Prognostic Impact of the Neutrophil-to-Lymphocyte and Lymphocyte-to-Monocyte Ratio, in Patients with Rectal Cancer: A Retrospective Study of 1052 Patients

Abstract

Despite the description of several new prognostic markers, colorectal cancer still represents the third most frequent cause of cancer-related death. As immunotherapy is considered a therapeutic alternative in such patients, neutrophil-to-lymphocyte (NLR) and lymphocyte-to-monocyte ratio (LMR) are hypothesized to provide reliable prognostic information. A retrospective study was conducted on 1052 patients operated on during 2013–2019 in two clinical hospitals from Hungary and Romania. Inclusion criteria targeted patients over 18 years old, diagnosed with rectal cancer, with preoperatively defined NLR and LMR. The overall survival rate, along with clinical and histopathological data, was evaluated. Overall survival was significantly associated with increased NLR (p = 0.03) and decreased LMR (p = 0.04), with cut-off values of 3.11 and 3.39, respectively. The two parameters were inversely correlated (p < 0.0001). There was no statistically significant association between tumor stage and NLR or LMR (p = 0.30, p = 0.06, respectively). The total mesorectal excision was especially obtained in cases with low NLR (p = 0.0005) and high LMR (p = 0.0009) values. A significant association was also seen between preoperative chemoradiotherapy and high NLR (p = 0.0001) and low LMR (p = 0.0001). In patients with rectal cancer, the preoperative values of NLR and LMR can be used as independent prognostic parameters. An NLR value of ≥3.11 can be used to indicate the response to preoperative chemoradiotherapy, but a low chance of sphincter preservation or obtaining a complete TME. Higher values of NLR and lower values of LMR require a more attentive preoperative evaluation of the mesorectum.

Prognostic Significance of NLR, PLR, LMR and Tumor Infiltrating T Lymphocytes in Patients Undergoing Surgical Resection for Hilar Cholangiocarcinoma

“…Similar conclusions were reached by Simone Conci et al in patients with biliary tract tumors (21).The prognostic value of LMR had also been demonstrated in other malignancies, such as hepatocellular carcinoma, lung cancer, colorectal cancer, etc. (22)(23)(24).This study also discovered that patients in the high NLR group or low LMR group had a worse survival prognosis. However, only LMR was identified as independent prognostic markers even in multivariate analysis for OS.…”

Biomarkers and cell-based models to predict the outcome of neoadjuvant therapy for rectal cancer patients

“…Moreover, patients with high P/L ratio had a significantly worse 5-year disease-free survival, and stage II and III patients with high N/L ratio had worse 5-year disease-free survival and overall survival. Yet, another study didn't find any correlation with N/L or P/L ratios and survival [77], and a recently published retrospective study of 1052 rectal cancer patients [78] showed that an N/L ratio above 3.1 was significantly associated with increased overall survival.…”

“…Immunological markers Blood-based immunological markers [72][73][74][75][76][77][78][79][80][81][82][83][84][85][86] The MAPK/ERK and PI3K/AKT/mTOR signaling pathways Both the MAPK/ERK and the PI3K/AKT/mTOR signaling pathways are involved in many and diverse intracellular functions within the cell and can among other things lead to proliferation, differentiation and apoptosis [22,23]. These two pathways have in common that they can be initiated by tyrosine kinase receptor signalling, such as by the epidermal growth factor receptor (EGFR).…”

Prognostic Impact of An Integrative Landscape of Clinical, Immune, and Molecular Features in Non-Metastatic Rectal Cancer

“…Consistently, RC cluster 2 tumors showed elevated NPS compared with cluster 1 tumors. NPS is a systemic inflammatory response marker that was significantly associated with a worse CRT response (Supplementary Table 2) and has been described in different CRC series independently of TNM, although it has not yet been prospectively validated (73,74). It is noteworthy that the higher relative values of circulating neutrophils in poor responders (reflected by a higher NPS) and its association with poor survival have been related to neutrophils' capability to remodel the tumor microenvironment towards a more favorable immunoresistant profile (75).…”