Annals of Coloproctology

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Malignant disease, Rectal cancer,Colorectal cancer,Prognosis,Biomarker & risk factor

Pretreatment inflammatory markers predicting treatment outcomes in colorectal cancer: Sanghyun An, Hongjin Shim, Kwangmin Kim, Bora Kim, Hui-Jae Bang, Hyejin Do, Hyang-Rae Lee, Youngwan Kim; Ann Coloproctol. 2022;38(2):97-108. Published online March 29, 2022; DOI: https://doi.org/10.3393/ac.2021.01004.0143

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36 Web of Science
39 Citations

We aimed to review whether pretreatment inflammatory markers reflect the short- and long-term outcomes of patients with colon cancer, rectal cancer, colon and rectal cancers, and metastatic colorectal cancer (CRC). We found that pretreatment complete blood count and blood chemistry tests reflect short-term and long-term oncological outcomes in patients with CRC. Specifically, in patients with colon cancer, hypoalbuminemia was associated with worse postoperative morbidity, mortality, and inferior survival. In patients with rectal cancer, elevated neutrophil-lymphocyte ratio (NLR) and thrombocytosis were associated with postoperative complications, poor overall survival (OS), and disease-free survival (DFS). A high C-reactive protein/albumin ratio (CAR) was associated with poor OS and DFS. In patients with metastatic CRC, increased NLR and platelet-lymphocyte ratio (PLR) were associated with poor OS, DFS, and progression-free survival (PFS). In addition, high CAR and a low albumin/globulin ratio on blood chemistry tests were associated with poor OS and PFS. Although universal cut-off values were not available, various types of pretreatment laboratory markers could be utilized as adjuncts to predict prognosis in patients with CRC.

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Original Articles

Malignant disease, Rectal cancer,Prognosis,Biomarker & risk factor

Can pretreatment platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios predict long-term oncologic outcomes after preoperative chemoradiation followed by surgery for locally advanced rectal cancer?: Sang Hyun An, Ik Yong Kim; Ann Coloproctol. 2022;38(3):253-261. Published online March 7, 2022; DOI: https://doi.org/10.3393/ac.2021.00633.0090

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145 Download
14 Web of Science
17 Citations

Abstract PDF

Purpose
Systemic inflammation is associated with various malignancies, including colorectal cancer, as possible prognostic predictors. We aimed to evaluate the correlation of pretreatment the platelet-to-lymphocyte (PLR) and the neutrophil-to-lymphocyte (NLR) ratio with long-term oncologic outcomes and pathologic complete response (pCR) in locally ad vanced rectal cancer patients who received neoadjuvant concurrent chemoradiotherapy (CRT) followed by curative resection.
Methods
Between October 1996 and December 2015, 168 rectal cancer patients treated with preoperative CRT followed by surgery were enrolled. The set cut-off/mean PLR and NLR were 170 and 2.8. We analyzed the relationship between PLR, NLR, and the 5-year overall survival (OS), disease-free survival (DFS), and pCR rate.
Results
The 5-year OS rates were 75.9% and 59.8% in the highand low-PLR groups. The 5-year DFS rates were 62.9% and 50.8% in the high- and low-PLR groups, with no significant difference. In addition, the 5-year OS rates were 75.7% and 58.4%, and the 5-year DFS rates were 62.5% and 50.0% in the high- and low-NLR groups, respectively, both without any significant difference. Multivariate analysis showed only pretreatment PLR as an independent prognostic factor for OS (hazard ratio, 1.850; 95% confidence interval, 1.041–3.287; P=0.036), and both serologic markers were not independent prognostic factors for 5-year DFS.
Conclusion
Neither PLR nor NLR was associated with 5-year DFS nor pCR to neoadjuvant CRT. Only pretreatment PLR can be used in predicting OS in locally advanced rectal cancer patients who received neoadjuvant CRT followed by curative resection.

