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Opere Edilebilir Kolorektal Kanserli Hastalarda Kısa Dönem Mortalitenin Belirlenmesinde Preoperatif Nötrofil-Lenfosit Oranı ve Trombosit-Lenfosit Oranının Öngörü Değerlerinin Değerlendirilmesi

Yıl 2022, Cilt: 24 Sayı: 1, 67 - 73, 30.04.2022
https://doi.org/10.18678/dtfd.1063922

Öz

Amaç: Bu çalışmanın amacı, opere edilebilir kolorektal kanserli (KRK) hastalarda ameliyat öncesi nötrofil-lenfosit oranı (NLO) ve trombosit-lenfosit oranının (PLO) kısa dönem mortalitede prediktif bir değeri olup olmadığının araştırılmasıdır.
Gereç ve Yöntemler: 2016 ve 2021 yılları arasında bir üniversite hastanesinde KRK ameliyatı yapılmış olan toplam 231 (93 kadın, 138 erkek) hasta geriye dönük olarak incelendi. Ortanca yaş 68 (aralık, 26-92) yıl ve takip süresi ortancası 25 (aralık, 0-54) ay idi. Hastalar sağ kalım durumuna göre, sağ kalanlar (n=175) ve takipler sırasında ölenler (n=56) olmak üzere gruplandırıldı.
Bulgular: NLO için eğri altında kalan alan 0,649 (%95 GA: 0,563-0,734; p=0,001), optimal kesim noktası 5,08 idi ve bu kesim noktası mortaliteyi tahmin etmek için %48,2 duyarlılık ve %81,7 özgüllük gösterdi. PLO için eğri altında kalan alan 0,635 (%95 GA: 0,546-0,723; p=0,002), optimal kesim noktası 221,5 idi ve bu kesim noktası %55,4 duyarlılık ve %72,0 özgüllük gösterdi. Çoklu regresyon analizi, nüks (OR: 60,910; 95% GA: 9,807-378,319; p=<0,001), sızıntı (OR: 10,724; 95% GA: 1,281-89,747; p=0,029), yüksek NLO (OR: 3,735; 95% GA: 1,602-8,711; p=0,002) ve yaşın artışının (OR: 1,136; 95% GA: 1,081-1,193; p<0,001) bağımsız olarak mortalite ile ilişkili olduğunu ortaya koydu.
Sonuç: Bu çalışmanın sonuçları, cerrahi rezeksiyon uygulanan KRK hastalarında preoperatif NLO ve PLO'nun kısa dönem mortaliteyi öngörmede etkili olduğunu gösteren çalışmaları desteklemektedir. Bu konuda daha fazla çalışma gerekli olmasına rağmen, bu biyobelirteçler, KRK hastalarında prognostik araçlar olarak gelecekte kullanım açısından umut vericidir.

