Elevated Neutrophil to Lymphocyte Ratio Predicts Poor Prognosis in Advanced Colorectal Cancer Patients Receiving Oxaliplatin-Based Chemotherapy

Abstract

Background: The aim of this study was to assess whether the neutrophil to lymphocyte ratio (NLR) and other laboratory markers may predict the prognosis of advanced colorectal cancer (CRC) patients receiving palliative chemotherapy. Methods: The study population included50 patients with far advanced or recurrent unresectable CRC who received oxaliplatin-based combination chemotherapy as first-line treatment in our hospital between June 2005 and November 2010. Seven clinical variables and 7 laboratory indices before chemotherapy were evaluated retrospectively as the possible prognostic factors of overall and progression-free survival. Results: During the study period, 27 patients (54%) died of CRC. Elevated NLR (≥4.0) was observed in 15 patients (30%). By univariate analysis, elevated NLR, performance status and hypoalbuminemia were significantly associated with both poor overall and progression-free survivals. Multivariate analysis showed that elevated NLR (hazard ratio 4.39, 95% confidence interval 1.82–10.7; p = 0.0013) and thrombocytosis (hazard ratio 5.02, 95% confidence interval 1.69–13.4; p = 0.0066) were independently associated with overall survival. Conclusion: Elevated NLR is a powerful predictor of poor response to oxaliplatin-based chemotherapy in patients with unresectable CRC. The ratio is a simply accessible and inexpensive but useful biomarker in CRC patients receiving chemotherapy.

Functio Laesa: Cancer Inflammation and Therapeutic Resistance

“…The NLR has also been shown to predict outcomes in patients with advanced colorectal cancer who are receiving chemotherapy, and it has been used as a predictor of tumor recurrence and progression. 9,10 However, the prognostic potential of the NLR may not apply to all therapeutic scenarios. For example, in an unplanned secondary analysis of patients with muscle-invasive bladder treated in a randomized phase III study with or without neoadjuvant chemotherapy, the NLR was not found to be prognostic of overall survival benefit from neoadjuvant chemotherapy.…”

Association of peripheral blood cell count-derived ratios, biomarkers of inflammatory response and tumor growth with outcome in previously treated metastatic colorectal carcinoma patients receiving cetuximab

“…From these, six with initial CEA higher than 5 μg/L and an increase of more than 10% were considered as surge. The median increase of CEA concentration of 22.6% (range 10.6-56.8%) was observed after a median seven (range [6][7][8][9][10][11][12][13][14] days.…”

“…However, it has been demonstrated during the past few years that relative lymphocyte numbers in the peripheral blood expressed as a ratio to other blood elements are also a powerful biomarker predictive of patient prognosis, again across a range of tumor types. Neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR) and systemic inflammatory index (SII) have been shown to predict outcome in different solid tumors, including colorectal carcinoma [7][8][9][10][11][12][13][14][15].…”

Glasgow Prognostic Score predicts prognosis of intrahepatic cholangiocarcinoma

“…These include the Glasgow Prognostic Score (GPS), which is based on serum CRP and albumin levels (22)(23)(24)(25)(26)(27)(28), neutrophil-to-lymphocyte ratio (NLR) (29,30), platelet-to-lymphocyte ratio (31,32), prognostic nutritional index (33,34), and prognostic index (34,35).…”