Impact of platelet to lymphocyte ratio and metabolic syndrome on the prognosis of colorectal cancer patients

Figures & data

Table 1 Characteristics of CRC patients treated with surgical resection according to PLR

Characteristic	All patients N (%)	PLR ≤120 N=491	120< PLR ≤220 N=465	PLR >220 N=207	P-value
Median PLR (mean ± SD)	152.9±75.8	92.1±19.8	159.7±27.0	281.9±64.8	–
Demographic data
Male, n (%)	700 (60.2%)	294 (59.9%)	288 (61.9%)	118 (57.0%)	0.475
Female, n (%)	463 (39.8%)	197 (40.1%)	177 (38.1%)	89 (43.0%)
Age (mean ± SD)	65.2±12.2	66.1±11.6	64.6±12.1	64.5±13.4	0.103
BMI (kg/m^2) (mean ± SD)	22.0±3.4	22.1±3.2	22.2±3.5	21.2±3.2	0.001
DM, n (%)	112 (9.6%)	43 (8.8%)	47 (10.1%)	22 (10.6%)	0.674
Hypertension, n (%)	326 (28.0%)	135 (27.5%)	142 (30.5%)	49 (23.7%)	0.177
Smoking, n (%)	308 (26.5%)	132 (26.9%)	123 (26.5%)	53 (25.6%)	0.936
MetS, n (%)	234 (20.1%)	95 (19.3%)	99 (21.3%)	40 (19.3%)	0.719
3*	156	69 (44.2%)	68 (43.6%)	19 (12.2%)	0.016
4*	78	26 (33.3%)	31 (39.7%)	21 (26.9%)
Laboratory data
Fasting glucose (mmol/dL)	6.1±2.2	5.9±2.3	6.1±2.1	6.3±2.0	0.144
Total cholesterol (mmol/dL)	4.5±1.1	4.6±0.9	4.5±1.1	4.2±1.2	0.001
Triglycerides (mmol/dL)	1.5±1.0	1.5±0.9	1.5±1.2	1.3±0.8	0.007
HDL (mmol/dL)	1.1±0.3	1.2±0.3	1.1±0.3	1.1±0.3	0.001
LDL (mmol/dL)	2.7±0.9	2.7±0.8	2.8±0.9	2.6±1.0	0.117
Albumin (g/L)	40.6±5.4	41.9±4.5	40.5±5.4	37.9±6.2	0.001
Creatinine (μmol/L)	67.6±32.0	67.7±27.5	69.2±35.0	64.0±34.4	0.151
Uric acid (mmol/L)	297.8±94.9	309.4±87.9	300.1±97.1	264.8±98.7	0.001
CEA (ng/mL)	30.5±153.4	28.5±152.9	29.5±150.9	37.9±160.8	0.765
Pathological data
Location					0.001
Right side, n (%)	172 (14.8%)	49 (10.0%)	71 (15.3%)	52 (25.1%)
Sigmoid, n (%)	200 (17.2%)	86 (17.5%)	80 (17.2%)	34 (16.45%)
Rectal, n (%)	638 (54.9%)	305 (62.1%)	254 (54.6%)	79 (38.2%)
TNM staging					0.002
Stage I, n (%)	189 (16.3%)	100 (20.4%)	69 (14.8%)	20 (9.7%)
Stage II, n (%)	444 (38.2%)	174 (35.4%)	186 (40.0%)	84 (40.6%)
Stage III, n (%)	442 (38.0%)	190 (38.7%)	174 (37.4%)	78 (37.7%)
Stage IV, n (%)	88 (7.5%)	27 (5.5%)	36 (7.7%)	25 (12.1%)
Tumor differentiation
Well/moderate, n (%)	868 (74.6%)	372 (75.8%)	350 (75.3%)	146 (70.5%)	0.321
Poor, n (%)	295 (25.4%)	119 (24.2%)	115 (24.7%)	61 (29.5%)
Vascular invasion, n (%)	166 (14.3%)	51 (10.4%)	81 (17.4%)	34 (16.4%)	0.005
Treatment					0.591
Local treatment, n (%)	147 (12.6%)	56 (11.4%)	65 (14.0%)	26 (12.6%)
Op alone, n (%)	290 (24.9%)	116 (23.6%)	121 (26.0%)	53 (25.6%)
Op + CTx/RTx, n (%)	726 (62.4%)	319 (65.0%)	279 (60.0%)	128 (61.8%)

Note:

* Number of metabolic risk factors.

Abbreviations: BMI, body mass index; CEA, carcinoembryonic antigen; CRC, colorectal cancer; CTx, chemotherapy; DM, diabetes mellitus; HDL, high-density lipoprotein; LDL, low-density lipoprotein; MetS, metabolic syndrome; Op, operation; PLR, platelet to lymphocyte ratio; RTx, radiotherapy; SD, standard deviation; TNM, tumor-node-metastasis.

Figure 1 The graded relationship between increasing number of MetS components and PLR.

Abbreviations: MetS, metabolic syndrome; PLR, platelet to lymphocyte ratio.