Citations

Citations to this article as recorded by

Development of clinical inflammatory models to predict the efficacy of neoadjuvant chemoradiotherapy and survival in patients with locally advanced rectal cancer: a retrospective study
Min Yang, Ruoyu Zhang, Yao Li, Fuhai Ma, Wenzhuo Jia, Tao Yu
International Journal of Colorectal Disease.2025;[Epub] CrossRef
Correlation between neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with prognosis in gastric cancer patients undergoing neoadjuvant chemotherapy: a meta-analysis
Shuang Yang, Zhuoyang Li, Tianhong Wang, Congcong Zou, Siman Wang, Shuang Deng, Yusi Hua
BMC Gastroenterology.2025;[Epub] CrossRef
Prognostic Value of Dynamic Changes in Immune-Inflammatory and Tumor Biomarkers Following Chemoradiotherapy in Locally Advanced Rectal Cancer
Mahmoud Al-Masri, Yasmin Safi, Mohammad Almasri, Ramiz Kardan, Daliana Mustafa, Osama Alayyan, Bilal Kahalah, Rama AlMasri
Cancers.2025; 17(20): 3383. CrossRef
Immunomarkers could predict overall survival and disease-free survival after neoadjuvant therapy and surgery due to locally advanced rectal cancer
Miguel A. Bonilla-Cozar, Anabel Garcia-Leon, Carlos J. Garcia-Sanchez, M. Luisa Reyes-Diaz, Irene Ramallo-Solis, Fernando De la Portilla, Javier Padillo, Rosa M. Jimenez-Rodriguez
Cirugía Española (English Edition).2025; : 800199. CrossRef
Effect of preoperative pan-immune-inflammation value on clinical and oncologic outcomes after colorectal cancer surgery: a retrospective study
Yun Ju Seo, Kyeong Eui Kim, Woon Kyung Jeong, Seong Kyu Baek, Sung Uk Bae
Annals of Surgical Treatment and Research.2024; 106(3): 169. CrossRef
Systemic Inflammatory Response Following Preoperative Chemoradiotherapy Can Affect Oncologic Outcomes in MSI-H/dMMR Rectal Cancer
Hyukjin Choi, Jin Ho Baek, An Na Seo, Su Yeon Park, Hye Jin Kim, Jun Seok Park, Gyu Seog Choi, Jong Gwang Kim, Byung Woog Kang
Chonnam Medical Journal.2024; 60(2): 105. CrossRef
Prognostic role of platelet-to-lymphocyte ratio in patients with rectal cancer undergoing resection: a systematic review and meta-analysis
Lijuan Ma, Fei Yang, Wentao Guo, Shufang Tang, Yarui Ling
Frontiers in Oncology.2024;[Epub] CrossRef
Predictive and prognostic value of inflammatory markers in locally advanced rectal cancer (PILLAR) – A multicentric analysis by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Gastrointestinal Study Group
Giuditta Chiloiro, Angela Romano, Silvia Mariani, Gabriella Macchia, Diana Giannarelli, Luciana Caravatta, Pierfrancesco Franco, Luca Boldrini, Alessandra Arcelli, Almalina Bacigalupo, Liliana Belgioia, Antonella Fontana, Elisa Meldolesi, Giampaolo Montes
Clinical and Translational Radiation Oncology.2023; 39: 100579. CrossRef
Prognostic role of platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte, and lymphocyte-to-monocyte ratio in operated rectal cancer patients: systematic review and meta-analysis
Giuseppe Portale, Patrizia Bartolotta, Danila Azzolina, Dario Gregori, Valentino Fiscon
Langenbeck's Archives of Surgery.2023;[Epub] CrossRef
Neutrophil-to-lymphocyte ratio predicts survival of patients with rectal cancer receiving neo-adjuvant chemoradiation followed by radical resection: a meta-analysis
Giuseppe Colloca, Antonella Venturino, Domenico Guarneri
Expert Review of Anticancer Therapy.2023; 23(4): 421. CrossRef
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Chul Seung Lee
Annals of Coloproctology.2023; 39(4): 287. CrossRef
Impact of Postoperative Naples Prognostic Score to Predict Survival in Patients with Stage II–III Colorectal Cancer
Su Hyeong Park, Hye Seung Woo, In Kyung Hong, Eun Jung Park
Cancers.2023; 15(20): 5098. CrossRef
Body composition parameters combined with blood biomarkers and magnetic resonance imaging predict responses to neoadjuvant chemoradiotherapy in locally advanced rectal cancer
Jianguo Yang, Qican Deng, Zhenzhou Chen, Yajun Chen, Zhongxue Fu
Frontiers in Oncology.2023;[Epub] CrossRef
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Minsung Kim, Il Tae Son, Bo Young Oh
The Ewha Medical Journal.2023;[Epub] CrossRef
How Can We Improve the Tumor Response to Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer?
Jeonghee Han
The Ewha Medical Journal.2023;[Epub] CrossRef
Neoadjuvant chemoradiotherapy determines the prognostic impact of anastomotic leakage in advanced rectal cancer
Bo Young Oh, Yoon Ah Park, Jung Wook Huh, Yong Beom Cho, Seong Hyeon Yun, Hee Cheol Kim, Woo Yong Lee
Annals of Surgical Treatment and Research.2022; 103(4): 235. CrossRef
Study on the Relationship between NEUT, NLR, PLR and the Severity of Coronary Artery Disease in Patients with ACS
延春蒋
Advances in Clinical Medicine.2022; 12(11): 9836. CrossRef

