Profil Hemoglobin, Trombosit, dan Rasio Neutrofil Limfosit pada Pasien Kanker Kolorektal: Studi Deskriptif di RSUP Haji Adam Malik Medan

Ruth Vanessa Simatupang; Katharine; Bintang Yinke Magdalena Sinaga; Hafaz Zakky Abdillah

doi:10.36452/jkdoktmeditek.v31i5.3488

Authors

Ruth Vanessa Simatupang Fakultas Kedokteran, Universitas Sumatera Utara, Medan, Indonesia
Katharine Fakultas Kedokteran, Universitas Sumatera Utara, Medan, Indonesia
Bintang Yinke Magdalena Sinaga Fakultas Kedokteran, Universitas Sumatera Utara, Medan, Indonesia
Hafaz Zakky Abdillah Fakultas Kedokteran, Universitas Sumatera Utara, Medan, Indonesia

DOI:

https://doi.org/10.36452/jkdoktmeditek.v31i5.3488

Keywords:

colorectal cancer, hemoglobin, neutrophil-to-lymphocyte ratio, platelet

Abstract

Introduction: Colorectal cancer is a global health problem with an increasing incidence. Monitoring cancer stage is crucial as it is closely related to therapeutic decisions, prognosis, and patient survival. Simple hematological parameters, such as hemoglobin, platelet count, and neutrophil-to-lymphocyte ratio, may aid in clinical evaluation. Objective: This study aimed to describe the profiles of hemoglobin, platelet count, and neutrophil-to-lymphocyte ratio in patients with colorectal cancer. Methods: The study employed a descriptive observational method with a cross-sectional approach. Secondary data were obtained from the medical records of 141 patients using the total sampling method. Data analysis was performed using descriptive statistics. Results: Anemia was found in 83% of patients, with a higher incidence at higher stages. Normal platelet counts were observed in 80% of patients, with decreasing proportions in higher stages. Elevated NLR was found in 78% of patients and was more frequent at higher stages of disease. Conclusion: These findings indicate the presence of anemia and a systemic inflammatory response, but not thrombocytosis. This research highlights the potential of these simple biomarkers in monitoring cancer stages and treatment strategies.

Author Biographies

Ruth Vanessa Simatupang, Fakultas Kedokteran, Universitas Sumatera Utara, Medan, Indonesia

Program Studi Pendidikan Dokter

Katharine, Fakultas Kedokteran, Universitas Sumatera Utara, Medan, Indonesia

Departemen Penyakit Dalam

Bintang Yinke Magdalena Sinaga, Fakultas Kedokteran, Universitas Sumatera Utara, Medan, Indonesia

Departemen Pulmonologi dan Kedokteran Respirasi

Hafaz Zakky Abdillah, Fakultas Kedokteran, Universitas Sumatera Utara, Medan, Indonesia

Departemen Ilmu Kesehatan Anak

References

Siegel RL, Wagle NS, Cercek A, Smith RA, Jemal A. Colorectal cancer statistics, 2023. CA Cancer J Clin [Internet]. 2023 [cited 2024 Apr 30];73(3):233–54. Available from: https://doi.org/10.3322/caac.21772

Morgan E, Arnold M, Gini A, Lorenzoni V, Cabasag CJ, Laversanne M, et al. Global burden of colorectal cancer in 2020 and 2040: incidence and mortality estimates from GLOBOCAN. Gut [Internet]. 2023 Feb [cited 2024 Aug 30];72(2):338–44. Available from: https://doi.org/10.1136/gutjnl-2022-327736

International Agency for Research on Cancer. The global cancer observatory : all cancer in Indonesia [Internet]. Lyon (FR): International Agency for Research on Cancer; 2022 [cited 2024 Apr 21]. Available from: https://gco.iarc.who.int/media/globocan/factsheets/populations/360-indonesia-fact-sheet.pdf

