title: Preoperative platelet to lymphocyte ratio is a valuable prognostic biomarker in patients with colorectal cancer.
abstract: OBJECTIVE
  Recent studies suggest that an elevated preoperative platelet to lymphocyte ratio (PLR) may be considered a poor prognostic biomarker in patients with colorectal cancer (CRC). The aim of this study was to evaluate the prognostic impact of PLR in patients with CRC.
  
  
  METHODS
  We enrolled 1314 patients who underwent surgery for CRC between 2005 and 2011. Preoperative PLR level was stratified into quintiles for Kaplan-Meier analysis and multivariable Cox proportional hazard regression models.
  
  
  RESULTS
  Higher PLR quintiles were significantly associated with poorer overall survival (P = 0.002). Multivariate analysis showed that PLR was an independent risk factor for overall survival (OS) (P = 0.034). Patients in PLR quintile 5 had lower overall survival than in quintile 1 (hazard ratio (HR) = 1.701, 95% confidence interval (CI): 1.267-2.282, P < 0.001). Although patients in PLR quintile 5 had significantly lower disease-free survival (DFS) than in quintile 1 (HR = 1.522, 95% CI: 1.114-2.080, P = 0.008), this association was not significant after multivariable adjustment (P = 0.075). In the subgroup analysis, PLR remained an independent factor in terms of advanced tumor stage (III, IV), male sex, carcinoembryonic antigen (≤ 5 ng/ml), age (> 65 years) and body mass index (≤ 25) (P < 0.05 for all measurements). The results remained unchanged when the PLR was analyzed as a dichotomous variable by applying different cut-off values of 150, 185, 220.
  
  
  CONCLUSIONS
  Elevated preoperative PLR was independently associated with an increased risk of mortality in patients with CRC. The utility of PLR may help to improve prognostic predictors.
authors.affiliation: Department of Oncological Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.|Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.
authors.forename: Jie
authors.initials: J
authors.lastname: You
authors.affiliation: Department of Infection and Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.|School of The First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Gui-Qi
authors.initials: GQ
authors.lastname: Zhu
authors.affiliation: Cancer Center of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
authors.forename: Linka
authors.initials: L
authors.lastname: Xie
authors.affiliation: Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Wen-Yue
authors.initials: WY
authors.lastname: Liu
authors.affiliation: Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Shi
authors.affiliation: Department of Oncological Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Ou-Chen
authors.initials: OC
authors.lastname: Wang
authors.affiliation: Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.
authors.forename: Zong-Hai
authors.initials: ZH
authors.lastname: Huang
authors.affiliation: Global Medicines Development, AstraZeneca R & D, Alderley Park, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: Braddock
authors.affiliation: Department of Oncological Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Gui-Long
authors.initials: GL
authors.lastname: Guo
authors.affiliation: Department of Infection and Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.|Institute of Hepatology, Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Ming-Hua
authors.initials: MH
authors.lastname: Zheng
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D015179:Colorectal Neoplasms / Q000097:blood* / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011379:Prognosis; D016016:Proportional Hazards Models
chemical_list: D014408:Biomarkers, Tumor
keywords: colorectal cancer; disease-free survival; overall survival; platelet to lymphocyte ratio; prognostic biomarker