233 Background: The neutrophil-to-lymphocyte ratio (NLR) has been shown to correlate with overall and disease-free survival in patients with colorectal cancer. The data about prognostic value of the NLR in patients undergoing liver resection for colorectal liver metastases (CRLM) is limited. We aimed to describe the relationship between the NLR, overall survival and disease progression in patients who underwent liver resection for CRLM in a safety-net hospital. Methods: We identified patients who underwent liver resection with curative intent for metastatic colorectal cancer at a large safety net hospital between 2008 and 2020. All patients had a complete blood count with differential available within three months prior to resection. We compared patients who had a pre-operative NLR ≤3 with those who had a NLR > 3, a cut-off based on ROC analysis. We used the Chi-squared statistic and t-test to compare the frequencies of categorical variables and the means of continuous variables, respectively. Multivariate survival analyses were performed using the Cox-regression model after adjusting for sex, age at liver resection, race/ethnicity, body mass index, insurance status, initial presentation of colorectal cancer (emergency room vs outpatient), primary malignancy (colon vs. rectal), temporality of CRLM (synchronous vs metachronous presentation with primary), staged vs simultaneous removal of primary mass and CRLM, number and size of liver CRLM, other metastatic sites at the time of liver resection, carcinoembryonic antigen (at initial diagnosis, before and after resection), and receipt of at least six months of peri-liver resection chemotherapy. Results: We identified 76 patients who underwent liver resection with curative intent for CRLM with a median follow up of 40.7 months. The population had a mean age of 56.2 (SD 9.9), was 50% female, and predominantly non-White (73.7%). Compared with patients who had a NLR ≤3 (N = 50), patients with a NLR > 3 (N = 26) were more likely to be white (46.2% vs 16.0%) and have rectal cancer (61.5% vs 28.0%). In unadjusted analysis, patients with NLR > 3 had 1.87 times (95% CI 1.01-3.47) increased risk of mortality, compared with patients who had an NLR ≤3. In adjusted analysis, patients with NLR > 3 had 6.88 times (95% CI 1.61-29.42), increased risk of mortality, compared with patients who had an NLR ≤ 3. There was no significant difference in risk of CRLM recurrence or overall disease progression among patients with NLR ≤3 vs patients with NLR > 3. Conclusions: An elevated pre-operative NLR > 3 is a potential predictor of overall survival among patients undergoing liver resection for metastatic colorectal cancer. This widely available test may aid clinicians in pre-operative risk stratification.
20 Background: Elderly colon cancer patients face unique age-specific challenges during their treatments. The resource availability at the healthcare facility can affect their cancer-related outcomes. We evaluated the utilization of therapies and compared outcomes among elderly colon cancer patients treated in a limited-resource versus a high-resource healthcare setting. Methods: Patients >70 years of age with stage II-IV colon adenocarcinoma diagnosed between 2011 and 2017 were identified from the tumor registry of a large safety-net hospital (limited-resource setting), and an NCI-designated Comprehensive Cancer Center (high-resource setting). We compared the frequencies of categorical variables using Chi-square and Fisher’s exact tests and used a t-test to compare continuous variables between the limited-resource and high-resource setting patients. A multivariate survival analysis was performed using the Cox proportional hazard models adjusting for age, race/ethnicity [Hispanic, non-Hispanic White (NHW), and non-Hispanic Black (NHB)], BMI (<18.5 and > 18.5), gender, hospital setting (limited-resource vs. high-resource setting), staging (II, III, and IV), laterality of the tumor (right or left) and performance of surgery. Results: One-hundred-twenty-one elderly colon cancer patients were identified; the median age at diagnosis was 75 years (IQR 72-80.5), predominantly females (53%). Fifty-four patients (44.6%) received treatment in the limited-resource setting while sixty-seven (55.4%) were treated in the high-resource setting. Most patients were NHW (46%), followed by NHB (25%) and Hispanics (23%). Hispanic patients were more frequent in the limited-resource setting (44% vs 6%) while NHW were more frequent in the high-resource setting (73.8% vs. 14.8%). Utilization of surgery (83% vs. 85%, p-value = 0.8), the use of adjuvant chemotherapy for stage III colon cancer (34.8% vs. 65.2%; p-value = 0.295) and palliative chemotherapy among stage IV (39% vs. 61%; p-value = 0.5) was not significantly different among the elderly patients treated in the limited-resource setting as compared to high-resource setting. On the multivariate survival analysis, stage IV disease (p-value = 0.002) and limited-resource setting (HR = 0.37, 95% CI = 0.19-0.71, p-value = 0.003) were independently associated with survival in this cohort. Conclusions: Elderly patients treated in the limited-resource setting had lower survival as compared to those treated in the high-resource setting. There was a trend toward lower utilization of chemotherapy for stage III and IV elderly colon cancer patients in the limited-resource setting compared to the high-resource setting. The patient or system-related factors that may contribute to this disparity should be further explored.
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