Kaynakça

  • Recio-Boiles A, Cagir B. Colon Cancer. Treasure Island, FL: StatPearls Publishing; 2021.
  • Sagaert X, Vanstapel A, Verbeek S. Tumor heterogeneity in colorectal cancer: what do we know so far? Pathobiology. 2018;85(1-2):72-84.
  • Yoshida D, Minami K, Sugiyama M, Ota M, Ikebe M, Morita M, et al. Prognostic impact of the neutrophil-to-lymphocyte ratio in stage I-II rectal cancer patients. J Surg Res. 2020;245:281-7.
  • Mahar AL, Compton C, Halabi S, Hess KR, Weiser MR, Groome PA. Personalizing prognosis in colorectal cancer: A systematic review of the quality and nature of clinical prognostic tools for survival outcomes. J Surg Oncol. 2017;116(8):969-82.
  • Dong YW, Shi YQ, He LW, Su PZ. Prognostic significance of neutrophil-to-lymphocyte ratio in rectal cancer: a meta-analysis. Onco Targets Ther. 2016;9:3127-34.
  • Ying HQ, Deng QW, He BS, Pan YQ, Wang F, Sun HL, et al. The prognostic value of preoperative NLR, d-NLR, PLR and LMR for predicting clinical outcome in surgical colorectal cancer patients. Med Oncol. 2014;31(12):305.
  • Yamamoto T, Kawada K, Obama K. Inflammation-related biomarkers for the prediction of prognosis in colorectal cancer patients. Int J Mol Sci. 2021;22(15):8002.
  • Moore MM, Chua W, Charles KA, Clarke SJ. Inflammation and cancer: causes and consequences. Clin Pharmacol Ther. 2010;87(4):504-8.
  • Xia LJ, Li W, Zhai JC, Yan CW, Chen JB, Yang H. Significance of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio and prognostic nutritional index for predicting clinical outcomes in T1-2 rectal cancer. BMC Cancer. 2020;20(1):208.
  • Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer. Cell. 2010;140(6):883-99.
  • Choi Y, Kim JW, Nam KH, Han SH, Kim JW, Ahn SH, et al. Systemic inflammation is associated with the density of immune cells in the tumor microenvironment of gastric cancer. Gastric Cancer. 2017;20(4):602-11.
  • Voronov E, Apte RN. IL-1 in colon inflammation, colon carcinogenesis and invasiveness of colon cancer. Cancer Microenviron. 2015;8(3):187-200.
  • Kim ER, Chang DK. Colorectal cancer in inflammatory bowel disease: the risk, pathogenesis, prevention and diagnosis. World J Gastroenterol. 2014;20(29):9872-81.
  • Haram A, Boland MR, Kelly ME, Bolger JC, Waldron RM, Kerin MJ. The prognostic value of neutrophil-to-lymphocyte ratio in colorectal cancer: A systematic review. J Surg Oncol. 2017;115(4):470-9.
  • Brierley JD, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. 8th ed. Oxford, UK; Hoboken, NJ: John Wiley & Sons, Inc.; 2017.
  • Inamoto S, Kawada K, Okamura R, Hida K, Sakai Y. Prognostic impact of the combination of neutrophil-to-lymphocyte ratio and Glasgow prognostic score in colorectal cancer: a retrospective cohort study. Int J Colorectal Dis. 2019;34(7):1303-15.
  • Zhang J, Zhang HY, Li J, Shao XY, Zhang CX. The elevated NLR, PLR and PLT may predict the prognosis of patients with colorectal cancer: a systematic review and meta-analysis. Oncotarget. 2017;8(40):68837-46.
  • Yasui K, Shida D, Nakamura Y, Ahiko Y, Tsukamoto S, Kanemitsu Y. Postoperative, but not preoperative, inflammation-based prognostic markers are prognostic factors in stage III colorectal cancer patients. Br J Cancer. 2021;124(5):933-41.
  • Li H, Zhao Y, Zheng F. Prognostic significance of elevated preoperative neutrophil-to-lymphocyte ratio for patients with colorectal cancer undergoing curative surgery: A meta-analysis. Medicine (Baltimore). 2019;98(3):e14126.
  • Mei Z, Shi L, Wang B, Yang J, Xiao Z, Du P, et al. Prognostic role of pretreatment blood neutrophil-to-lymphocyte ratio in advanced cancer survivors: A systematic review and meta-analysis of 66 cohort studies. Cancer Treat Rev. 2017;58:1-13.
  • Bomanji J, Flatman WD, Horne T, Fettich J, Britton KE, Ross G, et al. Quantitation of iodine-123 MIBG uptake by normal adrenal medulla in hypertensive patients. J Nucl Med. 1987;28(3):319-24.
  • Naszai M, Kurjan A, Maughan TS. The prognostic utility of pre-treatment neutrophil-to-lymphocyte-ratio (NLR) in colorectal cancer: A systematic review and meta-analysis. Cancer Med. 2021;10(17):5983-97.
  • Rossi S, Basso M, Strippoli A, Schinzari G, D'Argento E, Larocca M, et al. Are markers of systemic inflammation good prognostic indicators in colorectal cancer? Clin Colorectal Cancer. 2017;16(4):264-74.
  • Hamid HKS, Emile SH, Davis GN. Prognostic significance of lymphocyte-to-monocyte and platelet-to-lymphocyte ratio in rectal cancer: a systematic review, meta-analysis, and meta-regression. Dis Colon Rectum. 2022;65(2):178-87.
  • Chen N, Li W, Huang K, Yang W, Huang L, Cong T, et al. Increased platelet-lymphocyte ratio closely relates to inferior clinical features and worse long-term survival in both resected and metastatic colorectal cancer: an updated systematic review and meta-analysis of 24 studies. Oncotarget. 2017;8(19):32356-69.
  • Huang XZ, Chen WJ, Zhang X, Wu CC, Zhang CY, Sun SS, et al. An elevated platelet-to-lymphocyte ratio predicts poor prognosis and clinicopathological characteristics in patients with colorectal cancer: a meta-analysis. Dis Markers. 2017;2017:1053125.
  • Wang J, Li J, Wei S, Xu J, Jiang X, Yang L. The ratio of platelets to lymphocytes predicts the prognosis of metastatic colorectal cancer: a review and meta-analysis. Gastroenterol Res Pract. 2021;2021:9699499.
  • Ramphal W, Boeding JRE, Gobardhan PD, Rutten HJT, de Winter LJMB, Crolla RMPH, et al. Oncologic outcome and recurrence rate following anastomotic leakage after curative resection for colorectal cancer. Surg Oncol. 2018;27(4):730-6.
  • Takahashi H, Haraguchi N, Nishimura J, Hata T, Yamamoto H, Matsuda C, et al. The severity of anastomotic leakage may negatively impact the long-term prognosis of colorectal cancer. Anticancer Res. 2018;38(1):533-9.
  • Wang S, Liu J, Wang S, Zhao H, Ge S, Wang W. Adverse effects of anastomotic leakage on local recurrence and survival after curative anterior resection for rectal cancer: a systematic review and meta-analysis. World J Surg. 2017;41(1):277-84.
  • Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg. 2011;253(5):890-9.
  • Safari M, Mahjub H, Esmaeili H, Abbasi M, Roshanaei G. Specific causes of recurrence after surgery and mortality in patients with colorectal cancer: A competing risks survival analysis. J Res Med Sci. 2021;26:13.
  • Cyvoct C, Quantin C, Broet P, Benhamiche AM, Brunet-Lecomte P, D'athis P, et al. [Prognostic factors of recurrence and/or death in colorectal cancer: multistate modeling]. Rev Epidemiol Sante Publique. 1999;47(6):619-25. French.
  • Liang JL, Wan DS, Pan ZZ, Zhou ZW, Chen G, Li LR, et al. [Multivariate regression analysis of recurrence following curative surgery for colorectal cancer]. Ai Zheng. 2004;23(5):564-7. Chinese.
  • Jiang Y, Yuan H, Li Z, Ji X, Shen Q, Tuo J, et al. Global pattern and trends of colorectal cancer survival: a systematic review of population-based registration data. Cancer Biol Med. 2021;19(2):175-86.
  • Schreckenbach T, Zeller MV, El Youzouri H, Bechstein WO, Woeste G. Identification of factors predictive of postoperative morbidity and short-term mortality in older patients after colorectal carcinoma resection: A single-center retrospective study. J Geriatr Oncol. 2018;9(6):649-58.
  • Micu BV, Vesa ŞC, Pop TR, Micu CM. Evaluation of prognostic factors for 5 year-survival after surgery for colorectal cancer. Ann Ital Chir. 2020;91:41-8.

