Neutrophil to Hemoglobin Lymphocyte Ratio (NHLR) as a Novel Biomarker is Superior to Neutrophil Lymphocyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) as Predictors of Advanced Colorectal Cancer

Heri Purnomo, Yuda Handaya, Nurcahya Setyawan

Abstract


Background: Neutrophils, Hemoglobin, and Lymphocytes are biological markers that may be related to the colorectal cancer stage. Neutrophils to Hemoglobin-Lymphocytes Ratio (NHLR) is a new biomarker that will be tested with Neutrophil Lymphocyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) as common biomarkers that have been shown to have predictive value with colorectal cancer stage. This study aims to prove NHLR as a new biomarker that can predict advanced colorectal cancer in terms of staging and site of cancer compared to NLR and PLR.

 

Methods: This is a retrospective cross-sectional study. Data obtained from the medical records of colorectal cancer patients undergoing surgery at Dr Sardjito Hospital from 2020 until 2022.

 

Results: 386 patients enrolled in the study, and 62 patients met the inclusion criteria. Twentyeight patients (45.16 %) were male, and 34 (54.84 %) were female. The mean age is 58.82 years. Bivariate analysis showed a significant relationship between NHLR, NLR, and PLR with colorectal cancer stage and significant differences between NHLR and NLR with early and advanced colorectal cancer, but not with PLR. There are also significant differences between NHLR, NLR, and PLR with colorectal cancer sites in the colon and rectum. Still, in locally advanced stages of colorectal cancer, there is no significant association between NLR and cancer sites. On the contrary, there are significant differences between colon and rectal cancer sites with NHLR and PLR.

 

Conclusions: NHLR is superior to NLR and PLR in predicting the stage and site of advanced colorectal cancer.


Keywords


cancer stage, colorectal cancer, NHLR, NLR, PLR

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DOI: 10.33371/ijoc.v18i1.1099

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References


Joachim C, Macni J, Drame M, et al. Overall survival of colorectal cancer by stage at diagnosis: Data from the Martinique Cancer Registry. Medicine (Baltimore). 2019;98(35):e16941.

Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209–49.

Sideras K, Kwekkeboom J. Cancer inflammation and inflammatory biomarkers: can neutrophil, lymphocyte, and platelet counts represent the complexity of the immune system? Transpl Int. 2014;27(1):28–31.

Stojkovic Lalosevic M, Pavlovic Markovic A, Stankovic S, et al. Combined Diagnostic Efficacy of Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Mean Platelet Volume (MPV) as Biomarkers of Systemic Inflammation in the Diagnosis of Colorectal Cancer. Dis Markers. 2019;2019:6036979.

Beal EW, Cloyd JM. Neutrophil-to-Lymphocyte Ratio in Colorectal Liver Metastases: Simply Prognostic or Clinically Relevant? Ann Surg Oncol. 2021;28(8):4072–3.

Huang X, Huan Y, Liu L, et al. Preoperative low absolute lymphocyte count to fibrinogen ratio correlated with poor survival in nonmetastatic colorectal cancer. World J Surg Oncol. 2022;20(1):1–12.

Raskov H, Orhan A, Christensen JP, Gögenur I. Cytotoxic CD8+ T cells in cancer and cancer immunotherapy. Br J Cancer. 2021;124(2):359–67.

Sun K, Chen S, Xu J, et al. The prognostic significance of the prognostic nutritional index in cancer: a systematic review and meta-analysis. J Cancer Res Clin Oncol. 2014;140(9):1537–49.

Ozdemir Y, Akin ML, Sucullu I, et al. Pretreatment neutrophil/lymphocyte ratio as a prognostic aid in colorectal cancer. Asian Pacific J Cancer Prev. 2014;15(6):2647–50.

Li MX, Liu XM, Zhang XF, et al. Prognostic role of neutrophil-to-lymphocyte ratio in colorectal cancer: A systematic review and meta-analysis. Int J Cancer. 2014;134(10):2403–13.

Gvirtzman R, Livovsky DM, Tahover E, et al. Anemia can predict the prognosis of colorectal cancer in the pre-operative stage: a retrospective analysis. World J Surg Oncol. 2021;19(1):341.

Who, Chan M. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva, Switz World Heal Organ. 2011;1–6.

Alexiusdottir KK, Möller PH, Snaebjornsson P, et al. Association of symptoms of colon cancer patients with tumor location and TNM tumor stage. Scand J Gastroenterol. 2012 Jul;47(7):795—801.

Väyrynen JP, Tuomisto A, Väyrynen SA, et al. Preoperative anemia in colorectal cancer: Relationships with tumor characteristics, systemic inflammation, and survival. Sci Rep. 2018;8(1):1–11.

Turhan VB, Ünsal A, Gök HF, et al. Predictive Value of Preoperative Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratio in Determining the Stage of Colon Tumors. Cureus. 2021;13(9).

Rohit Krishna A, Anil Kumar AV. Neutrophil-lymphocyte ratio and platelet-lymphocyte ratios correlate with staging in patients with colorectal carcinoma. Int Surg J. 2020;7(12):4094.

Forget P, Khalifa C, Defour JP, et al. What is the normal value of the neutrophil-to-lymphocyte ratio? BMC Res Notes. 2017;10(1):1–4.

Dupont WD, Plummer WD. Power and Sample Size Calculations for Studies Involving Linear Regression. Control Clin Trials. 1998;19(6):589–601.

Amin MB, Greene FL, Edge SB, et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin [Internet]. 2017;67(2):93–9.

Song Y, Yang Y, Gao P, et al. The preoperative neutrophil to lymphocyte ratio is a superior indicator of prognosis compared with other inflammatory biomarkers in resectable colorectal cancer. BMC Cancer. 2017;17(1):1–8.

Spicer JD, McDonald B, Cools-Lartigue JJ, et al. Neutrophils promote liver metastasis via Mac-1-mediated interactions with circulating tumor cells. Cancer Res. 2012;72(16):3919–27.

Tan D, Fu Y, Tong W, Li F. Prognostic significance of lymphocyte to monocyte ratio in colorectal cancer: A meta-analysis. Int J Surg. 2018;55:128–38.

Selders GS, Fetz AE, Radic MZ, Bowlin GL. An overview of the role of neutrophils in innate immunity, inflammation and host-biomaterial integration. Regen Biomater. 2017;4(1):55–68.

Goubran HA, Stakiw J, Radosevic M, Burnouf T. Platelets Effects on Tumor Growth. Semin Oncol. 2014;41(3):359–69.

Li K, Yan J, Zhang H. Correlation between peripheral blood hemoglobin/erythrocyte distribution width ratio and prognosis of patients with primary colorectal cancer. Medicine (Baltimore). 2023;102(23).

Ho CH, Yu Y Bin, Wu PH. The prevalence of iron deficiency anemia and its clinical implications in patients with colorectal carcinoma. J Chinese Med Assoc. 2008;71(3):119–22.

Edna TH, Karlsen V, Jullumstrø E, Lydersen S. Prevalence of anaemia at diagnosis of colorectal cancer: Assessment of associated risk factors. Hepatogastroenterology. 2012;59(115):713–6.

Al-Saeed EF, Tunio MA, Al-Obaid O, et al. Correlation of pretreatment hemoglobin and platelet counts with clinicopathological features in colorectal cancer in Saudi population. Saudi J Gastroenterol. 2014;20(2):134–8.

Sadahiro S, Suzuki T, Tokunaga N, et al. Anemia in patients with colorectal cancer. J Gastroenterol. 1998;33(4):488–94.


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