title: Preoperative platelet-lymphocyte ratio is an independent prognostic marker and superior to carcinoembryonic antigen in colorectal peritoneal carcinomatosis patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
abstract: OBJECTIVE
  The aim of this study was to examine the prognostic significance of preoperative inflammatory-based indices, platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), and carcinoembryonic antigen (CEA) in predicting overall survival (OS) in patients with colorectal peritoneal carcinomatosis (CPC) treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).
  
  
  METHODS
  Sixty patients with pathologically confirmed CPC treated with CRS and HIPEC between 2003 and 2015 were included. Levels of preoperative PLR, NLR, and CEA were recorded. Univariate and multivariate analyses were conducted to identify prognostic factors associated with OS.
  
  
  RESULTS
  Median OS was 36 months (95% CI, 26.6-45.4) and 5-year OS was 40.5% (95% CI, 27.3-51.6%). Preoperative PLR (p = 0.034) and CEA (p = 0.036) were found to be significant prognostic markers of OS, whereas NLR did not affect OS. PLR remained significant on multivariate analysis (hazard ratio, 1.035; 95% CI, 1.027-1.043; p < 0.001).
  
  
  CONCLUSIONS
  Our study indicates that preoperative PLR may be used as a prognostic marker in CPC patients undergoing CRS and HIPEC and could be useful in the preoperative setting when selecting patients for surgery. The subset of patients with PLR > 300 have a median OS of 5 months (95% CI, 0-24.6 months), indicating that CRS and HIPEC may not be superior to systemic chemotherapy in this subset of patients.
authors.affiliation: Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
authors.forename: Tiffany Sin Hui
authors.initials: TSH
authors.lastname: Bong
authors.affiliation: Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
authors.forename: Grace Hwei Ching
authors.initials: GHC
authors.lastname: Tan
authors.affiliation: Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
authors.forename: Claramae
authors.initials: C
authors.lastname: Chia
authors.affiliation: Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
authors.forename: Khee Chee
authors.initials: KC
authors.lastname: Soo
authors.affiliation: Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore. melissa.teo.c.c@nccs.com.sg.
authors.forename: Melissa Ching Ching
authors.initials: MCC
authors.lastname: Teo
mesh_terms: D000328:Adult; D000368:Aged; D001792:Blood Platelets / Q000473:pathology*; D002272:Carcinoembryonic Antigen / Q000097:blood*; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D065426:Cytoreduction Surgical Procedures; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D057234:Preoperative Period; D011379:Prognosis; D016016:Proportional Hazards Models; D016896:Treatment Outcome
chemical_list: D002272:Carcinoembryonic Antigen
keywords: Colorectal cancer; Cytoreductive surgery; Hyperthermic intraperitoneal chemotherapy; Neutrophil–lymphocyte ratio; Peritoneal carcinomatosis; Platelet–lymphocyte ratio