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Kolorektal Kanserin Anatomik Lokalizasyonun Belirlenmesinde İnflamatuar Belirteçler Faydalı Mıdır?: İmmatür Granulosit ve Kırmızı Hücre Dağılım Genişliği

Year 2025, Volume: 6 Issue: 3, 157 - 165, 28.09.2025

Ümit Özdemir , Necip Tolga Baran

https://doi.org/10.47482/acmr.1627472

Abstract

Arka Plan: Sağ ve sol kolon tümörleri arasında embriyolojik, klinikopatolojik ve prognostik farklar bulunur. Bu çalışmanın amacı sağ ve sol kolon kanserlerinin ayrılmasında inflamatuar belirteçlerin tanısal faydasının araştırılmasıdır.
Yöntemler: Hastalar sağ kolon kanseri(RCC) n=71 ((33.8%)) ve sol kolorektal kanser(LCRC) (n =139 (66.2%)) olarak ikiye ayrıldı. Klinik özellikler, hemoglobin, nötrofil lenfosit oranı (NLR), platelet lenfosit oranı(PLR), Sistemik İmmün-inflamasyon İndeksi(SII), İmmatür Granulosit sayısı(IGC), İmmatür Granulosit yüzdesi (IG%), Kırmızı Hücre Dağılım Genişliği yüzdesi (RDW) parametreleri gruplar arasında karşılaştırıldı.
Bulgular: Karşılaştırmada TNM evresi, NLR, PLR, SII, IGC ve IG% gruplar arasında benzerdir. RCC grubunda, hemoglobin düşük (11.35 (6.40 – 16.40) vs 13.00 (6.00 – 17.00) mg/dl), RDW yüksektir (14.80 %(11.90 – 27.90) vs 13.70% (11.00 – 37.10)), p=0.001 ve p=0.005 sırasıyla. ROC analizi hemoglobin(p<0.001, AUC=0.640) ve RDW% (p=0.004, AUC=0.621) açısından anlamlıdır
Sonuçlar: CRC’nin anatomik lokalizasyonu göstermede daha önce araştırılmış NLR, PLR ve ilk kez araştırılan, umut vadeden SII, IGC gibi inflamatuar belirteçler yetersizdir. Fark gözlenen RDW ve hemoglobin ise RCC grubunda sıkça görülen subklinik kanamaya bağlanabilir.

Keywords

kolorektal kanser kolorektal kanser lokalizasyonu inflamatuar belirteçler immatür granulosit kırmız hücre dağılım genişliği

