Neutrophil-to-lymphocyte ratio has limited predictive value for determining outcomes in perforated colon cancer: a retrospective study.

Abstract

Background: The neutrophil-to-lymphocyte ratio (NLR) is a significant prognostic marker in resectable colorectal cancer; however, there are no equivalent findings for perforated colon cancer. Using our colorectal cancer database, we retrospectively analyzed the data from 1995 to 2015 to determine if preoperative NLR was associated with survival outcomes in patients with perforated colon cancer. Methods: One-to-one propensity score matching (PSM) was applied to minimize the difference between the higher- (>5) and lower- (≤5) NLR groups. Clinicopathological factors, long-term overall survival (OS), and disease-free survival (DFS) were analyzed and compared between the two groups. The main outcome measures were OS and DFS. Results: Before PSM, the higher-NLR group had significantly higher prevalence of leukocytosis (lower- vs. higher-NLR groups: 12 [12.9%] vs. 46 [59.7%], p<0.001), lower serum albumin levels (lower- vs. higher-NLR groups: 30 [32.3%] vs. 42 [54.5%], p=0.003), and higher emergent operation rate (lower- vs. higher-NLR groups: 5 [5.4%] vs. 20 [26.0%], p<0.001). After one-to-one PSM, the groups comprised 41 patients each; none of the parameters were significantly different. The mean follow-up period was 76.3 months. Five-year OS and DFS were not significantly different (OS: p=0.637; DFS: p=0.827) between the higher- and lower-NLR groups. Conclusion: NLR have limited predictive value for outcomes in patients with perforated colon cancer.