Benign GI diease,Benign diesease & IBD,Complication,Biomarker & risk factor

A development study of drain fluid gastrografin as a biomarker of anastomotic leak: David A. Clark, Edward Yeoh, Aleksandra Edmundson, Craig Harris, Andrew Stevenson, Daniel Steffens, Michael Solomon; Ann Coloproctol. 2022;38(2):124-132. Published online January 11, 2021; DOI: https://doi.org/10.3393/ac.2020.12.24

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5 Web of Science
5 Citations

Abstract PDF

Purpose
Anastomotic leakage (AL) is the anathema of colorectal surgery. Its occurrence leads to increased morbidity and mortality and a prolonged hospital stay. Much work has gone into studying various biomarkers in drain fluid to facilitate early detection of AL. This stage 2a development study aims to assess the safety and feasibility of reliably detecting the iodine in Gastrografin (GG; Bayer Australia Ltd.) in drain fluid and stool samples by dual-energy computed tomography (DECT).
Methods
This is a prospective, observational, controlled, consecutive cohort study establishing the safety and feasibility of the detection of GG in surgical drain fluid and stool as a biomarker of AL when patients with a low pelvic colorectal anastomosis undergo luminal flushing of the rectal tube with GG.
Results
Ten consecutive patients were allocated to the saline flush group and the following 10 to the GG flush group. Three patients in the saline flush group developed an AL. One patient in the GG flush group developed an AL. An elevation in the drain fluid GG was detected using DECT on the day of clinical deterioration. None of the patients in the control group were found to have a positive result on DECT.
Conclusion
This study demonstrates the safety of a novel approach to the early detection of AL from extraperitoneal colorectal anastomoses. The technique requires validation in a larger cohort and a multicenter study is planned to investigate the efficacy of GG rectal tube flushes as an early biomarker of AL in low pelvic anastomoses.

