Preoperative Neutrophil-to-Lymphocyte Ratio is a Better Prognostic Serum Biomarker than Platelet-to-Lymphocyte Ratio in Patients Undergoing Resection for Nonmetastatic Colorectal Cancer

Choi, Woo Jin; Cleghorn, Michelle C.; Jiang, Haiyan; Jackson, Timothy; Okrainec, Allan; Quereshy, Fayez A.

doi:10.1245/s10434-015-4571-7

Cited by 82 publications

(80 citation statements)

References 26 publications

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“…Therefore, different statistical methods may obtain different thresholds. However, the method used by the present study was based on R, which has been reliably used by other studies (15,51,52). To conclude, the present study revealed that the combination of the CRP/Alb ratio and NLR represents a potential inflammation-based prognostic marker.…”

Section: Univariate Analysismentioning

confidence: 60%

C‑reactive protein/albumin and neutrophil/lymphocyte ratios and their combination predict overall survival in patients with gastric cancer

et al. 2017

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Abstract. Multiple studies have reported the prognostic association of certain inflammatory factors with various types of cancer. The present study assessed the prognostic value of the C-reactive protein (CRP)/albumin (Alb) ratio and the neutrophil/lymphocyte ratio (NLR), separately and in combination, in gastric cancer (GC). A total of 337 cases pathologically diagnosed with gastric adenocarcinoma were retrospectively evaluated. The clinicopathological and prognostic relevance of the CRP/Alb ratio and NLR and their combination were analyzed. The optimal cut-off values of the CRP/Alb ratio and NLR were 0.38 and 3.14, respectively. High CRP/Alb ratio (≥0.38) and NLR (≥3.14) values were associated with increased tumor invasion, more distant metastasis and a more advanced tumor-node-metastasis stage (all P<0.05). In addition, a high NLR value was also associated with increased tumor size (P= 0.02). The CRP/Alb ratio (≥0.38/<0.38) and NLR (≥3.14/<3.14) were independent prognostic factors for overall survival time (OS) in GC by multivariate analysis (P= 0.005 and P= 0.001). Using the CRP/Alb ratio and NLR classification, patients were stratified into three subgroups with different OS time (P<0.001), which were identified as independent prognostic variables in multivariate analysis (P<0.001). The present study demonstrated that the CRP/Alb ratio and NLR were independent prognostic factors for OS in patients with GC. The combination of these indexes was associated with significant prognostic value and may further stratify prognosis. IntroductionGastric cancer (GC) is one of the most common types of tumor globally. In 2015, GC had the second highest incidence and rate of mortality among cancer patients in China (1). Due to the rapid progression of GC and the absence of early specific symptoms and signs, the majority of patients are diagnosed at the late stage of gastric carcinoma (2-5). At present, surgery is the preferred treatment for patients without distant metastasis, and postoperative metastasis and recurrence are the predominant causes of mortality (3,5). Although disease-free and overall survival (OS) may be improved by postoperative chemotherapy and radiotherapy, the prognosis of GC remains poor (3,6). Identifying simple but effective prognostic markers for GC remains an important aim for researchers.Inflammation occurs in various types of tumor, and serves a crucial function in tumor development and distant metastasis (7-10). Previous studies have indicated that inflammation is associated with the formation of the tumor microenvironment by inflammatory mediators, including vasoactive amines and cytokines (11-13). The C-reactive protein (CRP)/albumin (Alb) ratio is used as a novel inflammation-based prognostic indicator in multiple types of tumor. Previous studies have demonstrated the prognostic value of CRP/Alb ratio in colorectal (14) and esophageal cancer (15), hepatocellular carcinoma (16), and renal (17) and pancreatic cancer (18). Another important inflammatory marker is the neutrophil/lymphocyte ratio (...

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Section: Univariate Analysismentioning

confidence: 60%

C‑reactive protein/albumin and neutrophil/lymphocyte ratios and their combination predict overall survival in patients with gastric cancer

et al. 2017

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“…Similarly, Ishizuka et al [40] reported a higher frequency of nodal involvement in patients with elevated NLR and platelet counts. Other investigators have reported an association between high NLR and colorectal tumour size [41], poor differentiation [4] and mucinous type [42]. In contrast, only a couple of investigators failed to show any association between NLR and clinicopathological features or Dukes staging [43,44].…”

Section: Discussionmentioning

confidence: 99%

The Neutrophil-to-Lymphocyte Ratio as a Marker of Lymph Node Status in Patients with Rectal Cancer

