Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Locally Advanced Rectal Cancer Treated with Neoadjuvant Chemoradiotherapy

Abstract

BackgroundIncreasing evidence suggests that cancer-associated inflammation is associated with poorer outcomes. The neutrophil-to-lymphocyte ratio (NLR), considered as a systemic inflammation marker, is thought to predict prognoses in colorectal cancer. In this study, we explored the association between the NLR and prognoses following neoadjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC).Material/MethodsFrom February 2002 to December 2012, a group of 202 patients diagnosed with LARC and receiving neoadjuvant CRT followed by radical surgery was included in our retrospective study. The associations between the pre-CRT NLR and clinicopathological characteristics, as well as the predictive value of pre-CRT NLR against survival outcomes, were analyzed.ResultsThe average NLR was 2.7±1.5 (median 2.4, range 0.6–12.8). There were 63 (31.2%) patients with NLR ≥3.0, and 139 (68.8%) patients with NLR <3.0. Correlation analyses showed that no clinicopathological characteristics except age were associated with NLR. We did not find an association between NLR and survival outcomes. In multivariate Cox model analyses, the R1/R2 resection, lymph node ratio ≥0.1, and perineural/lymphovascular invasion were independently associated with worse disease-free survival and overall survival.ConclusionsIn our cohort, the NLR did not correlate with survival outcomes in LARC patients undergoing neoadjuvant CRT. The prognostic value of NLR should be validated in large-scale prospective studies.

The Impact of Neutrophil to Lymphocytic Ratio (NLR) as a Predictor of Treatment Outcomes in Rectal Carcinomas: A Retrospective Cohort Study

“…Jinwen Shen et al [17] defined the cutoff value of NLR in their study to be 2.7 ± 1.5 and they found that it didn't correlate with any clinico-pathologic characteristics except age; furthermore it didn't correlate with any survival outcomes, our results didn't come into alignment with that of Jinwen Shen possibly as this study dealt with those patients with locally advanced cancer rectum only who were decided to be treated with neoadjuvant CRT.…”

Cancer Inflammation and Cytokines

“…Several studies have evaluated the prognostic and predictive value of neutrophil-to-lymphocyte ratio (NLR) in peripheral blood of cancer patients. NLR is commonly used as a measure of systemic inflammation, and it has been shown to predict patient clinical outcome in a number of human cancers, such as rectal (Shen et al 2017), esophageal (Nakamura et al 2017), prostate (Gokce et al 2016), pancreatic (Kadokura et al 2016), and breast cancer (Ethier et al 2017). Overall, a high NLR score was associated with worse survival and retained a more consistent prognostic value among patients with an advanced disease stage, who are also more likely to receive chemotherapy treatments or who are not operable (Guthrie et al 2013).…”

Roles of neutrophils in cancer growth and progression

“…Several studies have evaluated the prognostic and predictive value of neutrophil‐to‐lymphocyte ratio (NLR) in peripheral blood of cancer patients. NLR is considered an indicator of systemic inflammation and predicted patient clinical outcome in several human cancers, such as rectal, esophageal, prostate, pancreatic, and breast cancer . Moreover, a high NLR score was associated with worst survival and displayed a more consistent prognostic value among patients with advanced disease .…”