Citations

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Drain fluid iodine as a biomarker of anastomotic leak after low anterior resection in patients undergoing Gastrografin rectal tube flushes and omission of a diverting ileostomy: The GUSH study
David A. Clark, Karen Dobeli, Darren Allen, Brett McWhinney, Michael Lonne, Aleksandra Edmundson
Colorectal Disease.2025;[Epub] CrossRef
Impact of Postoperative Naples Prognostic Score to Predict Survival in Patients with Stage II–III Colorectal Cancer
Su Hyeong Park, Hye Seung Woo, In Kyung Hong, Eun Jung Park
Cancers.2023; 15(20): 5098. CrossRef
Successful colorectal anastomotic leakage management: a two oncological centres' 12-year experience
Kiril G. KIROV, Tsvetomir M. IVANOV, Nadya S. IVANOVA
Chirurgia.2022;[Epub] CrossRef
Neoadjuvant chemoradiotherapy determines the prognostic impact of anastomotic leakage in advanced rectal cancer
Bo Young Oh, Yoon Ah Park, Jung Wook Huh, Yong Beom Cho, Seong Hyeon Yun, Hee Cheol Kim, Woo Yong Lee
Annals of Surgical Treatment and Research.2022; 103(4): 235. CrossRef
Does an ileostomy cover the surgeon or the anastomosis?
David A. Clark, Andrew Stevenson, John Lumley, Damien Petersen, Craig Harris, Daniel Steffens, Michael Solomon
ANZ Journal of Surgery.2022; 92(1-2): 19. CrossRef

Malignant disease, Rectal cancer

The Use of M2-Pyruvate Kinase as a Stool Biomarker for Detection of Colorectal Cancer in Tertiary Teaching Hospital: A Comparative Study: Shahidah Che Alhadi, Wan Zainira Wan Zain, Zalina Zahari, Mohd Nizam Md Hashim, Syed Hassan Syed Abd. Aziz, Zaidi Zakaria, Michael Pak-Kai Wong, Andee Dzulkarnaen Zakaria; Ann Coloproctol. 2020;36(6):409-414. Published online September 18, 2020; DOI: https://doi.org/10.3393/ac.2020.08.27

7,907 View
114 Download
11 Web of Science
11 Citations

Abstract PDF

Purpose
Guaiac fecal occult blood test (gFOBT) has been the standard for colorectal screening but it has low sensitivity and specificity. This study evaluated the use of fecal tumor M2-pyruvate kinase (M2-PK) for detection of colorectal cancer and to compare with the current surveillance tool; gFOBT in symptomatic adult subjects underwent colonoscopy.
Methods
Stool samples were collected prospectively from symptomatic adults who had elective colonoscopy from September 2014 to January 2016 and were analyzed with the ScheBo M2-PK Quick test and laboratory detection of fecal hemoglobin.
Results
The results were correlated to the colonoscopy findings and/or histopathology report. Eighty-five subjects (age of 56.8 ± 15.3 years [mean ± standard deviation]) were recruited with a total of 17 colorectal cancer (20.0%) and 10 colorectal adenoma patients (11.8%). The sensitivity of M2-PK test in colorectal cancer detection was higher than gFOBT (100% vs. 64.7%). M2-PK test had a lower specificity when compared to gFOBT (72.5% vs. 88.2%) in colorectal cancer detection. The positive and negative predictive values were 47.2% and 100% for M2-PK test and 57.9% and 90.9% for gFOBT.
Conclusion
Fecal M2-PK Quick test has a high sensitivity for detection of colorectal cancer when compared to gFOBT, making it the potential choice for colorectal tumor screening biomarker in the future.

