title: Prognostic Impact of Neutrophil/Lymphocyte Ratio, Platelet Count, CRP, and Albumin Levels in Metastatic Colorectal Cancer Patients Treated with FOLFIRI-Bevacizumab.
abstract: OBJECTIVE
  Metastatic colorectal cancer (mCRC) is a lethal disease and fluorouracil-leucovorin-irinotecan (FOLFIRI) plus bevacizumab (bev) is a standard approach. Hence, there is a strong need for identifying new prognostic factors to show the efficacy of FOLFIRI-bev.
  
  
  METHODS
  This is a retrospective study including patients (n = 90) with mCRC from two centers in Turkey. Neutrophil/lymphocyte (N/L) ratio, platelet count, albumin, and C-reactive protein (CRP) were recorded before FOLFIRI-bev therapy. The efficacy of these factors on progression-free survival (PFS) was analyzed with Kaplan Meier and Cox regression analysis. And the cutoff value of N/L ratio was analyzed with ROC analysis.
  
  
  RESULTS
  The median age was 56 years (range 21-80). Forty-seven percent of patients with N/L ratio >2.5 showed progressive disease versus 43 % in patients with N/L ratio <2.5 (p = 0.025). The median PFS was 8.1 months for the patients with N/L ratio >2.5 versus 13.5 months for the patients with N/L ratio <2.5 (p = 0.025). At univariate Cox regression analysis, high baseline neutrophil count, LDH, N/L ratio, and CRP were all significantly associated with poor prognosis. At multivariate Cox regression analysis, CRP was confirmed to be a better independent prognostic factor. CRP variable was divided into above the upper limit of normal (ULN) and normal value. The median PFSs of the patients with normal and above ULN were 11.3 versus 5.8 months, respectively (p = 0.022).
  
  
  CONCLUSIONS
  CRP and N/L ratio are potential predictors for advanced mCRC treated with FOLFIRI-bev.
authors.affiliation: Department of Medical Oncology, Meram Medical Faculty, Necmettin Erbakan University, 42080, Konya, Turkey. mehmetartac@yahoo.com.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Artaç
authors.affiliation: Department of Medical Oncology, Afyon Kocatepe University Medical Faculty, Afyon, Turkey.
authors.forename: Mükremin
authors.initials: M
authors.lastname: Uysal
authors.affiliation: Department of Medical Oncology, Meram Medical Faculty, Necmettin Erbakan University, 42080, Konya, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Karaağaç
authors.affiliation: Department of Medical Oncology, Meram Medical Faculty, Necmettin Erbakan University, 42080, Konya, Turkey.
authors.forename: Levent
authors.initials: L
authors.lastname: Korkmaz
authors.affiliation: Department of Medical Oncology, Meram Medical Faculty, Necmettin Erbakan University, 42080, Konya, Turkey.
authors.forename: Zehra
authors.initials: Z
authors.lastname: Er
authors.affiliation: Department of Medical Oncology, Meram Medical Faculty, Necmettin Erbakan University, 42080, Konya, Turkey.
authors.forename: Tunç
authors.initials: T
authors.lastname: Güler
authors.affiliation: Department of Medical Oncology, Meram Medical Faculty, Necmettin Erbakan University, 42080, Konya, Turkey.
authors.forename: Melih Cem
authors.initials: MC
authors.lastname: Börüban
authors.affiliation: Department of Medical Oncology, Akdeniz University Faculty of Medicine, Antalya, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Bozcuk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000074322:Antineoplastic Agents, Immunological / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000032:analysis; D002166:Camptothecin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D053208:Kaplan-Meier Estimate; D002955:Leucovorin / Q000627:therapeutic use; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D010976:Platelet Count; D011379:Prognosis; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis; D016896:Treatment Outcome; D014421:Turkey; D055815:Young Adult
chemical_list: D000074322:Antineoplastic Agents, Immunological; D012709:Serum Albumin; D000068258:Bevacizumab; D002097:C-Reactive Protein; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin
keywords: Bevacizumab; CRP; Metastatic colorectal cancer; Neutrophil/lymphocyte ratio; Systemic inflammation