The Prognostic Value of Serum Apolipoprotein A-I Level and Neutrophil-to-Lymphocyte Ratio in Colorectal Cancer Liver Metastasis

Background. Colorectal cancer liver metastasis (CRLM) is a high degree of malignancy with rapid disease progression and has a poor prognosis. Both serum apolipoprotein A-I (ApoA-I) and neutrophil-to-lymphocyte ratio (NLR) play key roles in anti-inflammation and antitumor. This study is aimed at evaluating the implication of serum ApoA-I level in combination with NLR in the prognosis of CRLM. Methods. We retrospectively analyzed the serum ApoA-I level and NLR in 237 patients with CRLM. Cox regression analyses were used to identify the independent prognostic significance of these indicators. Kaplan-Meier method and Log-rank test were applied to compute overall survival (OS). Both the ApoA-I and NLR were divided into three levels, according to their medians. A risk-stratified prediction model was established to evaluate the prognosis of patients with CRLM. The ROC curve AUC values were applied to evaluate the capability of the model. Results. Higher levels of ApoA-I and lower NLR were strongly associated with prolonged OS (Log-rank test, $P<0.05$ ). The patients were then grouped into three queues according to the ApoA-I level and NLR. There was a crucial diversity in the OS ( $P<0.001$ ) between the high-risk ( $\text{ApoA}-\text{I}\le 1.03$ g/L and $\text{NLR}>3.24$ ), medium-risk ( $\text{ApoA}-\text{I}>1.03$ g/L or $\text{NLR}\le 3.24$ ) and low-risk groups ( $\text{ApoA}-\text{I}>1.03$ g/L and $\text{NLR}\le 3.24$ ). The AUC value of the prediction model ( $\text{AUC}=0.623$ , 95% CI: 0.557-0.639, $P=0.001$ ) was higher than other individual indicators (including ApoA-I, NLR, cT classification, and cN classification). Additionally, the association of the prediction model and cTN classification ( $\text{AUC}=0.715$ , 95% CI: 0.606-0.708, $P<0.001$ ) was better than the model and cTN classification alone. Conclusion. The combination of ApoA-I level and NLR could be a prognostic indicator for CRLM.