Evaluation of Preoperative Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio for their Predictive Value in Determining Short-Term Mortality in Patients with Operable Colorectal Cancers

Yıl 2022, Cilt: 24 Sayı: 1, 67 - 73, 30.04.2022
https://doi.org/10.18678/dtfd.1063922

Öz

Aim: The aim of this study was to investigate whether preoperative neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have a predictive value in short-term mortality in patients with operable colorectal cancer (CRC).
Material and Methods: A total of 231 (93 female, 138 male) patients with operated CRC between 2016 and 2021 in a university hospital were analyzed retrospectively. Median age was 68 (range, 26-92) years and patients had been under follow-up for a median of 25 (range, 0-54) months. Patients were grouped with respect to survival, those who were alive (n=175) and those who died (n=56) during the follow-up.
Results: The area under the curve for NLR was 0.649 (95% CI: 0.563-0.734, p=0.001), optimal cut-off was 5.08 and demonstrated a sensitivity of 48.2% and a specificity of 81.7% for predicting mortality. The area under the curve for PLR was 0.635 (95% CI: 0.546-0.723, p=0.002), optimal cut-off was 221.5 and demonstrated a sensitivity of 55.4% and a specificity of 72.0%. Multiple regression analysis revealed that recurrence (OR: 60.910, 95% CI: 9.807-378.319, p=<0.001), leakage (OR: 10.724, 95% CI: 1.281-89.747, p=0.029), high NLR (OR: 3.735, 95% CI: 1.602-8.711, p=0.002) and higher age (OR: 1.136, 95% CI: 1.081-1.193, p<0.001) were independently associated with mortality.
Conclusion: The results of this study support studies indicating that preoperative NLR and PLR are effective in predicting short-term mortality in CRC patients who underwent surgical resection. Although further studies are necessary, these biomarkers are promising for future use as prognostic tools in CRC patients.