Table 2 Baseline characteristics of CRC patients stratified by MetS

Variables	MetS(−) (n=929)	MetS(+) (n=234)	P-value
Demographic data
Male gender, n (%)	571 (61.5%)	129 (55.15%)	0.077
Age (years)	64.8±12.5	67.0±10.5	0.007
BMI (kg/m^2)	21.3±2.9	24.6±3.7	<0.001
DM, n (%)	70 (7.5%)	42 (17.9%)	<0.001
Hypertension, n (%)	219 (23.6%)	107 (45.7%)	<0.001
Smoking, n (%)	250 (26.9%)	58 (24.9%)	0.527
Preoperative laboratory data
PLR	150.6±68.3	162.0±99.8	0.039
Fasting glucose (mmol/dL)	5.8±1.7	7.4±3.2	<0.001
Albumin (g/L)	40.7±5.2	40.5±5.9	0.593
Total cholesterol (mmol/dL)	4.5±1.0	4.6±1.2	0.169
Triglycerides (mmol/dL)	1.3±0.8	2.0±1.3	<0.001
HDL (mmol/dL)	1.2±0.3	1.0±0.3	<0.001
LDL (mmol/dL)	2.7±0.9	2.7±0.9	0.844
Creatinine (μmol/L)	66.7±26.4	71.3±48.0	0.163
Uric acid (mmol/L)	294.5±92.8	310.9±101.7	0.018
CEA (ng/mL)	31.9±160.4	25.0±121.4	0.553

Abbreviations: BMI, body mass index; CEA, carcinoembryonic antigen; CRC, colorectal cancer; DM, diabetes mellitus; HDL, high-density lipoprotein; LDL, low-density lipoprotein; MetS, metabolic syndrome; PLR, platelet to lymphocyte ratio.

Figure 2 Kaplan–Meier survival curves showing overall survival (A) and disease-free survival (B) stratified by PLR in CRC patients (cutoff values 120, 220, respectively).

Abbreviations: CRC, colorectal cancer; PLR, platelet to lymphocyte ratio.

Figure 3 Kaplan–Meier survival curves showing overall survival (A) and disease-free survival (B) stratified by MetS in CRC patients.

Abbreviations: CRC, colorectal cancer; MetS, metabolic syndrome.

Table 3 Cox proportional hazard regression models of risk factors associated with prognosis among CRC patients

	Overall survival						Disease-free survival
	Univariable			Multivariable			Univariable			Multivariable
	HR	95% CI	P-value	HR	95% CI	P-value	HR	95% CI	P-value	HR	95% CI	P-value
Gender (male vs female)	1.365	1.113–1.673	0.003	1.447	1.136–1.844	0.003	1.336	1.072–1.665	0.010	1.384	1.096–1.747	0.006
Age	1.014	1.005–1.022	<0.001	1.008	1.003–1.021	0.068	1.001	0.993–1.010	0.747
Diabetes	0.997	0.847–1.174	0.974				0.990	0.830–1.182	0.915
Hypertension	0.860	0.697–1.060	0.158				0.860	0.697–1.060	0.158
MetS	0.932	0.830–1.047	0.235				0.929	0.818–1.055	0.257
BMI (continuous)	0.974	0.945–1.003	0.080	0.986	0.954–1.019	0.391	1.000	0.969–1.032	0.990
PLR (continuous)	1.001	1.000–1.003	0.014	0.996	0.993–1.000	0.043	1.001	1.000–1.002	0.117
PLR ≤120	1.000	–	–	1.000	–	–	1.000	–	–	1.000 –		–
120< PLR ≤220	1.247	1.002–1.552	0.048	1.445	1.029–2.030	0.034	1.089	0.860–1.379	0.478	1.077	0.844–1.374	0.551
PLR >220	1.594	1.227–2.070	<0.001	2.374	1.127–5.002	0.023	1.434	1.082–1.902	0.012	1.110	0.809–1.523	0.519
Total cholesterol	0.908	0.823–1.002	0.055	1.064	0.950–1.191	0.283	0.947	0.852–1.053	0.316
Triglycerides	0.887	0.790–0.996	0.042	0.948	0.841–1.068	0.378	0.976	0.875–1.089	0.663
HDL	0.574	0.412–0.798	<0.001	0.876	0.588–1.306	0.516	0.534	0.371–0.767	0.001	0.668	0.451–0.989	0.044
LDL	0.934	0.811–1.076	0.347				0.921	0.790–1.073	0.291
Albumin	0.958	0.942–0.973	<0.001	0.964	0.942–0.986	0.002	0.970	0.952–0.988	0.001	0.978	0.957–0.999	0.044
Creatinine	1.001	0.998–1.003	0.652				1.001	0.998–1.004	0.428
Uric acid	0.999	0.998–1.000	0.037	0.999	0.998–1.001	0.347	0.999	0.998–1.000	0.104
TNM staging
Stage I	1.000	–	–	1.000	–	–	1.000	–	–	1.000 –		–
Stage II	0.983	0.675–1.431	0.927	0.840	0.565–1.249	0.390	1.022	0.707–1.478	0.908	0.956	0.650–1.406	0.819
Stage III	2.794	1.983–3.938	<0.001	2.321	1.602–3.364	<0.001	2.920	2.082–4.095	<0.001	2.780	1.936–3.993	<0.001
Stage IV	15.369	10.407–22.699	<0.001	12.655	8.252–19.406	<0.001	8.007	1.933–33.165	0.004	7.300	1.746–30.523	<0.001
Differentiation	0.676	0.548–0.833	<0.001	0.917	0.728–1.156	0.464	0.664	0.528–0.834	<0.001	0.882	0.690–1.128	0.316
Vascular invasion	0.532	0.420–0.674	<0.001	0.777	0.587–1.012	0.061	0.589	0.450–0.771	<0.001	0.844	0.630–1.130	0.255
CEA	1.001	1.001–1.002	<0.001	1.000	1.000–1.001	0.089	1.001	1.000–1.001	0.272