References

  • Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023;73(1):17-48.
  • Cronin KA, Scott S, Firth AU, Sung H, Henley SJ, Sherman RL, et al. Annual report to the nation on the status of cancer, part 1: National cancer statistics. Cancer. 2022;128(24):4251-84.
  • Benedix F, Schmidt U, Mroczkowski P, Gastinger I, Lippert H, Kube R. Colon carcinoma—classification into right and left sided cancer or according to colonic subsite? Analysis of 29,568 patients. Eur J Surg Oncol. 2011;37(2):134-9.
  • Siegel RL, Wagle NS, Cercek A, Smith RA, Jemal A. Colorectal cancer statistics, 2023. CA Cancer J Clin. 2023;73(3):233-54.
  • Petrelli F, Tomasello G, Borgonovo K, Ghidini M, Turati L, Dallera P, et al. Prognostic survival associated with left-sided vs right-sided colon cancer: a systematic review and meta-analysis. JAMA Oncol. 2017;3(2):211-9.
  • Yahagi M, Okabayashi K, Hasegawa H, Tsuruta M, Kitagawa Y. The worse prognosis of right-sided compared with left-sided colon cancers: a systematic review and meta-analysis. J Gastrointest Surg. 2016;20(3):648-55.
  • Shen H, Yang J, Huang Q, Jiang MJ, Tan YN, Fu JF, et al. Different treatment strategies and molecular features between right-sided and left-sided colon cancers. World J Gastroenterol. 2015;21(21):6470-7.
  • Brulé S, Jonker D, Karapetis C, O’Callaghan CJ, Moore M, Wong R, et al. Location of colon cancer (right-sided versus left-sided) as a prognostic factor and a predictor of benefit from cetuximab in NCIC CO.17. Eur J Cancer. 2015;51(11):1405-14.
  • Saidi H, Karuri D, Nyaim E. Correlation of clinical data, anatomical site and disease stage in colorectal cancer. East Afr Med J. 2008;85(6):259-62.
  • Borsig L, Wolf MJ, Roblek M, Lorentzen A, Heikenwalder M. Inflammatory chemokines and metastasis—tracing the accessory. Oncogene. 2014;33(25):3217-24.
  • Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nat. 2008;454(7203):436-44.
  • Bozan MB, Yazar FM, Kale IT, Yüzbaşıoğlu MF, Boran ÖF, Azak Bozan A. Delta neutrophil index and neutrophil-to-lymphocyte ratio in the differentiation of thyroid malignancy and nodular goiter. World J Surg. 2021;45(2):507-14.
  • Chen B, Ye B, Zhang J, Ying L, Chen Y. RDW to platelet ratio: a novel noninvasive index for predicting hepatic fibrosis and cirrhosis in chronic hepatitis B. PLoS One. 2013;8(7):e68780.
  • Gallois C, Pernot S, Zaanan A, Taieb J. Colorectal cancer: why does side matter? Drugs. 2018;78(7):789-98.
  • Logan RF, Patnick J, Nickerson C, Coleman L, Rutter MD, von Wagner C. Outcomes of the Bowel Cancer Screening Programme (BCSP) in England after the first 1 million tests. Gut. 2012;61(10):1439-46.
  • Young PE, Womeldorph CM. Colonoscopy for colorectal cancer screening. J Cancer. 2013;4(3):217-26.
  • Guo D, Li X, Xie A, Cao Q, Zhang J, Zhang F, et al. Differences in oncological outcomes and inflammatory biomarkers between right-sided and left-sided stage I-III colorectal adenocarcinoma. J Clin Lab Anal. 2020;34(4):e23132.
  • Hayama T, Ozawa T, Asako K, Kondo R, Ono K, Okada Y, et al. Impact of colon cancer location on the prognostic significance of nutritional indexes and inflammatory markers. In Vivo. 2021;35(2):1261-9.
  • Spell DW, Jones DV Jr, Harper WF, Bessman JD. The value of a complete blood count in predicting cancer of the colon. Cancer Detect Prev. 2004;28(1):37-42.
  • Fancellu A, Zinellu A, Mangoni AA, Popova A, Galotti F, Feo CF, et al. Red blood cell distribution width (RDW) correlates to the anatomical location of colorectal cancer. Implications for clinical use. J Gastrointest Cancer. 2022;53(1):1-6.
  • Pedrazzani C, Tripepi M, Turri G, Fernandes E, Scotton G, Conci S, et al. Prognostic value of red cell distribution width (RDW) in colorectal cancer. Results from a single-center cohort on 591 patients. Sci Rep. 2020;10(1):1072.
  • Benedix F, Kube R, Meyer F, Schmidt U, Gastinger I, Lippert H, et al. Comparison of 17,641 patients with right- and left-sided colon cancer: differences in epidemiology, perioperative course, histology, and survival. Dis Colon Rectum. 2010;53(1):57-64.
  • Elinav E, Nowarski R, Thaiss CA, Hu B, Jin C, Flavell RA. Inflammation- induced cancer: crosstalk between tumours, immune cells and microorganisms. Nat Rev Cancer. 2013;13(11):759-71.
  • Candido J, Hagemann T. Cancer-related inflammation. J Clin Immunol. 2013;33 Suppl 1:S79-84.
  • Yang L, He W, Kong P, Jiang C, Yang Q, Xie Q, et al. Clinical baseline and prognostic difference of platelet lymphocyte ratio (PLR) in right-sided and left-sided colon cancers. BMC Cancer. 2017;17(1):1-11.
  • Menyhart O, Fekete JT, Győrffy B. Inflammation and colorectal cancer: a meta-analysis of the prognostic significance of the systemic immune–inflammation index (SII) and the systemic inflammation response index (SIRI). Int J Mol Sci. 2024;25(15):8441.
  • Dong M, Shi Y, Yang J, Zhou Q, Lian Y, Wang D, et al. Prognostic and clinicopathological significance of systemic immune-inflammation index in colorectal cancer: a meta-analysis. Ther Adv Med Oncol. 2020;12:1758835920937425.
  • Chen JH, Zhai ET, Yuan YJ, Wu KM, Xu JB, Peng JJ, et al. Systemic immune-inflammation index for predicting prognosis of colorectal cancer. World J Gastroenterol. 2017;23(34):6261-72.
  • Hernandez-Ainsa M, Velamazan R, Lanas A, Carrera-Lasfuentes P, Piazuelo E. Blood-cell-based inflammatory markers as a useful tool for early diagnosis in colorectal cancer. Front Med (Lausanne). 2022;9:843074.
  • Senthilnayagam B, Kumar T, Sukumaran J, Rao KR. Automated measurement of immature granulocytes: performance characteristics and utility in routine clinical practice. Pathol Res Int. 2012;2012:483670.
  • Ünal Y. A new and early marker in the diagnosis of acute complicated appendicitis: immature granulocytes. Ulus Travma Acil Cerrahi Derg. 2018;24(5):435-41.
  • Barut O, Demirkol MK, Kucukdurmaz F, Sahinkanat T, Resim S. Pre-treatment delta neutrophil index as a predictive factor in renal cell carcinoma. J Coll Physicians Surg Pak. 2021;31(2):156-62.
  • Bozan MB, Yazar FM, Kale IT, Topuz S, Bozan AA, Boran OF. Immature granulocyte count and delta neutrophil index as new predictive factors for axillary metastasis of breast cancer. J Coll Physicians Surg Pak. 2022;32(2):220-5.
  • Öter S, Özkömeç A, Bozan MB, Yazar FM, Kale İT, Bozan AA, et al. Preoperative delta neutrophil index, platelet lymphocyte ratio and immature granulocyte count for differentiating metastatic colon cancer from non-metastatic colon cancer: a retrospective study. Ann Ital Chir. 2024;95(5):825-31.
  • Montagnana M, Danese E. Red cell distribution width and cancer. Ann Transl Med. 2016;4(20):400.

