Systemic Inflammatory Biomarkers as Prognostic Indicators in Metastatic Colorectal Cancer: A Retrospective Study

Area of Science:

• Oncology
• Clinical Biomarkers
• Colorectal Cancer Research

Background:

• Systemic inflammatory biomarkers are increasingly recognized as potential prognostic indicators in metastatic colorectal cancer (mCRC).
• The prognostic reliability of common inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), C-reactive protein-to-albumin ratio (CAR), and Glasgow Prognostic Score (GPS), requires further investigation.
• Characterizing the prognostic significance of these markers is crucial for improving patient management in mCRC.

Purpose of the Study:

• To evaluate the prognostic significance of NLR, PLR, CRP, CAR, and GPS for progression-free survival (PFS) in a Romanian cohort of patients with mCRC.
• To assess the robustness of these inflammatory markers as independent predictors of outcomes in mCRC.
• To explore the association between inflammatory indices and PFS using advanced statistical modeling.

Main Methods:

• A retrospective observational study involving 148 patients diagnosed with mCRC.
• Baseline laboratory parameters were used to determine inflammatory biomarker levels (NLR, PLR, CRP, CAR, GPS).
• Progression-free survival (PFS) was the primary endpoint, analyzed using Kaplan-Meier, Cox regression (including Firth penalized and multivariable models), restricted cubic splines, and time-dependent ROC analyses.

Main Results:

• In univariable analyses, elevated NLR, PLR, CRP, and CAR were associated with shorter PFS.
• Restricted cubic spline analysis revealed a significant nonlinear association between NLR and PFS.
• However, after multivariable adjustment for clinicopathologic confounders, the association between NLR and PFS was not retained, and time-dependent ROC analysis indicated limited discriminatory performance.

Conclusions:

• While several inflammatory markers showed an association with shorter PFS in univariable analyses, their prognostic impact in metastatic colorectal cancer is not consistently robust.
• The prognostic effect of the neutrophil-to-lymphocyte ratio (NLR) was attenuated after adjustment for confounders and did not demonstrate consistent predictive performance across all statistical models.
• Further research is needed to fully elucidate the role of systemic inflammatory biomarkers in predicting outcomes for patients with mCRC.