Kaynakça

  • Recio-Boiles A, Cagir B. Colon Cancer. Treasure Island, FL: StatPearls Publishing; 2021.
  • Sagaert X, Vanstapel A, Verbeek S. Tumor heterogeneity in colorectal cancer: what do we know so far? Pathobiology. 2018;85(1-2):72-84.
  • Yoshida D, Minami K, Sugiyama M, Ota M, Ikebe M, Morita M, et al. Prognostic impact of the neutrophil-to-lymphocyte ratio in stage I-II rectal cancer patients. J Surg Res. 2020;245:281-7.
  • Mahar AL, Compton C, Halabi S, Hess KR, Weiser MR, Groome PA. Personalizing prognosis in colorectal cancer: A systematic review of the quality and nature of clinical prognostic tools for survival outcomes. J Surg Oncol. 2017;116(8):969-82.
  • Dong YW, Shi YQ, He LW, Su PZ. Prognostic significance of neutrophil-to-lymphocyte ratio in rectal cancer: a meta-analysis. Onco Targets Ther. 2016;9:3127-34.
  • Ying HQ, Deng QW, He BS, Pan YQ, Wang F, Sun HL, et al. The prognostic value of preoperative NLR, d-NLR, PLR and LMR for predicting clinical outcome in surgical colorectal cancer patients. Med Oncol. 2014;31(12):305.
  • Yamamoto T, Kawada K, Obama K. Inflammation-related biomarkers for the prediction of prognosis in colorectal cancer patients. Int J Mol Sci. 2021;22(15):8002.
  • Moore MM, Chua W, Charles KA, Clarke SJ. Inflammation and cancer: causes and consequences. Clin Pharmacol Ther. 2010;87(4):504-8.
  • Xia LJ, Li W, Zhai JC, Yan CW, Chen JB, Yang H. Significance of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio and prognostic nutritional index for predicting clinical outcomes in T1-2 rectal cancer. BMC Cancer. 2020;20(1):208.
  • Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer. Cell. 2010;140(6):883-99.
  • Choi Y, Kim JW, Nam KH, Han SH, Kim JW, Ahn SH, et al. Systemic inflammation is associated with the density of immune cells in the tumor microenvironment of gastric cancer. Gastric Cancer. 2017;20(4):602-11.
  • Voronov E, Apte RN. IL-1 in colon inflammation, colon carcinogenesis and invasiveness of colon cancer. Cancer Microenviron. 2015;8(3):187-200.
  • Kim ER, Chang DK. Colorectal cancer in inflammatory bowel disease: the risk, pathogenesis, prevention and diagnosis. World J Gastroenterol. 2014;20(29):9872-81.
  • Haram A, Boland MR, Kelly ME, Bolger JC, Waldron RM, Kerin MJ. The prognostic value of neutrophil-to-lymphocyte ratio in colorectal cancer: A systematic review. J Surg Oncol. 2017;115(4):470-9.
  • Brierley JD, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. 8th ed. Oxford, UK; Hoboken, NJ: John Wiley & Sons, Inc.; 2017.
  • Inamoto S, Kawada K, Okamura R, Hida K, Sakai Y. Prognostic impact of the combination of neutrophil-to-lymphocyte ratio and Glasgow prognostic score in colorectal cancer: a retrospective cohort study. Int J Colorectal Dis. 2019;34(7):1303-15.
  • Zhang J, Zhang HY, Li J, Shao XY, Zhang CX. The elevated NLR, PLR and PLT may predict the prognosis of patients with colorectal cancer: a systematic review and meta-analysis. Oncotarget. 2017;8(40):68837-46.
  • Yasui K, Shida D, Nakamura Y, Ahiko Y, Tsukamoto S, Kanemitsu Y. Postoperative, but not preoperative, inflammation-based prognostic markers are prognostic factors in stage III colorectal cancer patients. Br J Cancer. 2021;124(5):933-41.
  • Li H, Zhao Y, Zheng F. Prognostic significance of elevated preoperative neutrophil-to-lymphocyte ratio for patients with colorectal cancer undergoing curative surgery: A meta-analysis. Medicine (Baltimore). 2019;98(3):e14126.
  • Mei Z, Shi L, Wang B, Yang J, Xiao Z, Du P, et al. Prognostic role of pretreatment blood neutrophil-to-lymphocyte ratio in advanced cancer survivors: A systematic review and meta-analysis of 66 cohort studies. Cancer Treat Rev. 2017;58:1-13.