Citations

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Emerging Non-Invasive Biomarkers for Early Detection of Gastrointestinal Cancers
Adeshpal Singh, Hemanth Kesani, Tareq Mohammed Saleh, Manju Rai
Cureus.2025;[Epub] CrossRef
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Kha Wai Hon, Rakesh Naidu
Biomolecules.2025; 15(10): 1376. CrossRef
The Importance of Evaluating Serum Levels of Tumor Markers M2-PK and Inhibin A in Patients Undergoing Colonoscopy
Mahmood Khosravi, Ali Arash Anoushirvani, Zahedin Kheiri, Ali Rahbari, Ali Jadidi
Technology in Cancer Research & Treatment.2023;[Epub] CrossRef
Noninvasive fecal testing for colorectal cancer
Jianhua Zou, Zhanshuo Xiao, Yu Wu, Jingyan Yang, Ning Cui
Clinica Chimica Acta.2022; 524: 123. CrossRef
Comparison of faecal protein biomarkers' diagnostic accuracy for colorectal advanced neoplasms: a systematic review and meta-analysis
Atefeh Nasir Kansestani, Mohammad Erfan Zare, Qingchao Tong, Jun Zhang
Scientific Reports.2022;[Epub] CrossRef
Direction of diagnosis and treatment improvement in colorectal cancer
In Ja Park
Journal of the Korean Medical Association.2022; 65(9): 540. CrossRef
Epidemiology, risk factors, and prevention of colorectal cancer
Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim
Journal of the Korean Medical Association.2022; 65(9): 549. CrossRef
Epidemiology, Risk Factors, and Prevention of Colorectal Cancer-An English Version
Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim
Journal of the Anus, Rectum and Colon.2022; 6(4): 231. CrossRef
Update on Diagnosis and Treatment of Colorectal Cancer
Chan Wook Kim
The Ewha Medical Journal.2022;[Epub] CrossRef
Towards Novel Non-Invasive Colorectal Cancer Screening Methods: A Comprehensive Review
Allegra Ferrari, Isabelle Neefs, Sarah Hoeck, Marc Peeters, Guido Van Hal
Cancers.2021; 13(8): 1820. CrossRef
Genotypic and Phenotypic Characteristics of Hereditary Colorectal Cancer
Jin Cheon Kim, Walter F. Bodmer
Annals of Coloproctology.2021; 37(6): 368. CrossRef

Neutrophil to Lymphocyte Ratio: A Predictive Marker for Treatment Outcomes in Patients With Rectal Cancer Who Underwent Neoadjuvant Chemoradiation Followed by Surgery: Byong Ho Jeon, Ui Sup Shin, Sun Mi Moon, Jung Il Choi, Mi-Sook Kim, Kie Hwan Kim, Se-Jin Sung; Ann Coloproctol. 2019;35(2):100-106. Published online April 30, 2019; DOI: https://doi.org/10.3393/ac.2018.10.01

6,252 View
133 Download
19 Web of Science
20 Citations

Abstract PDF

Purpose
In this study, we investigated the role of neutrophil to lymphocyte ratio (NLR) as a predictor of tumor response and as a prognostic factor in patients with rectal cancer who had undergone curative surgery after neoadjuvant chemoradiation therapy (nCRT).
Methods
Between January 2009 and July 2016, we collected 140 consecutive patients who had undergone curative intent surgery after nCRT due to rectal adenocarcinoma. We obtained the pre- and post-nCRT NLR by dividing the neutrophil count by the lymphocyte count. The cutoff value was obtained using receiver operating characteristic analysis for tumor response and using maximally selected rank analysis for recurrence-free survival (RFS). The relationship among NLR, tumor response, and RFS was assessed by adjusting the possible clinico-pathological confounding factors.
Results
The possibility of pathologic complete response (pCR) was significantly decreased in high pre- (>2.77) and postnCRT NLR (>3.23) in univariate regression analysis. In multivariate analysis, high post-nCRT NLR was an independent negative predictive factor for pCR (adjusted odds ratio, 0.365; 95% confidence interval [CI], 0.145–0.918). The 5-year RFS of all patients was 74.6% during the median 37 months of follow-up. Patients with higher pre- (>2.66) and post-nCRT NLR (>5.21) showed lower 5-year RFS rates (53.1 vs. 83.3%, P = 0.006) (69.2 vs. 75.7%, P = 0.054). In multivariate Cox analysis, high pre-nCRT NLR was an independent poor prognostic factor for RFS (adjusted hazard ratio, 2.300; 95% CI, 1.061–4.985).
Conclusion
Elevated NLR was a negative predictive marker for pCR and was independently associated with decreased RFS. For confirmation, a large-scale study with appropriate controls is needed.

Citations

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