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Preoperative platelet–lymphocyte ratio is an independent prognostic marker and superior to carcinoembryonic antigen in colorectal peritoneal carcinomatosis patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

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Abstract

Objective

The aim of this study was to examine the prognostic significance of preoperative inflammatory-based indices, platelet–lymphocyte ratio (PLR), neutrophil–lymphocyte ratio (NLR), and carcinoembryonic antigen (CEA) in predicting overall survival (OS) in patients with colorectal peritoneal carcinomatosis (CPC) treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

Methods

Sixty patients with pathologically confirmed CPC treated with CRS and HIPEC between 2003 and 2015 were included. Levels of preoperative PLR, NLR, and CEA were recorded. Univariate and multivariate analyses were conducted to identify prognostic factors associated with OS.

Results

Median OS was 36 months (95% CI, 26.6–45.4) and 5-year OS was 40.5% (95% CI, 27.3–51.6%). Preoperative PLR (p = 0.034) and CEA (p = 0.036) were found to be significant prognostic markers of OS, whereas NLR did not affect OS. PLR remained significant on multivariate analysis (hazard ratio, 1.035; 95% CI, 1.027–1.043; p < 0.001).

Conclusion

Our study indicates that preoperative PLR may be used as a prognostic marker in CPC patients undergoing CRS and HIPEC and could be useful in the preoperative setting when selecting patients for surgery. The subset of patients with PLR > 300 have a median OS of 5 months (95% CI, 0–24.6 months), indicating that CRS and HIPEC may not be superior to systemic chemotherapy in this subset of patients.

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Acknowledgements

We thank Mr. Mrinal Kumar for helping in statistical analysis, and Ms. Thakshayeni Skanthakumar and Ms. Tuty Muliana Bte Ismail for assisting with data collection.

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Authors and Affiliations

  1. Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore

    Tiffany Sin Hui Bong, Grace Hwei Ching Tan, Claramae Chia, Khee Chee Soo & Melissa Ching Ching Teo

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  1. Tiffany Sin Hui Bong
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  2. Grace Hwei Ching Tan
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Correspondence to Melissa Ching Ching Teo.

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Bong, T.S.H., Tan, G.H.C., Chia, C. et al. Preoperative platelet–lymphocyte ratio is an independent prognostic marker and superior to carcinoembryonic antigen in colorectal peritoneal carcinomatosis patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Int J Clin Oncol 22, 511–518 (2017). https://doi.org/10.1007/s10147-017-1092-3

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