  • Bomanji J, Flatman WD, Horne T, Fettich J, Britton KE, Ross G, et al. Quantitation of iodine-123 MIBG uptake by normal adrenal medulla in hypertensive patients. J Nucl Med. 1987;28(3):319-24.
  • Naszai M, Kurjan A, Maughan TS. The prognostic utility of pre-treatment neutrophil-to-lymphocyte-ratio (NLR) in colorectal cancer: A systematic review and meta-analysis. Cancer Med. 2021;10(17):5983-97.
  • Rossi S, Basso M, Strippoli A, Schinzari G, D'Argento E, Larocca M, et al. Are markers of systemic inflammation good prognostic indicators in colorectal cancer? Clin Colorectal Cancer. 2017;16(4):264-74.
  • Hamid HKS, Emile SH, Davis GN. Prognostic significance of lymphocyte-to-monocyte and platelet-to-lymphocyte ratio in rectal cancer: a systematic review, meta-analysis, and meta-regression. Dis Colon Rectum. 2022;65(2):178-87.
  • Chen N, Li W, Huang K, Yang W, Huang L, Cong T, et al. Increased platelet-lymphocyte ratio closely relates to inferior clinical features and worse long-term survival in both resected and metastatic colorectal cancer: an updated systematic review and meta-analysis of 24 studies. Oncotarget. 2017;8(19):32356-69.
  • Huang XZ, Chen WJ, Zhang X, Wu CC, Zhang CY, Sun SS, et al. An elevated platelet-to-lymphocyte ratio predicts poor prognosis and clinicopathological characteristics in patients with colorectal cancer: a meta-analysis. Dis Markers. 2017;2017:1053125.
  • Wang J, Li J, Wei S, Xu J, Jiang X, Yang L. The ratio of platelets to lymphocytes predicts the prognosis of metastatic colorectal cancer: a review and meta-analysis. Gastroenterol Res Pract. 2021;2021:9699499.
  • Ramphal W, Boeding JRE, Gobardhan PD, Rutten HJT, de Winter LJMB, Crolla RMPH, et al. Oncologic outcome and recurrence rate following anastomotic leakage after curative resection for colorectal cancer. Surg Oncol. 2018;27(4):730-6.
  • Takahashi H, Haraguchi N, Nishimura J, Hata T, Yamamoto H, Matsuda C, et al. The severity of anastomotic leakage may negatively impact the long-term prognosis of colorectal cancer. Anticancer Res. 2018;38(1):533-9.
  • Wang S, Liu J, Wang S, Zhao H, Ge S, Wang W. Adverse effects of anastomotic leakage on local recurrence and survival after curative anterior resection for rectal cancer: a systematic review and meta-analysis. World J Surg. 2017;41(1):277-84.
  • Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg. 2011;253(5):890-9.
  • Safari M, Mahjub H, Esmaeili H, Abbasi M, Roshanaei G. Specific causes of recurrence after surgery and mortality in patients with colorectal cancer: A competing risks survival analysis. J Res Med Sci. 2021;26:13.
  • Cyvoct C, Quantin C, Broet P, Benhamiche AM, Brunet-Lecomte P, D'athis P, et al. [Prognostic factors of recurrence and/or death in colorectal cancer: multistate modeling]. Rev Epidemiol Sante Publique. 1999;47(6):619-25. French.
  • Liang JL, Wan DS, Pan ZZ, Zhou ZW, Chen G, Li LR, et al. [Multivariate regression analysis of recurrence following curative surgery for colorectal cancer]. Ai Zheng. 2004;23(5):564-7. Chinese.
  • Jiang Y, Yuan H, Li Z, Ji X, Shen Q, Tuo J, et al. Global pattern and trends of colorectal cancer survival: a systematic review of population-based registration data. Cancer Biol Med. 2021;19(2):175-86.
  • Schreckenbach T, Zeller MV, El Youzouri H, Bechstein WO, Woeste G. Identification of factors predictive of postoperative morbidity and short-term mortality in older patients after colorectal carcinoma resection: A single-center retrospective study. J Geriatr Oncol. 2018;9(6):649-58.
  • Micu BV, Vesa ŞC, Pop TR, Micu CM. Evaluation of prognostic factors for 5 year-survival after surgery for colorectal cancer. Ann Ital Chir. 2020;91:41-8.
Toplam 37 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Araştırma Makalesi
Yazarlar