Abbreviations: BMI, body mass index; CEA, carcinoembryonic antigen; CI, confidence interval; CRC, colorectal cancer; HDL, high-density lipoprotein; HR, hazard ratio; LDL, low-density lipoprotein; MetS, metabolic syndrome; PLR, platelet to lymphocyte ratio; TNM, tumor-node-metastasis.

Figure 4 Kaplan–Meier survival curves showing overall survival stratified by PLR in CRC patients with MetS (A) and overall survival stratified by MetS in CRC patients with PLR >220 (B).

Abbreviations: CRC, colorectal cancer; MetS, metabolic syndrome; PLR, platelet to lymphocyte ratio.

Table 4 Cox proportional hazard regression analysis of prognosis stratified by MetS

MetS	PLR	Overall survival						Disease-free survival
		Univariable			Multivariable*			Univariable			Multivariable*
		HR	95% CI	P-value	HR	95% CI	P-value	HR	95% CI	P-value	HR	95% CI	P-value
MetS(+) group	PLR**	–	–	0.006			0.047			0.110			0.323
	PLR ≤120	1.000	–	–	1.000	–	–	1.000	–	–	1.000	–	–
	120< PLR ≤220	1.452	0.896–2.354	0.130	1.241	0.763–2.018	0.385	1.075	0.645–1.790	0.782	0.946	0.564–1.588	0.834
	PLR >220	2.471	1.422–4.293	0.001	1.997	1.143–3.489	0.015	1.843	1.012–3.355	0.046	1.468	0.801–2.689	0.214
MetS(−) group	PLR**			0.066			0.018			0.185			0.111
	PLR ≤120	1.000	–	–	1.000	–	–	1.000	–	–	1.000	–	–
	120< PLR ≤220	1.194	0.934–1.526	0.158	1.253	0.980–1.603	0.072	1.092	0.837–1.425	0.517	1.139	0.873–1.487	0.338
	PLR >220	1.415	1.050–1.906	0.023	1.525	1.131–2.058	0.006	1.349	0.979–1.857	0.067	1.410	1.022–1.946	0.036

Notes:

* Adjusted for all covariates including age, gender, PLR, and TNM staging.

** Categorical variable.

Abbreviations: CI, confidence interval; HR, hazard ratio; MetS, metabolic syndrome; PLR, platelet to lymphocyte ratio; TNM, tumor-node-metastasis.

Table 5 Cox proportional hazard regression analysis of the prognosis of the subgroups of PLR

PLR	Overall survival						Disease-free survival
	Multivariable*			Multivariable**			Multivariable*			Multivariable**
	HR	95% CI	P-value	HR	95% CI	P-value	HR	95% CI	P-value	HR	95% CI	P-value
<120
MetS	1.072	0.619–1.408	0.742	1.052	0.695–1.592	0.810	1.105	0.734–1.664	0.633	1.298	0.857–1.966	0.218
PLR	1.003	0.989–1.005	0.476	0.996	0.988–1.004	0.298	1.005	0.987–1.013	0.227	0.994	0.986–1.002	0.131
120–220
MetS	1.148	0.611–1.240	0.443	0.908	0.636–1.295	0.593	0.921	0.614–1.380	0.690	0.895	0.595–1.346	0.594
PLR	1.001	0.995–1.006	0.833	1.000	0.994–1.005	0.989	1.002	0.996–1.008	0.510	1.001	0.995–1.007	0.705
>220
MetS	2.016	1.233–3.289	0.005	1.704	1.028–2.825	0.039	1.887	1.081–3.289	0.025	1.779	1.008–3.135	0.047
PLR	1.005	1.000–1.009	0.031	1.004	1.000–1.008	0.051	1.005	1.000–1.010	0.044	1.005	1.000–1.010	0.058

Notes:

* Adjusted for MetS and PLR.

** Adjusted for covariates including age, gender, MetS, PLR, and TNM staging.

Abbreviations: CI, confidence interval; HR, hazard ratio; MetS, metabolic syndrome; PLR, platelet to lymphocyte ratio; TNM, tumor-node-metastasis.