Adilla A, Eka Mustika S. Hubungan usia dan jenis kelamin terhadap kejadian kanker kolorektal. J Kedokt STM. 2023;VI(1):53–9. [Internet]. 2023 [cited 2024 Jun 15];6(1):53–9. Available from: https://doi.org/10.30743/stm.v6i1.349

Ahmed SZ, Cirocchi N, Saxton E, Brown MK. Incidence of age migration of colorectal cancer in younger population: retrospective single centred-population based cohort study. Ann Med Surg [Internet]. 2022 [cited 2024 Sep 3];74(103214). Available from: https://doi.org/10.1016/j.amsu.2021.103214

Sanjaya IWB, Lestarini A, Dwi M, Bharata Y. Karakteristik klinis pada pasien kanker kolorektal yang menjalani kolonoskopi di RSUD Sanjiwani Gianyar Tahun 2019 - 2020. Aesculapius Med J [Internet]. 2023 [cited 2024 Sep 20];3(1):43–8. Available from: https://ejournal.warmadewa.ac.id/index.php/amj/article/download/5555/4297/33766

Ding R, Chen Z, He M, Cen H, Liu Z, Su Y. Application value of combined detection of NLR, PNI, D-Dimer, CD3+ T Lymphocytes, and CEA in colorectal cancer screening. Dis Markers [Internet]. 2022 [cited 2024 Sep 7];2022:7913025. Available from: https://doi.org/10.1155/2022/7913025

Farid MH. Hubungan derajat anemia dengan lokasi tumor pada pasien karsinoma kolorektal di RSUP Dr. M. Djamil Padang periode Januari – Desember 2020. Padang: Fakultas Kedokteran, Universitas Andalas [Internet]. 2021 [cited 2024 Sep 6]. 75 p. Available from: http://scholar.unand.ac.id/id/eprint/96187

Gvirtzman R, Livovsky DM, Tahover E, Goldin E, Koslowsky B. Anemia can predict the prognosis of colorectal cancer in the pre-operative stage: a retrospective analysis. World J Surg Oncol [Internet]. 2021 Dec [cited 2024 Apr 20];19(1):341. Available from: https://doi.org/10.1186/s12957-021-02452-7

Syahriana E, Mediarty M, Bahar E, Subandrate S. Perbedaan indeks trombosit antara pasien kanker kolorektal nonmetastasis dan metastasis di RSMH Palembang. J Kedokt dan Kesehat Publ Ilm Fak Kedokt Univ Sriwij. [Internet]. 2021 [cited 2024 Sep 20];8(2):99–104. Available from: https://doi.org/10.32539/jkk.v8i2.169

Giannakeas V, Kotsopoulos J, Brooks JD, Cheung MC, Rosella L, Lipscombe L, et al. Platelet count and survival after cancer. Cancers (Basel) [Internet]. 2022 Jan 21 [cited 2024 Apr 20];14(3):549. Available from: https://doi.org/10.3390/cancers14030549

Zhu X, Cao Y, Lu P, Kang Y, Lin Z, Hao T, et al. Evaluation of platelet indices as diagnostic biomarkers for colorectal cancer. Sci Rep [Internet]. 2018 Aug 7 [cited 2024 Jun 8];8(1):11814. Available from: http://dx.doi.org/10.1038/s41598-018-29293-x

Lalosevic M, Markovic A, Stankovic S, Stojkovic M, Dimitrijevic I, Radoman-Vujacic I, et al. Combined diagnostic efficacy of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) as biomarkers of systemic inflammation in the diagnosis of colorectal cancer. Dis Markers [Internet]. 2019 Jan 17 [cited 2024 Jun 8];2019:6036979. Available from: https://doi.org/10.1155/2019/6036979

Lathifah SH, Yohana W, Rodian M. Neutrophil-to-lymphocyte ratio (NLR) as an inflammation degree marker in tongue cancer patient. J Kesehat gigi [Internet]. 2019 [cited 2024 Jun 8];6:68–71. Available from: http://ejournal.poltekkes-smg.ac.id/ojs/index.php/jkg/index

American Joint Committee on Cancer (AJCC). AJCC cancer staging manual. 8th ed. New York: Springer Cham. 2017. 1032 p.