Are Inflammatory Markers Useful in Determining The Anatomic Localisation of Colorectal Cancer? Immature Granulocytes and Red Cell Distributon Width.

Year 2025, Volume: 6 Issue: 3, 157 - 165, 28.09.2025

Ümit Özdemir , Necip Tolga Baran

https://doi.org/10.47482/acmr.1627472

Abstract

Background: There are embryological, clinicopathlogical, and prognostic differences between right and left colon tumours. The aim of this study was to investigate the diagnostic benefit of inflammatory markers in the differentiation of right and left colon cancers.
Methods: Two groups of patients were formed as 71 (33.8%) with right colon cancer (RCC) and 139 (66.2%) with left colorectal cancer (LCRC). The groups were compared in respect of clinical characteristics, hemoglobin, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), systemic immune inflammation index (SII), immature granulocyte count (IGC), immature granulocyte percentage (IG%), and red blood cell distribution width percentage (RDW%).
Results: The TNM grade, and NLR, PLR, SII, IGC, and IG% values were similar in both groups. In the RCC group, hemoglobin was determined to be lower than in the LCRC group (11.35 [6.40-16.40] vs. 13.00 [6.00-17.00] mg/dl), and RDW was higher (14.80% [11.90-27.90] vs. 13.70% [11.00-37.10]) (p=0.001, p=0.005, respectively). In ROC analysis, hemoglobin (AUC:0.640, p<0.001) and RDW% (AUC:0.621, p=0.004) were determined to be significant.
Conclusion: Inflammatory markers such as NLR and PLR, which have been previously investigated, and SII and IGC, promising and examined for the first time, are insufficient to show the anatomic localization of CRC. However, differences were observed in RDW and hemoglobin and these may be associated with subclinical bleeding, which is frequently seen in RCC.

Keywords

Colorectal Cancer Colorectal Cancer Localisation Inflammatory markers Immature Granulocytes Red Cell Distribution Width

Ethical Statement

No funds, grants, or other support was received. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. All authors declare that the study was conducted in accordance with the Declaration of Helsinki and followed the ethical standards of Türkiye. Approval was granted by the Ethics Committee of Ankara Etlik City Hospital (Date: 20.03.2024, No: AEŞH-BADEK-2024-238).