Khan

Akritidis²,

Pring³

et al. 2016

Oncology

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Aim: The aim of the study was to investigate the role of the neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker of rectal cancers. Methods: We undertook a retrospective review of patients with rectal cancer. Pre-treatment NLR was assessed for association and predictive values against clinicopathological staging and post-treatment outcomes. Results: A total of 140/180 cases were included in the final analysis [male:female 2:1; mean age 68 years (interquartile range 58-75)]. The pre-operative mean NLR was 5.4 ± 6.8. There was a strong positive correlation between NLR and C-reactive protein (Spearman's rho 64.3%, p < 0.001). A high NLR was associated with a positive nodal status on MRI (5.2 vs. 3.8, p = 0.03) and histopathological (4.8 vs. 3.8, p = 0.02) assessment. The NLR showed an average value for predicting MRI and pathological nodal status on receiver operating characteristic analysis [area under the curve = 0.72 (95% CI = 0.54-0.91), p = 0.031 and area under the curve = 0.64 (95% CI = 0.52-0.077), p = 0.021, respectively]. On multivariate analysis, the total lymph node retrieved at operation was the best predictor of pathological nodal involvement; NLR did not show any predictive value. Patients with an NLR >4 showed reduced recurrence-free (60 vs. 86 months, p = 0.52) and overall survival (57 vs. 84 months, p = 0.40) without statistical significance. Conclusion: Raised pre-treatment NLR may indicate nodal involvement in patients with rectal cancer.

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“…None of the clinical factors used in known [12][13][14][16][17][18][19][20][21][22] In addition, we did not validate neutrophil-to-lymphocyte ratio above 5 as associated with outcomes, although this has been shown in separate series. 31,32 Measurement of HV CTCs preoperatively by central venous catheterization is feasible but invasive and impractical for a single blood draw. We showed that features more readily measurable preoperatively are associated with HV CTCs.…”

Section: Discussionmentioning

confidence: 99%

Central, But Not Peripheral, Circulating Tumor Cells are Prognostic in Patients Undergoing Resection of Colorectal Cancer Liver Metastases

et al. 2015

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Background. Colorectal cancer liver metastases (CRLMs) are potentially curable with resection, but most patients recur and succumb to their disease. Clinical covariates do not account for all outcomes. Circulating tumor cells (CTCs) are prognostic in the primary and metastatic settings of breast, prostate and colorectal cancer (CRC), and evolving evidence supports their role in CRLMs. Our objective was to determine whether CTCs in peripheral (PV) and hepatic venous (HV) compartments are associated with disease-free survival (DFS) and overall survival (OS) post-CRLM resection. Methods. CTCs were measured by CellSearch assay from intraoperative HV and PV samples from 63 patients who underwent CRLM resection from June 2007 to August 2012 at a single center. DFS and OS were primary endpoints.Results. HV CTCs [ 3 were associated with shorter DFS and OS, but not PV CTCs, although no significant difference was found between CTC measurements in the two compartments. By univariate analysis, CRC stage and site, CRLM recurrence, and hepatic capsule invasion were also associated with OS, but only HV CTCs and CRC site were significant by multivariate Cox. Only HV CTCs were associated with DFS by multivariate analysis. Cases with elevated HV CTCs had hepatic vein invasion and lymph node metastases, and were younger with larger tumors. Conclusions. Elevated HV CTCs are prognostic for DFS and OS following CRLM resection. Clinicopathologic features associated with HV CTCs are identifiable preoperatively and should be considered in CRLM surgical decision making. We found no evidence that PV CTCs are prognostic in this setting.Approximately half of colorectal cancer (CRC) patients develop either synchronous or metachronous liver metastases (CRLMs), 15-20 % of which are amenable to curative-intent resection. 1 Five-year disease-free survival (DFS) and overall survival (OS) were \50 % following resection of isolated CRLMs. 1 Patient selection is poorly guided by clinical covariates 2,3 that do not accurately account for risk of recurrence and death in individual patients, 4 thus there is a need for novel biomarkers.Circulating tumor cells (CTCs) are malignant cells that have escaped from the primary or metastatic tumor site and gained access to the vasculature through intravasation. 5 CTC detection techniques can exploit CTC size, cell surface markers, secreted proteins, or microscopic appearance. CellSearch is the only FDA-approved technology for CTC detection. 6 Their adverse prognostic value in peripheral blood has been validated in the early and palliative settings in primary breast, 7 prostate 8 and primary CRC, 9,10 implying that CTCs may be of prognostic value in CRLMs. There are many retrospective series 11-23 and one meta-

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Preoperative Neutrophil-to-Lymphocyte Ratio is a Better Prognostic Serum Biomarker than Platelet-to-Lymphocyte Ratio in Patients Undergoing Resection for Nonmetastatic Colorectal Cancer

Abstract: High preoperative NLR in this series was shown to be a negative independent prognostic factor in patients undergoing surgical resection for nonmetastatic CRC. The prognostic utility of this serum biomarker may help to guide use of adjuvant therapies and patient counselling.

Cited by 82 publications

References 26 publications

C‑reactive protein/albumin and neutrophil/lymphocyte ratios and their combination predict overall survival in patients with gastric cancer

C‑reactive protein/albumin and neutrophil/lymphocyte ratios and their combination predict overall survival in patients with gastric cancer

The Neutrophil-to-Lymphocyte Ratio as a Marker of Lymph Node Status in Patients with Rectal Cancer

Central, But Not Peripheral, Circulating Tumor Cells are Prognostic in Patients Undergoing Resection of Colorectal Cancer Liver Metastases

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