Tong GJ, Zhang GY, Liu J, Zheng ZZ, Chen Y, Niu PP, et al. Comparison of the eighth version of the American Joint Committee on Cancer Manual to the seventh version for colorectal cancer: a retrospective review of our data. World J Clin Oncol [Internet]. 2018 Nov 10 [cited 2024 Sep 6];9(7):148–61. Available from: https://doi.org/10.5306/wjco.v9.i7.148

Husnah A, Yanti KaKE, Arifin AF, Hasbi BE, Ikram D. Karakteristik penderita kanker kolorektal di Rumah Sakit Pendidikan Ibnu Sina Makassar tahun 2022. Fakumi Med J. [Internet]. 2024 [cited 2024 Sep 20];4(1):19–28. Available from: https://doi.org/10.33096/fmj.v4i1.435

Pratama KP, Adrianto AA. Faktor-faktor yang memengaruhi kejadian kanker kolorektal stadium III di RSUP dr. Kariadi Semarang. Diponegoro Med J (Jurnal Kedokt Diponegoro) [Internet]. 2019 [cited 2024 Sep 6];8(2):768–84. Available from: https://doi.org/10.14710/dmj.v8i2.23798

Wu Z, Huang Y, Zhang R, Zheng C, You F, Wang M, et al. Sex differences in colorectal cancer: with a focus on sex hormone-gut microbiome axis. Cell Commun Signal [Internet]. 2024 Mar 7 [cited 2025 Jul 4];22(1):167. Available from: https://doi.org/10.1186/s12964-024-01549-2

Qiu H, Wang L, Zhou L, Wang X. Comorbidity patterns in patients newly diagnosed with colorectal cancer: network-based study. JMIR Public Heal Surveill [Internet]. 2023 Sep 5 [cited 2024 Apr 20];9:e41999. Available from: https://doi.org/10.2196/41999

Peeters PJHL, Bazelier MT, Leufkens HGM, De Vries F, De Bruin ML. The risk of colorectal cancer in patients with type 2 diabetes: associations with treatment stage and obesity. Diabetes Care [Internet]. 2015 Mar [cited 2025 Jul 4];38(3):495–502. Available from: https://doi.org/10.2337/dc14-1165

Kellokumpu I, Kairaluoma M, Mecklin JP, Kellokumpu H, Väyrynen V, Wirta EV, et al. Impact of age and comorbidity on multimodal management and survival from colorectal cancer: a population-based study. J Clin Med [Internet]. 2021 Apr 17 [cited 2024 Sep 6];10(8):1751. Available from: https://doi.org/10.3390/jcm10081751

Pedrazzani C, Mantovani G, Fernandes E, Bagante F, Luca Salvagno G, Surci N, et al. Assessment of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and platelet count as predictors of long-term outcome after R0 resection for colorectal cancer. Sci Rep [Internet]. 2017 [cited 2024 Apr 20];7(1):1–10. Available from: https://doi.org/10.1038/s41598-017-01652-0

Zannah SJ, Murti IS, Sulistiawati. Hubungan usia dengan stadium saat diagnosis penderita kanker kolorektal di RSUD Abdul Wahab Sjahranie Samarinda. J Sains dan Kesehat [Internet]. 2024 [cited 2024 Apr 20];3(5):701–5. Available from: https://jsk.ff.unmul.ac.id/index.php/JSK/article/view/491

Astuti GAEW, Siswandi A, Wulandari M, Kumala I. Karakteristik pasien kanker kolorektal stadium I–IV di Rumah Sakit Umum Daerah Dr. H. Abdul Moeloek. J Ilmu Kedokt dan Kesehat [Internet]. 2023 [cited 2024 Apr 21];10(7):2360–74. Available from: http://ejurnalmalahayati.ac.id/index.php/kesehatan/article/view/8335

