Activated systemic inflammatory response at diagnosis reduces lymph node count in colonic carcinoma

Area of Science:

• Oncology
• Immunology
• Surgical Pathology

Background:

• Prognosis in colon cancer is influenced by the patient's immune status.
• Systemic inflammatory response (SIR) markers, such as neutrophil-lymphocyte ratio (NLR) and albumin levels, are increasingly recognized as prognostic indicators.

Purpose of the Study:

• To investigate the relationship between lymph node yield and systemic inflammatory response in patients with colon cancer.
• To determine if markers of SIR correlate with the number of lymph nodes examined in surgical specimens.

Main Methods:

• A prospectively maintained database of patients undergoing curative colon resection was analyzed.
• Neutrophil-lymphocyte ratio (NLR) and serum albumin levels were used as markers for SIR, with NLR ≥ 4 and albumin < 35 defining an elevated SIR.
• Statistical analysis included 2 sample t-tests and chi-squared tests to compare groups.

Main Results:

• A total of 302 patients were included. Patients with an elevated NLR (≥ 4) exhibited a significantly lower mean lymph node yield compared to those with a normal NLR (< 4) [17.6 vs 19.2, P = 0.036].
• An elevated NLR was associated with a higher incidence of node-positive disease and an increased lymph node ratio (≥ 0.25, P = 0.044).

Conclusions:

• Activated systemic inflammatory response in colon cancer patients is associated with a reduced lymph node count.
• These findings suggest that immune status, as reflected by SIR markers, can influence lymph node yield in surgical pathology, assuming standardized surgical and pathological techniques.