Robust Predictive Performance of MLPAS and CCMLP for Clinical Outcome and Risk Stratification in Patients with Colorectal Cancer

Qiu-Ying Ye,1– 3,* Yuan-Yuan Wang,1,* Zhi-Jie Wang,1,* Min Lu,4 Hong-Xin Peng,5 Xin Wang,6 Xue-Xin Cheng,1 Hou-Qun Ying1,3,7 1Department of Clinical Laboratory, Immunity and Inflammation Key Laboratory of Jiangxi Province, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People’s Republic of China; 2Department of Medical Technology, Jiangxi Medical College, Shangrao, 334000, People’s Republic of China; 3Department of Laboratory Medicine, Central Hospital of Shangrao City, Shangrao, 334000, People’s Republic of China; 4Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People’s Republic of China; 5Department of Clinical Laboratory, Nanjing First Hospital, Nanjing, 210006, People’s Republic of China; 6Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Shandong First Medical University, Taian, 271000, People’s Republic of China; 7Shangrao Medical Center, The Second Affiliated Hospital of Nanchang University, Shangrao, 334000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Hou-Qun Ying, Department of Clinical Laboratory, Immunity and Inflammation Key Laboratory of Jiangxi Province, The Second Affiliated Hospital of Nanchang University, No. 1 of Minde Road, Nanchang, 330006, People’s Republic of China, Tel/Fax +86 0791 86297662, Email [email protected]: There is no recognized biomarker is recommended to monitor or predict the prognosis of colorectal cancer (CRC) patients with negative detection of carcinoembryonic antigen (CEA) or carbohydrate antigen 19– 9 (CA19-9) and to classify high recurrence-risk cases.Methods: Discovery and two-stage validation cohorts, which included 2111 radically resected patients with stage II–III CRC, were enrolled in this study. We detected preoperative peripheral monocyte, platelet, albumin (Alb), pre-albumin (pAlb), CEA, and CA19-9 and investigated the prognostic and risk-stratified roles of twelve new inflammatory biomarkers in the three cohorts.Results: In our study, monocyte-to-pAlb ratio (MPAR), monocyte-to-lymphocyte -to-Alb ratio (MLAR), monocyte-to-lymphocyte-to-pAlb ratio (MLPAR), monocyte- to-pAlb score (MPAS), lymphocyte-to-monocyte-Alb score (MLAS), lymphocyte-to monocyte-pAlb score (MLPAS), and platelet-to-lymphocyte-Alb score (PLAS) were significantly associated with both RFS and OS in three cohorts. MLPAS showed the best performance in predicting RFS and OS, and it was related to right-tumor location and significant cancer burden (≥ 5cm) in the overall population. Moreover, MLPAS is a robust prognostic biomarker in subgroups stratified by CEA or CA19-9. Patients with scores zero and two of the CEA-CA19-9-MLPAS score (CCMLP) showed the lowest and highest recurrence and death rates, respectively, and significant survival differences were observed between them.Conclusion: MLPAS is an optimal, independent, and robust prognostic biomarker in the stage II–III CRC population, especially with negative CEA or CA19-9. The CCMLP could effectively classify high recurrence-risk patients who require more focus, monitoring, and treatment for the clinic.Keywords: colorectal cancer, inflammation, prognosis, lymphocyte to monocyte-pre-albumin score, CEA-CA19-9-MLPAS score