The Neutrophil-to-Lymphocyte Ratio as a Marker of Lymph Node Status in Patients with Rectal Cancer

• Published in: Oncology Vol. 91; no. 2; p. 69
• Main Authors: Khan, Aftab A, Akritidis, Georgios, Pring, Toby, Alagarathnam, Swethan, Roberts, Geoffrey, Raymond, Regina, Varcada, Massimo, Novell, Richard
• Format: Journal Article
• Language: English
• Published: Switzerland 01.08.2016
• Subjects: Aged; Area Under Curve; Biomarkers, Tumor - blood; C-Reactive Protein - metabolism; Disease-Free Survival; Female; Humans; Lymph Node Excision; Lymph Nodes - diagnostic imaging; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphatic Metastasis; Lymphocyte Count; Lymphocytes; Magnetic Resonance Imaging; Male; Middle Aged; Neutrophils; Predictive Value of Tests; Rectal Neoplasms - blood; Rectal Neoplasms - pathology; Rectal Neoplasms - surgery; Retrospective Studies; ROC Curve; Survival Rate
• ISSN: 1423-0232
• DOI: 10.1159/000443504

The aim of the study was to investigate the role of the neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker of rectal cancers. We undertook a retrospective review of patients with rectal cancer. Pre-treatment NLR was assessed for association and predictive values against clinicopathological staging and post-treatment outcomes. A total of 140/180 cases were included in the final analysis [male:female 2:1; mean age 68 years (interquartile range 58-75)]. The pre-operative mean NLR was 5.4 ± 6.8. There was a strong positive correlation between NLR and C-reactive protein (Spearman's rho 64.3%, p < 0.001). A high NLR was associated with a positive nodal status on MRI (5.2 vs. 3.8, p = 0.03) and histopathological (4.8 vs. 3.8, p = 0.02) assessment. The NLR showed an average value for predicting MRI and pathological nodal status on receiver operating characteristic analysis [area under the curve = 0.72 (95% CI = 0.54-0.91), p = 0.031 and area under the curve = 0.64 (95% CI = 0.52-0.077), p = 0.021, respectively]. On multivariate analysis, the total lymph node retrieved at operation was the best predictor of pathological nodal involvement; NLR did not show any predictive value. Patients with an NLR >4 showed reduced recurrence-free (60 vs. 86 months, p = 0.52) and overall survival (57 vs. 84 months, p = 0.40) without statistical significance. Raised pre-treatment NLR may indicate nodal involvement in patients with rectal cancer.