Increased neutrophil counts are associated with poor overall survival in patients with colorectal cancer: a five-year retrospective analysis

Front Immunol. 2024 Sep 23:15:1415804. doi: 10.3389/fimmu.2024.1415804. eCollection 2024.

Abstract

Background: Colorectal cancer (CRC) continues to be a major health concern in today's world. Despite conflictive findings, evidence supports systemic inflammation's impact on CRC patients' survival rates. Therefore, this study aims to assess the prognostic role of the innate immune system in patients with CRC.

Method: A total of 449 patients were included, with a 5-year follow-up period, and absolute neutrophil counts and their related ratios were measured.

Results: The non-survival group had increased levels of white blood cells, neutrophils (both p<0.001), and monocytes (p=0.038), compared to the survival group, along with other neutrophil-related ratios. We observed increased mortality risk in patients in the highest tertile of white blood cells [HR=1.85 (1.09-3.13), p<0.05], neutrophils [HR=1.78 (95% CI: 1.07-2.96), p<0.05], and monocytes [HR=2.11 (95% CI: 1.22-3.63)], compared to the lowest tertile, after adjusting for all clinicopathological variables. Random forest analysis identified neutrophils as the most crucial variable in predicting survival rates, having an AUC of 0.712, considering all clinicopathological variables. A positive relationship between neutrophil counts and metastasis was observed when neutrophil counts are considered continuous (β=0.92 (0.41), p<0.05) and tumor size (width) when neutrophils were considered as logistic variable (T1 vs T3) [OR=1.42, (95% CI: 1.05-1.98), p<0.05].

Conclusion: This study offers comprehensive insights into the immune factors that impact the prognosis of CRC, emphasizing the need for personalized prognostic tools.

Keywords: colorectal cancer; inflammation; neutrophils; overall survival; prognosis.

MeSH terms

  • Aged
  • Colorectal Neoplasms* / immunology
  • Colorectal Neoplasms* / mortality
  • Colorectal Neoplasms* / pathology
  • Female
  • Humans
  • Leukocyte Count
  • Male
  • Middle Aged
  • Neutrophils* / immunology
  • Prognosis
  • Retrospective Studies

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by the “Centro de Investigacion Biomédica en Red Fisiopatología de la Obesidad y Nutricion”, which is an initiative of the “Instituto de Salud Carlos III” (ISCIII) of Spain, financed by the European Regional Development Fund under “A way to make Europe”/”Investing in your future” (CB06/03), a grant from ISCIII (PI18/01399, PI21/00633), UMA-FEDERJA-085, from Programa Operativo FEDER 2014-2020 of the Consejería de Economía y Conocimiento de la Junta de Andalucía. and a grant from the Consejeria Universidad, Investigacion e Innovacion Junta de Andalucia (PY20-01270). HB was supported by a predoctoral fellowship (“Plan Propio IBIMA 2020 A.1 Contratos predoctoral”, Ref.: predoc20_002 and by a “Sara Borrell” postdoctoral contract (CD22/00053) from the Instituto de Salud Carlos III-Madrid (Spain), “Financiado por la Unión Europea-NextGenerationEU” and the plan Recuperación, Transformación y Resiliencia. GG-C was supported by a predoctoral contract (FI23/00104). LG-F was supported by a “Sara Borrell” postdoctoral contract (CD21/000131) from the Instituto de Salud Carlos III—Madrid (Spain). AO-G was supported by a “Miguel Servet” postdoctoral contract (CP020/0060). MG was the recipient of the Nicolas Monardes Programme from the “Servicio Andaluz de Salud, Junta de Andalucia”, Spain (RC-0001-2018 and C-0029-2014).