Can neutrophil-to-lymphocyte ratio predict the survival of colorectal cancer patients who have received curative surgery electively?

• Published in: International journal of colorectal disease Vol. 27; no. 10; pp. 1347 - 1357
• Main Authors: Chiang, Sum-Fu, Hung, Hsin-Yuan, Tang, Reiping, Changchien, Chung Rong, Chen, Jinn-Shiun, You, Yau-Tong, Chiang, Jy-Ming, Lin, Jr-Rung
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.10.2012; Springer; Springer Nature B.V
• Subjects: Analysis; Cancer patients; Cell survival; Colorectal cancer; Colorectal Neoplasms - blood; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Development and progression; Elective Surgical Procedures; Female; Gastroenterology; Hepatology; Humans; Internal Medicine; Kaplan-Meier Estimate; Leukocyte Count; Lymphocytes; Lymphocytes - pathology; Male; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Multivariate Analysis; Neoplasm Staging; Neutrophils - pathology; Original Article; Patient outcomes; Proctology; Prognosis; Proportional Hazards Models; Rectal Neoplasms - pathology; Rectal Neoplasms - surgery; Risk Factors; ROC Curve; Surgery; Survival Analysis; Treatment Outcome; Colorectal; Neutrophil-to-lymphocyte ratio; Survival; Prognostic
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-012-1459-x

Purpose We evaluated the effect of neutrophil-to-lymphocyte ratio (NLR) on disease-free survival in patients with stages I to III colorectal cancer (CRC). Methods There were 3857 patients identified from our database. We used receiver operating characteristic (ROC) analysis to identify the best cutoff value of NLR. A 5-year disease-free survival was used as end point. Survival analysis was used to assess the NLR effect, after stratification by several clinopathologic factors. Results In the ROC analysis, NLR = 3 had the highest sensitivity and specificity. Elevated NLR (>3) in colon cancer seemed to accompany larger tumor size (≧5 cm) and more advanced T stage. By multivariate analysis, elevated NLR in colon cancer was associated with an increased risk of disease progression or cancer death [hazard ratio (HR) 1.377, 95  % confidence interval 1.104–1.717, P  = 0.014]. However, elevated NLR in rectal cancer lost its significance in multivariate analysis (HR 1.121, 95  % confidence interval 0.941–1.336, P  = 0.200). Patients with elevated NLR had worse outcome, especially for colon cancer. Conclusions Preoperative NLR influenced the disease-free survival in patients with stages I to III CRC. Elevated NLR (>3) was associated with worse outcome (5-year disease-free survival 66.3  % vs. 78.9  % in colon cancer, P  < 0.001; 60. 5 % vs. 66.2  % in rectal cancer, P  = 0.008). The difference was larger in colon cancer than in rectal cancer. NLR should be considered as a prognostic factor for stages I to III CRC patients after curative surgery.