Elevated Neutrophil-to-Lymphocyte Ratio in Perioperative Periods is Suggestive of Poor Prognosis in Patients with Colorectal Cancer

Abstract

Background: Recent data suggest that alterations in the neutrophil-to-lymphocyte ratio (NLR) in the perioperative periods can serve as prognostic factors. However, research on the clinical impact has been limited and even discordant in patients with colorectal cancer (CRC). Patients and Methods: The optimal cut-off value of preoperative NLR (NLR-pre), postoperative NLR (NLR-post), and its change (NLR-delta) were determined to maximize differences in overall survival (OS) between groups. Patients were categorized into four groups (NLR-trend) as follows: G1, low NLR-pre and NLR-post; G2, low NLR-pre and high NLR-post; G3, high NLR-pre and low NLR-post; and G4, high NLR-pre and NLR-post. Discriminatory performance was compared using integrated AUC (iAUC) between all indicators. Results: A total of 576 patients diagnosed with stage I-IV CRC were included. The cut-off points were determined as 2.33 for NLR-pre, 2.06 for NLR-post, and −1.08 for NLR-delta. Subgroup dichotomization using NLR-pre, NLR-post, NLR-delta and NLR-trend were all identified as significant prognostic factors by univariate analysis. However, NLR-trend was only remained as an independent prognostic factor in the multivariate analysis. The iAUC of the NLR-trend was superior to that of NLR-pre (bootstrap iAUC mean difference=0.036; 95% CI 0.013-0.073), NLR-post (bootstrap iAUC mean difference=0.045; 95% CI 0.019-0.081) and NLR-delta (bootstrap iAUC mean difference=0.061; 95% CI 0.025-0.104). Conclusion: Risk stratification and combining of preoperative and postoperative NLR (NLR-trend) can improve prognostic discrimination compared with single measurements or simple changes in NLR in patients with CRC.

The Efficacy of Different Inflammatory Markers for the Prognosis of Patients with Malignant Tumors

“…60,61 As a real-world clinical study with prognosis and malnutrition as the outcome variables, our study comprehensively reflects the overall situation of cancer patients to some extent. Although previous studies 14,62,63 have explored the use of inflammatory markers for prognostic prediction in patients with malignant tumors, there were certain limitations. First of all, there has been controversy about the choice of markers that best reflect inflammatory conditions.…”

Increased neutrophil-to-lymphocyte ratio is associated with unfavorable functional outcomes in acute pontine infarction

“…The neutrophil-to-lymphocyte ratio (NLR) combines information on neutrophils and lymphocytes and is less affected than other indices by physiological factors, specimen handling and other factors; it is also inexpensive and easy to obtain and produces relatively stable results. Recently, many studies confirmed the association between this indicator and multiple diseases, including acute coronary syndrome, cancer, and neuromyelitis optica spectrum disorder, and showed that the NLR has high clinical application value [ 7 – 10 ]. Relevant studies have found that the NLR may be an independent predictor of unfavorable prognosis and early death in patients with acute cerebral infarction [ 11 – 13 ].…”

Prognostic value of preoperative immune-nutritional scoring systems in remnant gastric cancer patients undergoing surgery

“…NLR and LMR are objective markers that reflect the inflammatory and immune status of the host. The increase in NLR and the decrease in LMR in patients are usually associated with a poor prognosis[ 21 , 35 ].…”