Colorectal cancer is a key contributing factor to the rise of cancer lethality. In an attempt to provide a more sensitive, cost-effective and easily accessible diagnostic maker, this study assessed the diagnostic ability of individual and combined bioscore of haematological parameters in detecting colorectal cancer (CRC). Selected sociodemographic, lifestyle, and clinical characteristics were used as adjustment in the assessment. Colorectal cancer was less recorded among the younger age group as compared to the older age group in this study with a mean age of 55.92 (p < 0.0001). There was a statistically significant difference between the ages of the CRC patients and the control group (p < 0.0001). Most of the cases (48.0%) were between the ages of 60-88 years. This result is in accordance with several similar studies that have linked CRC to age (Desch et al., 2005; Loconte et al., 2017; Lu et al., 2014). This findings showed consistent prevalence of CRC with age and calls for more roboust screening of CRC among aged people.
In China, haematological parameters in peripheral blood are used to evaluate the prognosis of breast cancer patients; they are simple, reproducible, and can provide a reference for hospitals at various levels (Chen et al., 2020). According to a previous study (Divsalar et al., 2021), evaluation of haematological factors is one of the reliable paraclinical methods to diagnose diseases, and can predict severity, mortality, and follow-up treatment in patients with breast cancer. In our study, the colorectal cancer participants had significantly decreased levels of red blood cells (3.93 x106/uL), haemoglobin (10.98 g/dL), haematocrit (27.07%) and mean cell corpuscular volume (83.79 fl) than compared to controls (p < 0.05). This is in line with the findings made by Divsalar et al., study which reported that, the mean (± SD) RBC, Hb, HCT, MCV, and MCH values in patients with breast cancer were lower than the controls (Divsalar et al., 2021). We once again observed that, colorectal cancer participants had significantly increased levels of platelet (260.12 x103/uL), and white blood cells (7.25 x103/uL) including lymphocytes (9.55 x103/uL), monocytes (2.61 x103/uL), neutrophils (20.83 x103/uL), eosinophils (1.22 x103/uL) and basophils (0.28 x103/uL) (p < 0.05). This is also in accordance with previous study findings (Divsalar et al., 2021). Another study (Çalışkan et al., 2017), also reported that neutrophil, white blood cell counts and NLR were significantly higher in patients with testicular cancer but lymphocyte counts were lower in these patients.
Moreover, it was observed that, colorectal cancer subjects had significantly lower levels of lymphocyte-monocyte ratio, haemoglobin-platelet ratio and platelet-lymphocyte ratio compared to controls. Our findings on LMR, and PLR contradicts the levels reported by Divsalar et al., in breast cancer (Divsalar et al., 2021). Also, our findings on PLR contradict that of previous studies (Çalışkan et al., 2017; Goksel et al., 2021; Petric et al., 2023), which reported an increased level of PLR in testicular cancer, endometrial cancer and lung cancer. Besides, colorectal cancer subjects had significantly higher levels of neutrophil-lymphocyte ratio than compared to controls. This once again supports the findings made in previous study (Divsalar et al., 2021).
To evaluate the predictive performance of LMR, NLR, HPR and PLR levels in detecting colorectal cancer, ROC analysis was used. Decreasing HPR levels was significantly associated with colorectal cancer among the study subjects with high area under the curve (AUC) of 0.916, indicating a better predictor of colorectal cancer among study subjects. Not much studies had been conducted on HPR levels with regard to solid malignancies, but our finding supports the findings of Hu et al., which also observed decreased levels of HPR in the colon cancer group as compared to the control group (Hu et al., 2020). Also other studies reported that HPR was associated with tumor invasion and tumor size (Hu et al., 2020; Yu et al., 2022). Additionally, this study observed that decreasing LMR and PLR could significantly predict colorectal cancer among study subjects with area under the curve of 0.733 and 0.635 respectively. This is in line with previous study findings (Kozak et al., 2017). According to Kozak et al., a decreasing monocyte-to-lymphocyte ratio independently predicts worse OS in patients with CRC (Kozak et al., 2017). Moreover, this study observed that increasing NLR could significantly predict colorectal cancer among study subjects with area under the curve of 0.766. This finding supports the findings made in previous study (Kozak et al., 2017), that an elevated neutrophil-to-lymphocyte ratio independently predict for worse OS in patients with CRC. According to Divsalar et al., high NLR in Caucasian populations is a negative prognostic marker for breast cancer (Divsalar et al., 2021). Another study (Çalışkan et al., 2017), also reported that neutrophil to lymphocyte ratio (NLR) may be used as a biomarker for testicular cancer. Again, Petric et al., also reported that neutrophil-lymphocyte ratio (NLR) was statistically significantly higher in patients with endometrial changes but reported a lower PLR for malignant endometrial cancer (Petric et al., 2023). Similarly, Goksel et al., also reported that NLR was significantly higher in patients with lung cancer (Goksel et al., 2021). These findings affirm the fact that NLR can be used as predictive marker for cancer. However, the current study identified HPR as a better marker of CRC.
In an individual and combined bioscore model using a logistics regression analyses, HPR alone was significantly associated with over 169-fold increased odds likelihood of detecting colorectal cancer among study subjects. Besides, HPR in combination with other haematological markers such as LMR significantly enhanced the likelihood of detecting colorectal cancer among study subjects; this is in accordance with the findings made in previous studies (Jakubowska et al., 2020; Mo et al., 2020). According to Mo et al., PLR or HPR combined with carcinoembryonic antigen can increase diagnostic efficacy and may be a useful diagnostic marker for patients with rectal cancer (Mo et al., 2020), whilst Jakubowska et al., also reported that, postoperative LMR in whole blood samples can be used as an independent prognostic factor in patients diagnosed with colorectal cancer (Jakubowska et al., 2020). This study findings underscores the potential predictive value of haematological parameters as markers, both individually and in combination, for detecting colorectal cancer.