Preoperative neutrophil to lymphocyte ratio as a prognostic factor for patients with colorectal cancer

Abstract

Introduction: This study aimed to determine the role of the neutrophil to lymphocyte ratio (NLR) as a prognostic marker for patients with colorectal cancer (CRC) undergoing curative resection. Management of CRC and postsurgical treatment is usually arranged using the TNM staging system, but there are still prognostic variations among patients at the same TNM stage. Recent studies showed correlations between the inflammatory response and clinical outcomes in various cancers. The NLR reflected a systematic inflammatory response with some evidence suggesting that an elevated preoperative NLR is associated with poorer survival in patients with CRC. Methods: One hundred seventy eight patients with CRC, undergoing surgical resection in Surgical Departement Generaly Hospital Studenica Kraljevo-Serbia, between 2010. and 2015. were included in our retrospective analysis. Patients separated into two groups according to a cut-off value for NLR. Patient data included age, gender, localisation and differentiation of tumor, TNM stage, survival rate were analyzed for correlation with the NLR. Results: Using ROC curve analysis, we determined a cut-off NLR value of 2.1 in order to best detect differences in patient survival between our groups. The average length of survival in patients that had NLR 2.1 was 7.3 months (72.7612) and within these patients, the median of survival had not been reached. Patients with NLR > 2.1 had an average length of survival of 60 months (60.1163.4) and median of survival was 70.0. The log-rank test showed that there was a statistically significant difference (P ¼ .041) of survival between patients that had NLR 2.1 compared with those who had NLR > 2.1. Also, the log-rank test showed that advanced pathologic TNM stage (P ¼ .000), pathologic nodal stage (P ¼ .007) were predictive of shorter survival. Conclusion: High pre-treatment levels of NLR is a significant independent predictor of shorter survival in patients with colorectal cancer. This parameter is a simple, cheap, easily accessible laboratory value for identifying patients with poorer prognosis. P À 079 Circulating tumor cell detection and microsatellite instability status in predicting outcomes of advanced CRC patients