The clinical significance of lactate dehydrogenase-albumin ratio and immunoinflammatory biomarkers in predicting prognosis of metastatic colorectal cancer
Objective To investigate the role of lactate dehydrogenase to albumin ratio(LAR)and immunoinflammatory biomarkers in the prognosis of metastatic colorectal cancer(mCRC).Methods Clinical data and follow-up data of patients diagnosed with mCRC from Daxing Hospital of Capital Medical University from January 2017 to December 2020 were retrospectively analyzed.Receiver operating characteristic(ROC)curves were used to determine the optimal cut-off values for neutrophil/lymphocyte ratio(NLR),platelet/lymphocyte ratio(PLR),nutritional prognosis index(PNI)and LAR for predicting prognosis.Patients were divided into chemotherapy + bevacizumab(CT+B)and chemotherapy(CT)groups depending on whether they received bevacizumab as first-line therapy.Kaplan-Meier method was used to analyze and draw the survival curve,and the survival difference was tested by Log-rank.Factors affecting overall survival(OS)and progression-free survival(PFS)of metastatic colorectal cancer were analyzed by Cox proportional regression model.Results The ROC curve showed that the best truncation values of PLR,NLR,PNI and LAR for OS diagnosis in mCRC patients were 140.63,2.81,45.85 and 4.0,respectively.Single-factor Cox proportional regression model showed that smoking history,multiple organ metastasis,PLR≥140.63,NLR≥2.81,LAR≥4.0,age and primary resection were the factors influencing OS(P<0.05).Smoking history,multiple organ metastasis,PLR≥140.63,NLR≥2.81,LAR≥4.0 were the factors affecting PFS(P<0.05).A new risk prediction model was developed combining NLR and LAR to classify patients into:low risk(0 factors:NLR<2.81 and LAR<4.0),medium risk(1 factor:NLR≥2.81 or LAR≥4.0),and high risk(2 factors:NLR≥2.81 and LAR≥4.0).Multivariate Cox risk prediction models showed independent prognostic factors for OS and PFS in the overall or CT+B first-line treatment subpopulation(P<0.05).The median OS(42.50 months vs.29.50 months,P=0.013)and PFS(44.50 months vs.23.50 months,P<0.001)were significantly longer in low-risk patients treated with first-line CT+B than with first-line CT.There was no significant difference in OS and PFS among high-risk patients(P=0.724,0.483).Conclusion Pre-treated LAR and NLR can be good indicators of survival outcomes of first-line CT in patients with mCRC,and risk prediction models based on NLR and LAR may be able to predict the clinical benefit of bevacizumab on first-line CT in patients with moderate and low risk.
Metastatic colorectal cancerBevacizumabFirst-line chemotherapyPrognosisLactate dehydrogenase to albumin ratio
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