Baseline neutrophil-lymphocyte ratio (≥2.8) as a prognostic factor for patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiation

Abstract

BackgroundThe neutrophil-lymphocyte ratio (NLR) has been proposed as an indicator of systemic inflammatory response and may predict the clinical outcome in some cancers, such as head and neck cancer and gastric cancer. However, the value of this ratio is variable in different cancers. Studies of the relationship between NLR and both survival and response to chemoradiation have been limited with respect to locally advanced rectal cancer.Methods and materialsFrom 2006 to 2011, 199 consecutive locally advanced rectal cancer patients who were treated with neoadjuvant chemoradiation in the Shanghai Cancer Center were enrolled and analysed retrospectively. Tumor response was evaluated by pathological findings. The baseline total white blood cell count (WBC) and the neutrophil, lymphocyte, platelet counts were recorded. The neutrophil-lymphocyte ratio (NLR) and the relationship with clinical outcomes such as overall survival (OS) and disease-free survival (DFS) was analyzed.ResultsWith ROC analysis, the baseline NLR value was found to significantly predict prognosis in terms of OS well in locally advanced rectal cancer patients. A multivariate analysis identified that a cut-off value of NLR ≥ 2.8 could be used as an independent factor to indicate decreased OS (HR, 2.123; 95% CI, 1.140-3.954; P = 0.018). NLR ≥ 2.8 was also associated with worse DFS in univariate analysis (HR, 1.662; 95% CI, 1.037-2.664; P = 0.035), though it was not significant in the multivariate analysis (HR, 1.363; 95% CI, 0.840-2.214; P = 0.210). There was no observed significant correlation of mean value of NLR to the response to neoadjuvant chemoradiation. The mean NLR in the ypT0-2 N0 group was 2.68 ± 1.38, and it was 2.77 ± 1.38 in the ypT3-4/N+ group, with no statistical significance (P = 0.703). The mean NLR in the TRG 0–1 group was 2.68 ± 1.42, and it was 2.82 ± 1.33 in the TRG 2–3 group with no statistical significance (P = 0.873).ConclusionsAn elevated baseline NLR is a valuable and easily available prognostic factor for OS in addition to tumor response after neoadjuvant therapy. Baseline NLR could be a useful candidate factor for stratifying patients and making treatment decisions in locally advanced rectal cancer.

Prognostic Impact of Neutrophil-to-Lymphocyte Ratio in Patients with Advanced Low Rectal Cancer Treated with Preoperative Chemoradiotherapy

“…They chose 5.0 as the NLR cut-off value, but they did not document the proportion of high and low NLR patients. However, there is no consensus about an NLR cut-off value, and the cutoff values that were used in previous reports targeting rectal cancer patients with NACRT were 2.8, 3.0, and 5.0 [18][19][20][21][22] . Shen et al [18] used both cut-off values of 2.8 and 5.0, and an NLR of ≥ 5.0 was also independently associated with worse OS.…”

“…However, there is no consensus about an NLR cut-off value, and the cutoff values that were used in previous reports targeting rectal cancer patients with NACRT were 2.8, 3.0, and 5.0 [18][19][20][21][22] . Shen et al [18] used both cut-off values of 2.8 and 5.0, and an NLR of ≥ 5.0 was also independently associated with worse OS. However, there were only 7.5% of patients with an NLR of ≥ 5.0 in the analysis by Shen et al [18] , and there were only 8 (4.0%) patients with an NLR of ≥ 5.0 in our present study.…”

“…However, the prognostic significance of NLR status in patients with low rectal cancer with NACRT is still limited. Shen et al [18] analyzed 199 patients with locally advanced rectal cancer, including mid and upper rectal cancer, who were treated with NACRT followed by surgery. They showed that a high NLR ( ≥ 2.8) was independently associated with worse OS in multivariate analysis, but NLR showed no association with disease-free survival (DFS).…”

“…The area under the curve was 0.591 for OS, and NLR of 3.2 had the highest sensitivity (42.1%) and specificity (84.6%). However, because previous studies, which analyzed the utility of NLR as a prognostic indicator in patients with CRC, used 2.5, 2.8, 3.0 or 5.0 as the cut-off value [9,[18][19][20][21][22]29] , the cut-off value of 3.0 was chosen as the closest value to 3.2. Categorical variables were compared using the chi-square test or Fisher's exact test where appropriate.…”

“…The status of the NLR may reflect the balance between pro-tumor inflammatory status and anti-tumor immune status, which may be why patients with high NLRs show worse prognosis in several malignancies. However, the prognostic significance of NLR status in patients with low rectal cancer undergoing NACRT is still limited [18][19][20][21][22][23] . The aim of this study was to evaluate the association between NLR status prior to NACRT and prognosis in patients with low rectal cancer treated with NACRT followed by surgery.…”