Preoperative carcinoembryonic antigen to lymphocyte ratio serves as a prognostic predictor in elderly patients with colorectal cancer: a multicentre retrospective study
Objectives The aim of this study is to derive and validate a reliable indicator for predicting an increased risk of postoperative mortality in elderly patients undergoing curative resection for colorectal cancer (CRC).Design This study is of multicentre retrospective design.Setting and participants...
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BMJ Publishing Group
2025-01-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/1/e086432.full |
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| author | Lei Jiang Ning Tan Xiaonan Zhang Jiayi Jiang Xinyi Li Gang Deng Tao Liang Haohan Ma Weiping Deng Lichang Guan Kaijun Zhang Xujie Cai Lishu Xu |
| author_facet | Lei Jiang Ning Tan Xiaonan Zhang Jiayi Jiang Xinyi Li Gang Deng Tao Liang Haohan Ma Weiping Deng Lichang Guan Kaijun Zhang Xujie Cai Lishu Xu |
| author_sort | Lei Jiang |
| collection | DOAJ |
| description | Objectives The aim of this study is to derive and validate a reliable indicator for predicting an increased risk of postoperative mortality in elderly patients undergoing curative resection for colorectal cancer (CRC).Design This study is of multicentre retrospective design.Setting and participants A total of 1227 CRC patients undergoing curative resection (age ≥65 years) from three distinct cohorts were retrospective enrolled. Participant cohorts consisted of the derivation (n=845), external validation (n=95) and localised validation (n=287) groups. The carcinoembryonic antigen (CEA) to lymphocyte ratio (CLR) was derived from the derivation cohort and subsequently validated in two additional cohorts. The observed end point was all-cause death during the follow-up period postoperation.Results In the derivation cohort, CLR demonstrated an independent association with all-cause mortality. In the two validation cohorts, CLR also presented a strong discriminatory ability in predicting postoperative all-cause death, with the area under the curve (AUC) of 0.68 in the external cohort and 0.78 in the localised cohort. Survival analyses revealed that CRC patients with CLR ≤2.53 tended to have better overall survival than those with CLR >2.53 (p<0.05 for all cohorts). Multivariate Cox proportional hazard models indicated that CLR ≤2.53 was significantly associated with reduced mortality risk in the derivation (HR: 0.405, p<0.001), external validation (HR: 0.519, p=0.039) and localised validation cohorts (HR: 0.167, p<0.001).Conclusions Preoperative CLR serves as a reliable predictor of all-cause death following curative resection in elderly patients with CRC. Individuals with CLR exceeding 2.53 are inclined to a lower overall survival probability. |
| format | Article |
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| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-2f4c0892291a4e3b81dc7bcee3f50d7c2025-01-21T10:50:09ZengBMJ Publishing GroupBMJ Open2044-60552025-01-0115110.1136/bmjopen-2024-086432Preoperative carcinoembryonic antigen to lymphocyte ratio serves as a prognostic predictor in elderly patients with colorectal cancer: a multicentre retrospective studyLei Jiang0Ning Tan1Xiaonan Zhang2Jiayi Jiang3Xinyi Li4Gang Deng5Tao Liang6Haohan Ma7Weiping Deng8Lichang Guan9Kaijun Zhang10Xujie Cai11Lishu Xu12Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, ChinaDepartment of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, Guangdong, ChinaSchool of Nursing, Tianjin Medical University, Tianjin, ChinaSchool of Pediatrics, Nanjing Medical University, Nanjing, Jiangsu, China2 Tsinghua University, Beijing, ChinaDepartment of Neurology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China1 School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, ChinaDepartment of Cardiology, Guangdong Provincial People`s Hospital, Guangzhou, Guangdong, ChinaDepartment of Geriatric Gastroenterology, Guangdong Provincial Geriatrics Institute, Guangzhou, Guangdong, ChinaDepartment of Geriatric Gastroenterology, Guangdong Provincial Geriatrics Institute, Guangzhou, Guangdong, ChinaDepartment of Geriatric Gastroenterology, Guangdong Provincial Geriatrics Institute, Guangzhou, Guangdong, ChinaDepartment of General Surgery (Area 1), People`s Hospital of Yingde City, Yingde, Guangdong, ChinaDepartment of Geriatric Gastroenterology, Guangdong Provincial Geriatrics Institute, Guangzhou, Guangdong, ChinaObjectives The aim of this study is to derive and validate a reliable indicator for predicting an increased risk of postoperative mortality in elderly patients undergoing curative resection for colorectal cancer (CRC).Design This study is of multicentre retrospective design.Setting and participants A total of 1227 CRC patients undergoing curative resection (age ≥65 years) from three distinct cohorts were retrospective enrolled. Participant cohorts consisted of the derivation (n=845), external validation (n=95) and localised validation (n=287) groups. The carcinoembryonic antigen (CEA) to lymphocyte ratio (CLR) was derived from the derivation cohort and subsequently validated in two additional cohorts. The observed end point was all-cause death during the follow-up period postoperation.Results In the derivation cohort, CLR demonstrated an independent association with all-cause mortality. In the two validation cohorts, CLR also presented a strong discriminatory ability in predicting postoperative all-cause death, with the area under the curve (AUC) of 0.68 in the external cohort and 0.78 in the localised cohort. Survival analyses revealed that CRC patients with CLR ≤2.53 tended to have better overall survival than those with CLR >2.53 (p<0.05 for all cohorts). Multivariate Cox proportional hazard models indicated that CLR ≤2.53 was significantly associated with reduced mortality risk in the derivation (HR: 0.405, p<0.001), external validation (HR: 0.519, p=0.039) and localised validation cohorts (HR: 0.167, p<0.001).Conclusions Preoperative CLR serves as a reliable predictor of all-cause death following curative resection in elderly patients with CRC. Individuals with CLR exceeding 2.53 are inclined to a lower overall survival probability.https://bmjopen.bmj.com/content/15/1/e086432.full |
| spellingShingle | Lei Jiang Ning Tan Xiaonan Zhang Jiayi Jiang Xinyi Li Gang Deng Tao Liang Haohan Ma Weiping Deng Lichang Guan Kaijun Zhang Xujie Cai Lishu Xu Preoperative carcinoembryonic antigen to lymphocyte ratio serves as a prognostic predictor in elderly patients with colorectal cancer: a multicentre retrospective study BMJ Open |
| title | Preoperative carcinoembryonic antigen to lymphocyte ratio serves as a prognostic predictor in elderly patients with colorectal cancer: a multicentre retrospective study |
| title_full | Preoperative carcinoembryonic antigen to lymphocyte ratio serves as a prognostic predictor in elderly patients with colorectal cancer: a multicentre retrospective study |
| title_fullStr | Preoperative carcinoembryonic antigen to lymphocyte ratio serves as a prognostic predictor in elderly patients with colorectal cancer: a multicentre retrospective study |
| title_full_unstemmed | Preoperative carcinoembryonic antigen to lymphocyte ratio serves as a prognostic predictor in elderly patients with colorectal cancer: a multicentre retrospective study |
| title_short | Preoperative carcinoembryonic antigen to lymphocyte ratio serves as a prognostic predictor in elderly patients with colorectal cancer: a multicentre retrospective study |
| title_sort | preoperative carcinoembryonic antigen to lymphocyte ratio serves as a prognostic predictor in elderly patients with colorectal cancer a multicentre retrospective study |
| url | https://bmjopen.bmj.com/content/15/1/e086432.full |
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