Neutrophil-albumin ratio as a biomarker for postoperative complications and long-term prognosis in patients with colorectal cancer undergoing surgical treatment

Hailun Xie; Lishuang Wei; Mingxiang Liu; Yanren Liang; Guanghui Yuan; Shunhui Gao; Qiwen Wang; Xin Lin; Shuangyi Tang; Jialiang Gan

doi:10.3389/fnut.2022.976216

Neutrophil-albumin ratio as a biomarker for postoperative complications and long-term prognosis in patients with colorectal cancer undergoing surgical treatment

Front Nutr. 2022 Nov 15:9:976216. doi: 10.3389/fnut.2022.976216. eCollection 2022.

Authors

Hailun Xie^{1

2}, Lishuang Wei³, Mingxiang Liu^{1

2}, Yanren Liang^{1

2}, Guanghui Yuan^{1

2}, Shunhui Gao^{1

2}, Qiwen Wang^{1

2}, Xin Lin^{2

4}, Shuangyi Tang⁵, Jialiang Gan^{1

2}

Affiliations

¹ Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, China.
² Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, China.
³ Department of Geriatric Respiratory Disease Ward, The First Affiliated Hospital, Guangxi Medical University, Nanning, China.
⁴ Grade 2018, Department of Clinical Medicine, Guangxi Medical University, Nanning, China.
⁵ Department of Pharmacy, The First Affiliated Hospital, Guangxi Medical University, Nanning, China.

Abstract

Background: To explore the prognostic value of the preoperative neutrophil-albumin ratio (NAR) in patients with colorectal cancer (CRC) undergoing surgical treatment.

Materials and methods: The standardized log-rank statistic was used to determine the optimal cut-off value for NAR. A logistic regression model was used to evaluate the value of NAR in predicting postoperative complications. Cox proportional hazards models were used to assess the independent association of NAR with progression-free survival (PFS) and overall survival (OS) in CRC patients. Restricted cubic splines were used to assess the relationship between continuous NAR and survival in CRC patients. The Kaplan-Meier method and log-rank test were used to compare survival differences between low and high NAR groups. NAR-based prognostic nomograms were constructed to predict the 1-5-year PFS and OS of CRC patients. The concordance index (C-index) and calibration curve were used to evaluate the prognostic accuracy of the nomograms.

Results: A total of 1,441 CRC patients were enrolled from January 2012 to December 2016. There were 904 men (62.7%) and 537 women (37.3%), with an average age of 58.12 ± 13.15 years. High NAR was closely associated with low BMI, advanced pathological stage, colon cancer, large tumors, vascular invasion, poor differentiation, high CEA levels, long hospital stay, and recurrence and metastasis. A high NAR was an independent risk factor for postoperative complications in CRC patients (OR: 2.298, 95% CI: 1.642-3.216, p < 0.001). Patients with a high NAR had worse PFS (40.7 vs. 59.5%, p < 0.001) and OS (42.6 vs. 62.4%, p < 0.001). After adjusting for confounders, high NAR was independently associated with PFS (HR: 1.280, 95% CI: 1.031-1.589, p = 0.025) and OS (HR: 1.280; 95% CI: 1.026-1.596, p = 0.029) in CRC patients. The C-index and calibration curves showed that the NAR-based prognostic nomograms had good predictive accuracy.

Conclusion: High NAR was an independent risk factor for postoperative complications and long-term prognosis of CRC patients. NAR-based research could provide references for prognostic judgment and clinical decision-making of CRC patients.

Keywords: colorectal cancer; complication; neutrophil-albumin ratio; nutrition; prognosis; systemic inflammation.