References

  • Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023;73(1):17-48.
  • Cronin KA, Scott S, Firth AU, Sung H, Henley SJ, Sherman RL, et al. Annual report to the nation on the status of cancer, part 1: National cancer statistics. Cancer. 2022;128(24):4251-84.
  • Benedix F, Schmidt U, Mroczkowski P, Gastinger I, Lippert H, Kube R. Colon carcinoma—classification into right and left sided cancer or according to colonic subsite? Analysis of 29,568 patients. Eur J Surg Oncol. 2011;37(2):134-9.
  • Siegel RL, Wagle NS, Cercek A, Smith RA, Jemal A. Colorectal cancer statistics, 2023. CA Cancer J Clin. 2023;73(3):233-54.
  • Petrelli F, Tomasello G, Borgonovo K, Ghidini M, Turati L, Dallera P, et al. Prognostic survival associated with left-sided vs right-sided colon cancer: a systematic review and meta-analysis. JAMA Oncol. 2017;3(2):211-9.
  • Yahagi M, Okabayashi K, Hasegawa H, Tsuruta M, Kitagawa Y. The worse prognosis of right-sided compared with left-sided colon cancers: a systematic review and meta-analysis. J Gastrointest Surg. 2016;20(3):648-55.
  • Shen H, Yang J, Huang Q, Jiang MJ, Tan YN, Fu JF, et al. Different treatment strategies and molecular features between right-sided and left-sided colon cancers. World J Gastroenterol. 2015;21(21):6470-7.
  • Brulé S, Jonker D, Karapetis C, O’Callaghan CJ, Moore M, Wong R, et al. Location of colon cancer (right-sided versus left-sided) as a prognostic factor and a predictor of benefit from cetuximab in NCIC CO.17. Eur J Cancer. 2015;51(11):1405-14.
  • Saidi H, Karuri D, Nyaim E. Correlation of clinical data, anatomical site and disease stage in colorectal cancer. East Afr Med J. 2008;85(6):259-62.
  • Borsig L, Wolf MJ, Roblek M, Lorentzen A, Heikenwalder M. Inflammatory chemokines and metastasis—tracing the accessory. Oncogene. 2014;33(25):3217-24.
  • Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nat. 2008;454(7203):436-44.
  • Bozan MB, Yazar FM, Kale IT, Yüzbaşıoğlu MF, Boran ÖF, Azak Bozan A. Delta neutrophil index and neutrophil-to-lymphocyte ratio in the differentiation of thyroid malignancy and nodular goiter. World J Surg. 2021;45(2):507-14.
  • Chen B, Ye B, Zhang J, Ying L, Chen Y. RDW to platelet ratio: a novel noninvasive index for predicting hepatic fibrosis and cirrhosis in chronic hepatitis B. PLoS One. 2013;8(7):e68780.
  • Gallois C, Pernot S, Zaanan A, Taieb J. Colorectal cancer: why does side matter? Drugs. 2018;78(7):789-98.
  • Logan RF, Patnick J, Nickerson C, Coleman L, Rutter MD, von Wagner C. Outcomes of the Bowel Cancer Screening Programme (BCSP) in England after the first 1 million tests. Gut. 2012;61(10):1439-46.
  • Young PE, Womeldorph CM. Colonoscopy for colorectal cancer screening. J Cancer. 2013;4(3):217-26.
  • Guo D, Li X, Xie A, Cao Q, Zhang J, Zhang F, et al. Differences in oncological outcomes and inflammatory biomarkers between right-sided and left-sided stage I-III colorectal adenocarcinoma. J Clin Lab Anal. 2020;34(4):e23132.
  • Hayama T, Ozawa T, Asako K, Kondo R, Ono K, Okada Y, et al. Impact of colon cancer location on the prognostic significance of nutritional indexes and inflammatory markers. In Vivo. 2021;35(2):1261-9.
  • Spell DW, Jones DV Jr, Harper WF, Bessman JD. The value of a complete blood count in predicting cancer of the colon. Cancer Detect Prev. 2004;28(1):37-42.
  • Fancellu A, Zinellu A, Mangoni AA, Popova A, Galotti F, Feo CF, et al. Red blood cell distribution width (RDW) correlates to the anatomical location of colorectal cancer. Implications for clinical use. J Gastrointest Cancer. 2022;53(1):1-6.
  • Pedrazzani C, Tripepi M, Turri G, Fernandes E, Scotton G, Conci S, et al. Prognostic value of red cell distribution width (RDW) in colorectal cancer. Results from a single-center cohort on 591 patients. Sci Rep. 2020;10(1):1072.
