The Diagnostic Importance of RDWLR, PDWLR, and Immature Granulocytes in Colorectal Cancer

Abstract

Objective: A complex inflammatory response forms against the local effects of malignancy. In the differentiation of colorectal cancer from benign colorectal polypoid lesions, inflammatory biomarkers such as platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), and Red Cell Distribution Width (RDW) have previously provided promising results. This study aimed to investigate the results of immature granulocytes (IG) and as yet unstudied biomarkers such as nucleated red blood cells (NRBC), platelet distribution width (PDW), and Mean Platelet Volume (MPV) with new inflammatory indexes such as the RDW-lymphocyte ratio (RDWLR) and the PDW-lymphocyte ratio (PDWLR). Material and Method: The hematological biomarkers were compared between 269 patients with colorectal benign polyps and 57 patients with colorectal adenocarcinoma. To determine the sensitivity and specificity of the biomarkers related to the neoplastic characteristics of the colorectal polyps, the Receiver Operating Characteristics (ROC) curve analysis was performed. Results: The mean NRBC count, IG count, and rates were similar in both groups. In the colorectal carcinoma group, PDW was lower (p=0.004) and RDW was higher (p=0.018). The NLR, PLR, RDWLR, and PDWLR values were significantly higher in the colorectal carcinoma group (p<0.001, p<0.001, p<0.001, p=0.003, respectively). In the ROC analysis for the differential diagnosis of colorectal cancer from colorectal polyp, the AUC values of NLR, PLR, and RDWLR were determined to be higher (0.714, 0.719, 0.720) with sensitivity and specificity of 73.68% and 64.31%, 64.91% and 72.75%, and 69.09 and 69.78%, respectively. The AUC value of PWDLR was determined to be 0.625, with a sensitivity of 73.21% and specificity of 52.81%. Conclusion: The diagnostic importance of NLR and PLR in colorectal cancer was confirmed, and RDWLR is a promising new parameter. IG has no significant diagnostic value.

Keywords

• Colorectal cancer
• colorectal polyp
• immature granulocyte
• red cell distribution width to lymphocyte ratio
• platelet distribution width to lymphocyte ratio
• diagnosis

Supporting Institution

No funds, grants, or other support was received.

Ethical Statement

Approval for the study was granted by the Ankara Etlik City Hospital Ethics Committee (decision no:AEŞH-BADEK-2024-195, dated:28.02.2024). All the study procedures complied with the Helsinki Declaration and local ethics criteria.

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