Prognostic role of preoperative inflammatory markers in postoperative lung metastasis of colorectal cancer: a retrospective study.

BACKGROUND

This study aims to investigate the predictive significance of inflammatory markers for postoperative lung metastasis in colorectal cancer (CRC) patients. The focus is on exploring the relationship between traditional inflammatory markers, such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and newly introduced indices like C-reactive protein (CRP)-albumin-lymphocyte (CALLY), and their association with CRC progression and lung metastasis.

METHODS

A retrospective review of medical records from 303 CRC patients at the First Affiliated Hospital of Nanjing Medical University (January 2014 to December 2023) was conducted. Various inflammatory markers, baseline characteristics, and survival data were analyzed. Statistical analyses, including univariate and multivariate Cox regression and logistic regression, were performed to determine associations between inflammatory factors and CRC outcomes.

RESULTS

Among the patients, 55 developed lung metastasis during the study period. The results revealed that PNI (HR 0.368, 95% CI 0.235-0.577; p < 0.001, Table 2), LMR (HR 0.383, 95% CI 0.223-0.657; p < 0.001, Table 2), and CALLY (HR 0.18, 95% CI 0.111-0.294; p < 0.001) were associated with progression free survival (PFS). Moreover, PNI (HR 0.252, 95% CI 0.137-0.461; p < 0.001, Table 3) and CALLY (HR 0.11, 95% CI 0.0.05-0.245; p < 0.001, Table 3) emerged as independent risk factors for postoperative lung metastasis. And PNI (p = 0.028, Table 5) is more specific for predicting pulmonary metastasis in CRC.

CONCLUSION

This study underscores the importance of inflammatory markers in predicting postoperative outcomes for CRC patients. Lower PNI, LMR, and CALLY were identified as significant predictors of reduced progression free survival, while PNI and CALLY were independently associated with an increased risk of postoperative lung metastasis. Further analysis demonstrated that PNI is a specific indicator for predicting the occurrence of pulmonary metastasis in CRC, independent of metastases to other sites. These findings highlight the potential clinical utility of these inflammatory markers in monitoring CRC recurrence and metastasis.

TRIAL REGISTRATION

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of the First Affiliated Hospital of Nanjing Medical University (protocol code 2024-SR-066, date of approval 2024-02-27).