Pretreatment Neutrophil/Lymphocyte Ratio as a Prognostic Aid in Colorectal Cancer


Background: Colorectal cancers(CRC) are the third most common cancer in the western world, with surgerypreferred for management of non-metastatic disease and post surgical treatment usually arranged according tothe TNM staging system. However, there is still prognostic variation between patients who have the same stage. Itis increasingly recognized that variations within disease course and clinical outcome in colorectal cancer patientsare influenced by not only oncological characteristics of the tumor itself but also host response factors. Recentstudies have shown correlation between the inflammatory response and clinical outcomes in various cancers.The neutrophil/lymphocyte ratio (NLR) has been described as a marker for immune response to various stimuliincluding cancer. Material-
Methods: Two hundred eighty-one CRC patients were included in our retrospectiveanalysis, separated into two groups according to a cut-off value for the NLR. Patient data including age, gender,vertical penetration, anatomic location, and differentiation of the tumor, TNM stage, survival rate, and diseasefreesurvival were analyzed for correlations with the NLR.
Results: Using ROC curve analysis, we determined acut-off value of 2.2 for NLR to be best to discriminate between patient survival in the whole group. In univariateanalysis, high pretreatment NLR (p=0.001, 95%CI 1.483-4.846), pathologic nodal stage (p<0.001, 95%CI 1.082-3.289) and advanced pathologic TNM stage (p<0.001, 95%CI 1.462-4.213) were predictive of shorter survival. Inmultivariate analysis, advanced pathologic TNM stage (p=0.001, 95%CI 1.303-26.542) and high pretreatmentNLR (p=0.005, 95%CI 1.713-6.378) remained independently associated with poor survival.
Conclusions: Highpre-treatment NLR is a significant independent predictor of shorter survival in patients with colorectal cancer.This parameter is a simple, easily accessible laboratory value for identifying patients with poorer prognosis.