of enhanced recovery pathways for colorectal surgery. Ann Surg. 259:670–676. 2014. View Article : Google Scholar
13	Damle RN, Cherng NB, Flahive JM, Davids JS, Maykel JA, Sturrock PR, Sweeney WB and Alavi K: Clostridium difficile Infection After Colorectal Surgery: A Rare but Costly Complication. J Gastrointest Surg. Aug;2014.(Epub ahead of print). View Article : Google Scholar : PubMed/NCBI
14	Kwag SJ, Kim JG, Kang WK, Lee JK and Oh ST: The nutritional risk is a independent factor for postoperative morbidity in surgery for colorectal cancer. Ann Surg Treat Res. 86:206–211. 2014. View Article : Google Scholar : PubMed/NCBI
15	Pommergaard HC, Gessler B, Burcharth J, Angenete E, Haglind E and Rosenberg J: Preoperative risk factors for anastomotic leakage after resection for colorectal cancer: a systematic review and meta-analysis. Colorectal Dis. 16:662–671. 2014. View Article : Google Scholar : PubMed/NCBI
16	Chapuis PH, Bokey L, Keshava A, et al: Risk factors for prolonged ileus after resection of colorectal cancer: an observational study of 2,400 consecutive patients. Ann Surg. 257:909–915. 2013. View Article : Google Scholar : PubMed/NCBI
17	Telem DA, Chin EH, Nguyen SQ and Divino CM: Risk factors for anastomotic leak following colorectal surgery: a case-control study. Arch Surg. 145:371–376. 2010. View Article : Google Scholar : PubMed/NCBI
18	Aytac E, Lavery IC, Kalady MF and Kiran RP: Impact of obesity on operation performed, complications, and long-term outcomes in terms of restoration of intestinal continuity for patients with mid and low rectal cancer. Dis Colon Rectum. 56:689–697. 2013. View Article : Google Scholar : PubMed/NCBI
19	Itatsu K, Sugawara G, Kaneoka Y, et al: Risk factors for incisional surgical site infections in elective surgery for colorectal cancer: focus on intraoperative meticulous wound management. Surg Today. 44:1242–1252. 2014. View Article : Google Scholar
20	Takakura Y, Hinoi T, Egi H, et al: Procalcitonin as a predictive marker for surgical site infection in elective colorectal cancer surgery. Langenbecks Arch Surg. 398:833–839. 2013. View Article : Google Scholar : PubMed/NCBI
21	Bot J, Piessen G, Robb WB, Roger V and Mariette C: Advanced tumor stage is an independent risk factor of postoperative infectious complications after colorectal surgery: arguments from a case-matched series. Dis Colon Rectum. 56:568–576. 2013. View Article : Google Scholar : PubMed/NCBI
22	Yasunaga H, Horiguchi H, Matsuda S, et al: Body mass index and outcomes following gastrointestinal cancer surgery in Japan. Br J Surg. 100:1335–1343. 2013. View Article : Google Scholar : PubMed/NCBI
23	Ishizuka M, Nagata H, Takagi K, Horie T and Kubota K: Inflammation-based prognostic score is a novel predictor of postoperative outcome in patients with colorectal cancer. Ann Surg. 246:1047–1051. 2007. View Article : Google Scholar : PubMed/NCBI
24	Ishizuka M, Nagata H, Takagi K, Iwasaki Y and Kubota K: Inflammation-based prognostic system predicts postoperative survival of colorectal cancer patients with a normal preoperative serum level of carcinoembryonic antigen. Ann Surg Oncol. 19:3422–3431. 2012. View Article : Google Scholar : PubMed/NCBI
25	Lai CC, You JF, Yeh CY, Chen JS, Tang R, Wang JY and Chin CC: Low preoperative serum albumin in colon cancer: a risk factor for poor outcome. Int J Colorectal Dis. 26:473–481. 2011. View Article : Google Scholar
26	Ishizuka M, Nagata H, Takagi K, Iwasaki Y and Kubota K: Inflammation-based prognostic system predicts survival after surgery for stage IV colorectal cancer. Am J Surg. 205:22–28. 2013. View Article : Google Scholar
27	Mohri Y, Tanaka K, Ohi M, Yokoe T, Miki C and Kusunoki M: Prognostic significance of host- and tumor-related factors in patients with gastric cancer. World J Surg. 34:285–290. 2010. View Article : Google Scholar
28	Sarraf KM, Belcher E, Raevsky E, Nicholson AG, Goldstraw P and Lim E: Neutrophil/lymphocyte ratio and its association with survival after complete resection in non-small cell lung cancer. J Thorac Cardiovasc Surg. 137:425–428. 2009. View Article : Google Scholar : PubMed/NCBI
29	Cho H, Hur HW, Kim SW, Kim SH, Kim JH, Kim YT and Lee K: Pre-treatment neutrophil to lymphocyte ratio is elevated in epithelial ovarian cancer and predicts survival after treatment. Cancer Immunol Immunother. 58:15–23. 2009. View Article : Google Scholar
30	Dinarello CA: Proinflammatory and anti-inflammatory cytokines as mediators in the pathogenesis of septic shock. Chest. 112:321S–329S. 1997. View Article : Google Scholar : PubMed/NCBI
31	Malicki S, Winiarski M, Matlok M, et al: IL-6 and IL-8 responses of colorectal cancer in vivo and in vitro cancer cells subjected to simvastatin. J Physiol Pharmacol. 60:141–146. 2009.
32	Ardestani SK, Inserra P, Solkoff D and Watson RR: The role of cytokines on tumor progression: A review. Cancer Detect Prev. 23:215–225. 1999. View Article : Google Scholar
33	Esfandi F, Mohammadzadeh Ghobadloo S and Basati G: Interleukin-6 level in patients with colorectal cancer. Cancer Lett. 244:76–78. 2006. View Article : Google Scholar : PubMed/NCBI
34	Galizia G, Orditura M, Romano C, et al: Prognostic significance of circulating IL-10 and IL-6 serum levels in colon cancer patients undergoing surgery. Clin Immunol. 102:169–178. 2002. View Article : Google Scholar : PubMed/NCBI
35	Belluco C, Nitti D, Frantz M, et al: Interleukin-6 blood level is associated with circulating carcinoembryonic antigen and prognosis in patients with colorectal cancer. Ann Surg Oncol. 7:133–138. 2000. View Article : Google Scholar : PubMed/NCBI
36	Tabuchi T, Shimazaki J, Satani T, et al: The perioperative granulocyte/lymphocyte ratio is a clinically relevant marker of surgical stress in patients with colorectal cancer. Cytokine. 53:243–248. 2011. View Article : Google Scholar
37	Kvarnström A, Swartling T, Kurlberg G, Bengtson JP and Bengtsson A: Pro-inflammatory cytokine release in rectal surgery: comparison between laparoscopic and open surgical techniques. Arch Immunol Ther Exp (Warsz). 61:407–411. 2013. View Article : Google Scholar
38	Tang Y, Xia XF, Zhang Y, et al: Establishment of an experimental mouse model of trauma-hemorrhagic shock. Exp Anim. 61:417–425. 2012. View Article : Google Scholar : PubMed/NCBI