Dursun Burak Özdemir 0000-0002-3672-5738

Ahmet Karayiğit 0000-0003-0380-9190

Hayrettin Dizen 0000-0002-4031-2557

Bülent Ünal 0000-0003-2538-7961

Yayımlanma Tarihi 30 Nisan 2022
Gönderilme Tarihi 27 Ocak 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 24 Sayı: 1

Kaynak Göster

APA Özdemir, D. B., Karayiğit, A., Dizen, H., Ünal, B. (2022). Evaluation of Preoperative Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio for their Predictive Value in Determining Short-Term Mortality in Patients with Operable Colorectal Cancers. Duzce Medical Journal, 24(1), 67-73. https://doi.org/10.18678/dtfd.1063922
AMA Özdemir DB, Karayiğit A, Dizen H, Ünal B. Evaluation of Preoperative Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio for their Predictive Value in Determining Short-Term Mortality in Patients with Operable Colorectal Cancers. Duzce Med J. Nisan 2022;24(1):67-73. doi:10.18678/dtfd.1063922
Chicago Özdemir, Dursun Burak, Ahmet Karayiğit, Hayrettin Dizen, ve Bülent Ünal. “Evaluation of Preoperative Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio for Their Predictive Value in Determining Short-Term Mortality in Patients With Operable Colorectal Cancers”. Duzce Medical Journal 24, sy. 1 (Nisan 2022): 67-73. https://doi.org/10.18678/dtfd.1063922.
EndNote Özdemir DB, Karayiğit A, Dizen H, Ünal B (01 Nisan 2022) Evaluation of Preoperative Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio for their Predictive Value in Determining Short-Term Mortality in Patients with Operable Colorectal Cancers. Duzce Medical Journal 24 1 67–73.
IEEE D. B. Özdemir, A. Karayiğit, H. Dizen, ve B. Ünal, “Evaluation of Preoperative Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio for their Predictive Value in Determining Short-Term Mortality in Patients with Operable Colorectal Cancers”, Duzce Med J, c. 24, sy. 1, ss. 67–73, 2022, doi: 10.18678/dtfd.1063922.
ISNAD Özdemir, Dursun Burak vd. “Evaluation of Preoperative Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio for Their Predictive Value in Determining Short-Term Mortality in Patients With Operable Colorectal Cancers”. Duzce Medical Journal 24/1 (Nisan 2022), 67-73. https://doi.org/10.18678/dtfd.1063922.
JAMA Özdemir DB, Karayiğit A, Dizen H, Ünal B. Evaluation of Preoperative Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio for their Predictive Value in Determining Short-Term Mortality in Patients with Operable Colorectal Cancers. Duzce Med J. 2022;24:67–73.
MLA Özdemir, Dursun Burak vd. “Evaluation of Preoperative Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio for Their Predictive Value in Determining Short-Term Mortality in Patients With Operable Colorectal Cancers”. Duzce Medical Journal, c. 24, sy. 1, 2022, ss. 67-73, doi:10.18678/dtfd.1063922.
Vancouver Özdemir DB, Karayiğit A, Dizen H, Ünal B. Evaluation of Preoperative Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio for their Predictive Value in Determining Short-Term Mortality in Patients with Operable Colorectal Cancers. Duzce Med J. 2022;24(1):67-73.
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