  • Benedix F, Kube R, Meyer F, Schmidt U, Gastinger I, Lippert H, et al. Comparison of 17,641 patients with right- and left-sided colon cancer: differences in epidemiology, perioperative course, histology, and survival. Dis Colon Rectum. 2010;53(1):57-64.
  • Elinav E, Nowarski R, Thaiss CA, Hu B, Jin C, Flavell RA. Inflammation- induced cancer: crosstalk between tumours, immune cells and microorganisms. Nat Rev Cancer. 2013;13(11):759-71.
  • Candido J, Hagemann T. Cancer-related inflammation. J Clin Immunol. 2013;33 Suppl 1:S79-84.
  • Yang L, He W, Kong P, Jiang C, Yang Q, Xie Q, et al. Clinical baseline and prognostic difference of platelet lymphocyte ratio (PLR) in right-sided and left-sided colon cancers. BMC Cancer. 2017;17(1):1-11.
  • Menyhart O, Fekete JT, Győrffy B. Inflammation and colorectal cancer: a meta-analysis of the prognostic significance of the systemic immune–inflammation index (SII) and the systemic inflammation response index (SIRI). Int J Mol Sci. 2024;25(15):8441.
  • Dong M, Shi Y, Yang J, Zhou Q, Lian Y, Wang D, et al. Prognostic and clinicopathological significance of systemic immune-inflammation index in colorectal cancer: a meta-analysis. Ther Adv Med Oncol. 2020;12:1758835920937425.
  • Chen JH, Zhai ET, Yuan YJ, Wu KM, Xu JB, Peng JJ, et al. Systemic immune-inflammation index for predicting prognosis of colorectal cancer. World J Gastroenterol. 2017;23(34):6261-72.
  • Hernandez-Ainsa M, Velamazan R, Lanas A, Carrera-Lasfuentes P, Piazuelo E. Blood-cell-based inflammatory markers as a useful tool for early diagnosis in colorectal cancer. Front Med (Lausanne). 2022;9:843074.
  • Senthilnayagam B, Kumar T, Sukumaran J, Rao KR. Automated measurement of immature granulocytes: performance characteristics and utility in routine clinical practice. Pathol Res Int. 2012;2012:483670.
  • Ünal Y. A new and early marker in the diagnosis of acute complicated appendicitis: immature granulocytes. Ulus Travma Acil Cerrahi Derg. 2018;24(5):435-41.
  • Barut O, Demirkol MK, Kucukdurmaz F, Sahinkanat T, Resim S. Pre-treatment delta neutrophil index as a predictive factor in renal cell carcinoma. J Coll Physicians Surg Pak. 2021;31(2):156-62.
  • Bozan MB, Yazar FM, Kale IT, Topuz S, Bozan AA, Boran OF. Immature granulocyte count and delta neutrophil index as new predictive factors for axillary metastasis of breast cancer. J Coll Physicians Surg Pak. 2022;32(2):220-5.
  • Öter S, Özkömeç A, Bozan MB, Yazar FM, Kale İT, Bozan AA, et al. Preoperative delta neutrophil index, platelet lymphocyte ratio and immature granulocyte count for differentiating metastatic colon cancer from non-metastatic colon cancer: a retrospective study. Ann Ital Chir. 2024;95(5):825-31.
  • Montagnana M, Danese E. Red cell distribution width and cancer. Ann Transl Med. 2016;4(20):400.
There are 35 citations in total.

Details

Primary Language English
Subjects Oncologic Surgery, Gastroenterology Surgery, General Surgery
Journal Section ORIGINAL ARTICLE
Authors

Ümit Özdemir 0000-0001-5681-7421

Necip Tolga Baran 0000-0001-6323-9885

Publication Date September 28, 2025
Submission Date January 27, 2025
Acceptance Date April 7, 2025
Published in Issue Year 2025 Volume: 6 Issue: 3

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APA Özdemir, Ü., & Baran, N. T. (2025). Are Inflammatory Markers Useful in Determining The Anatomic Localisation of Colorectal Cancer? Immature Granulocytes and Red Cell Distributon Width. Archives of Current Medical Research, 6(3), 157-165. https://doi.org/10.47482/acmr.1627472
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