Peripheral Neutrophil to Lymphocyte Ratio Improves Prognostication in Colon Cancer

Rashtak, Shahrooz; Ruan, Xiaoyang; Druliner, Brooke R.; Liu, Hongfang; Therneau, Terry M.; Mouchli, Mohamad; Boardman, Lisa A.

doi:10.1016/j.clcc.2017.01.008

Cited by 42 publications

(36 citation statements)

References 29 publications

(30 reference statements)

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“…The 2-year OS and DFS of stage III CC are reported as 65.9% and 59.2%, respectively, in the literature. 20 The figures of the resectable tumors are 94.1% and 77.5%. 21 Our results of follow-up indicated that NACRT made the survivals of the patients with unresectable disease improve towards those of the patients with resectable disease.…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant chemoradiotherapy followed by surgery in patients with unresectable locally advanced colon cancer: a prospective observational study

Chang¹,

Yu²,

Xiao³

et al. 2018

OTT

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BackgroundThe prognosis of locally unresectable colon cancer (CC) is poor. This prospective observational study aimed to further evaluate the feasibility and efficacy of neoadjuvant chemoradiotherapy (NACRT) followed by surgery in these patients.Patients and methodsWe consecutively enrolled patients who were diagnosed with locally unresectable CC from November 2010 to March 2017, and received NACRT followed by surgery. The data of all the patients were collected prospectively. The R0 resection, down-stage and pathologic complete response (pCR) rates were calculated to evaluate the short-term treatment effects. The overall survival (OS) was used to evaluate the long-term outcome. The incidence of NACRT-related acute toxicities and postsurgical complications were used to assess the safety.ResultsA total of 60 patients were eligible for analysis, including 57 (95.0%) patients who attained resectability after NACRT. Among patients managed with surgery, 49 cases (86.0%) achieved R0 resection, and 15 cases (26.3%) achieved pCR. Down T stage was seen in 47 cases (82.5%), and down N stage was seen in 53 cases (93.0%). After a median follow-up time of 26 months, the OS appeared as 76.7%. The most common grade 3/4 NACRT-related toxicity was myelosuppression (incidence, 20.0%). The incidence of grade 3/4 surgery-related complication was 7.0%.ConclusionNACRT might be a safe and effective choice for patients with locally unresectable CC to improve treatment effects, long-term survival and life quality, though further validation is needed.

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Section: Discussionmentioning

confidence: 99%

Neoadjuvant chemoradiotherapy followed by surgery in patients with unresectable locally advanced colon cancer: a prospective observational study

Chang¹,

Yu²,

Xiao³

et al. 2018

OTT

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“…The association between colon cancer and lymphocyte counts has been examined in studies as early as the 1970s, in which a decrease in lymphocyte counts was found in patients with more advanced colon cancer [ 21 ]. Additionally, as one of the potential predictive markers, an elevated preoperative NLR was found to be a predictor of recurrence and worse survival after resection of CRC [ 17 , 22 , 23 ]. In the present study, RFS and OS of stage II colon cancer were found to be highly correlated with decreased lymphocyte counts, though preoperative NLR was not found to be an independent prognostic variable for recurrence of stage II colon cancer, as previously reported [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Combined use of preoperative lymphocyte counts and the post/preoperative lymphocyte count ratio as a prognostic marker of recurrence after curative resection of stage II colon cancer

et al. 2017

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PurposeDiagnostic markers for recurrence of colorectal cancer have not been established. The aim of the present study was to identify new diagnostic markers for recurrence after curative surgery of stage II colon cancer.Materials and MethodsIn this study, the prognostic values of the preoperative lymphocyte count and the post/preoperative lymphocyte count ratio (PPLR) were evaluated in 142 patients with localized colon cancer treated with surgery at a single medical center. The associations of patient demographics, blood chemistry, and serum biochemical indices with recurrence-free survival (RFS) and cancer-specific survival (CSS) were examined by univariate and multivariate analyses.ResultsReceiver operating characteristic (ROC) curve analysis showed that the optimal cut-off values of the lymphocyte count and PPLR were, respectively, 1555.2/μl and 1.151 for RFS. On univariate analysis, tumor depth of invasion, carbohydrate antigen 19-9 (CA19-9), and preoperative low lymphocyte count (≤1555.2/μl) were all correlated with poorer RFS (p < 0.05). On multivariate analysis, T4, low lymphocyte count, and low PPLR were independent predictors of poor RFS. Furthermore, the patients were categorized into four categories based on preoperative lymphocyte count high/low and PPLR high/low. Patients with a low preoperative lymphocyte count and low PPLR had the poorest RFS and CSS compared to the other patients.ConclusionThe combination of the preoperative lymphocyte count and the PPLR appears to be a potential marker for predicting recurrence of stage II colon cancer.