Ploug M, Knudsen T, Qvist N, Kroijer R. Decrease in hemoglobin following colorectal surgery - a cohort study with focus on iron deficiency. Perioper Care Oper Room Manag [Internet]. 2024 Mar [cited 2024 Sep 6];34:100363. Available from: https://doi.org/10.1016/j.pcorm.2023.100363

Dunst J, Becker A, Lautenschläger C, Markau S, Becker H, Fischer K, et al. Anemia and elevated systemic levels of vascular endothelial growth factor (VEGF). Strahlentherapie und Onkol [Internet]. 2002 [cited 2024 Sep 20];178(8):436–41. Available from: https://doi.org/10.1007/s00066-002-1147-2

Kronborg CS, Jensen AR. Prognostic factors for overall survival in metastatic colorectal cancer using a stop-and-go FLIRI-based treatment strategy. [Internet]. 2015 [cited 2024 Sep 20];30(8):1059–65. Available from: https://doi.org/10.1007/s00384-015-2245-3

Giannakeas V, Kotsopoulos J, Cheung MC, Rosella L, Brooks JD, Lipscombe L, et al. Analysis of platelet count and new cancer diagnosis over a 10-year period. JAMA Netw Open. [Internet]. 2022 [cited 2024 Apr 20];5(1):e2141633. Available from: https://doi.org/10.1001/jamanetworkopen.2021.41633

Labelle M, Begum S, Hynes RO. Direct signaling between platelets and cancer cells induces an epithelial-mesenchymal-like transition and promotes metastasis. Cancer Cell [Internet]. 2011 Nov [cited 2025 Jul 4];20(5):576–90. Available from: https://doi.org/10.1016/j.ccr.2011.09.009

Wallace K, Li H, Brazeal JG, Lewin DN, Sun S, Ba A, et al. Platelet and hemoglobin count at diagnosis are associated with survival in African American and Caucasian patients with colorectal cancer. Cancer Epidemiol [Internet]. 2020 [cited 2024 Sep 20];67:101746. Available from: https://doi.org/10.1016/j.canep.2020.101746

Adelborg K, Veres K, Horváth-Puhó E, Clouser M, Saad H, Sørensen HT. Risk and adverse clinical outcomes of thrombocytopenia among patients with solid tumors—a danish population-based cohort study. Br J Cancer [Internet]. 2024 May 18 [cited 2024 Sep 20];130(9):1485–92. Available from: https://doi.org/10.1038/s41416-024-02630-w

Gao A, Zhang L, Zhong D. Chemotherapy-induced thrombocytopenia: literature review. Discov Oncol [Internet]. 2023 Jan 25 [cited 2025 Jul 4];14(1):10. Available from: https://doi.org/10.1007/s12672-023-00616-3

Widhyasih RM, Rahmadhanti SD, Fajrunni’mah R. Carcinoembryonic antigen (CEA) dan neutrofil-to-limfosit ratio (NLR) sebagai faktor prediktif kanker kolorektal. J Ilmu dan Teknol Kesehat [Internet]. 2019 [cited 2024 Sep 20];7(1):68–76. Available from: https://doi.org/10.32668/jitek.v7i1.223

Shaul ME, Fridlender ZG. Tumour-associated neutrophils in patients with cancer. Nat Rev Clin Oncol [Internet]. 2019 Oct 3 [cited 2025 Jul 4];16(10):601–20. Available from: https://doi.org/10.1038/s41571-019-0222-4

Li MX, Liu XM, Zhang XF, Zhang JF, Wang WL, Zhu Y, et al. Prognostic role of neutrophil-to-lymphocyte ratio in colorectal cancer: a systematic review and meta-analysis. Int J Cancer [Internet]. 2024 [cited 2024 Apr 20];134(10):2403–13. Available from: https://doi.org/10.1002/ijc.34999