Combined Detection of Preoperative Neutrophil-to-Lymphocyte Ratio and CEA as an Independent Prognostic Factor in Nonmetastatic Patients Undergoing Colorectal Cancer Resection Is Superior to NLR or CEA Alone

OBJECTIVE To explore the role of combined detection of carcinoembryonic antigen (CEA) and neutrophil-to-lymphocyte ratio (NLR) in the prognostic assessment of colorectal cancer (CRC). METHODS We investigated preoperative NLR and CEA in 125 surgical CRC patients, determined the patients' thresholds by receiver operating characteristic (ROC) curve analysis, and assessed their prognostic values by Kaplan-Meier curve and Cox regression models. In addition, we used nomograms of several risk factors to evaluate the risk in survival and predictive accuracy by using Harrell's concordance index (c-index). RESULTS Results of multivariate analysis showed high NLR, high CEA, and high COCN (combination of CEA and NLR) were significantly correlated with decreased disease-free survival (DFS) [HR: 2.229, 95% CI: 1.012-4.911, and P = 0.047; HR: 3.652, 95% CI: 1.630-8.179, and P = 0.002; HR: 3.139, 95% CI: 1.800-5.472, and P < 0.001]. But high CEA and COCN remained significant only for decreased overall survival (OS) [HR: 3.713, 95% CI: 1.396-9.873, and P = 0.009; HR: 3.106, 95% CI: 1.576-6.123, and P = 0.001]. High NLR showed higher mortality rates with worse OS (P = 0.058), and nomograms containing NLR improved the predictive accuracy. Area under the curve of COCN was higher than that of CEA or NLR. CONCLUSION COCN acts as a better independent prognostic biomarker of CRC than NLR or CEA alone.