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“…Walsh et al rst reported a correlation between preoperatively elevated NLR had a relationship with overall and cancer-speci c survival in colon cancer [24]. The predictive potential of NLR in evaluating the prognosis of patients with various types of malignancies, including resectable colon cancer, has been demonstrated in previous studies [8][9][10][11]. However, no study has analyzed a large cohort of patients with Stage II-III advanced colon cancer using propensity scores to minimize selection bias.…”

Section: Discussionmentioning

confidence: 99%

“…Among these, neutrophil-to-lymphocyte ratio (NLR) is calculated from white blood cell (WBC) differential counts and can be obtained easily in preoperative patients. Previous studies have reported on the predictive potential of NLR as a prognostic factor in various types of malignancies, including resectable colon cancer [8][9][10][11][12][13][14]. However, since these previous studies analyzed data by univariate or multivariate analysis, the possibility of selection bias and confounding factors could not be ruled out.…”

Section: Introductionmentioning

confidence: 99%

Neutrophil-to-lymphocyte ratio is a prognostic factor for colon cancer: a propensity score analysis

Mazaki

Katsumata

Kasahara

et al. 2020

Preprint

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Background: A large number of patients suffer recurrence after curative resection, and mortality from colon cancer remains high. The role of systemic inflammatory response, as reflected by neutrophil-to-lymphocyte ratio (NLR), in cancer recurrence and death has been increasingly recognized. This study aimed to analyze long-term oncologic outcomes of Stage II-III colon cancer to examine the prognostic value of NLR using a propensity score analysis.Methods: A total of 375 patients with colon cancer underwent radical surgery between 2000 and 2014 at Tokyo Medical University Hospital. Long-term oncologic outcomes of these patients were evaluated according to NLR values. A cut-off NLR of 3.0 was used based on receiver operating characteristic curve analysis. Primary outcomes were overall survival (OS) and relapse-free survival (RFS). An analysis of outcomes according to tumor sidedness was also performed.Results: Patients with lower NLR values (“lower NLR group”) were more likely to have lymph node metastasis compared to those with higher NLR values (“higher NLR group”) before case matching. After case matching, clinical outcomes were similar between the two groups. There were no significant differences in 5-year OS and 5-year RFS rates between the two groups before case matching based on propensity scores. After case matching, 5-year OS rates were 94.5% in the lower NLR group (n = 135) and 87.0% in the higher NLR group (n = 135), showing a significant difference (p = 0.042). Five-year RFS rates were 87.8% in the lower NLR group and 77.9% in the higher NLR group, also showing a significant difference (p = 0.032). Among patients with left-sided colon cancer in the matched cohort, 5-year OS and 5-year RFS rates were 95.2% and 87.3% in the lower NLR group (n = 88), respectively, and 86.4% and 79.2% in the higher NLR group (n = 71), respectively, showing significant differences (p = 0.014 and p = 0.047, respectively).Conclusions: The NLR is an important prognostic factor for advanced colon cancer, especially for left-sided colon cancer.

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Peripheral Neutrophil to Lymphocyte Ratio Improves Prognostication in Colon Cancer

Cited by 42 publications

References 29 publications

Neoadjuvant chemoradiotherapy followed by surgery in patients with unresectable locally advanced colon cancer: a prospective observational study

Neoadjuvant chemoradiotherapy followed by surgery in patients with unresectable locally advanced colon cancer: a prospective observational study

Combined use of preoperative lymphocyte counts and the post/preoperative lymphocyte count ratio as a prognostic marker of recurrence after curative resection of stage II colon cancer

Neutrophil-to-lymphocyte ratio is a prognostic factor for colon cancer: a propensity score analysis

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