Meta-Analysis on the Neutrophil-Lymphocyte Ratio in Rectal Cancer Treated With Preoperative Chemoradiotherapy: Prognostic Value of Pre- and Post-Chemoradiotherapy Neutrophil-Lymphocyte Ratio

Abstract

BackgroundTo evaluate the prognostic value of neutrophil-lymphocyte ratio (NLR) in rectal cancer patients treated with preoperative chemoradiotherapy (CRT) and curative surgery.MethodsA comprehensive search of the EMBASE and PubMed databases was performed to screen studies that compared treatment outcomes according to the pre-CRT and/or post-CRT NLR in patients receiving preoperative CRT and curative surgery for locally advanced rectal cancer. Hazard ratios (HRs) for disease-free survival (DFS) and/or overall survival (OS) were extracted, and a random-effects model was used for pooled analysis.ResultsTotally, 22 retrospective studies comprising 6316 patients were included. Preoperative CRT was administered with concurrent chemotherapy (mostly fluoropyrimidine-based regimens). The elevated pre-CRT NLR was significantly associated with an increased risk of recurrence (HR, 1.54; 95% confidence interval [CI], 1.31-1.81) and death (HR, 2.14; 95% CI, 1.61-2.84). Post-CRT NLR was reported in only 3 of 22 studies, and the correlation was not statistically significant for recurrence (HR, 1.44; 95% CI, 0.86-2.41) or death (HR, 2.38; 95% CI, 0.94-6.07).ConclusionsElevated pre-CRT NRL, but not post-CRT NRL, is associated with inferior DFS and OS. Further studies are needed to confirm the prognostic value of NLR in rectal cancer patients receiving preoperative CRT.

Prognostic value of neutrophil-to-lymphocyte ratio (NLR) and platelet-neutrophil (PN) index in locally advanced rectal cancer patients: a retrospective cohort study

“…Here, we have found an association between worse OS and NLR, an integrated index based on peripheral neutrophils and lymphocytes. The value of NLR in the prognosis of rectal cancer has been extensively described previously 25 , although these results should be read with caution since a large-scale study of 1237 patients could not confirm the prognostic or predictive value of NLR or PLR 26 . Nevertheless, in our study, this score performed better than other scores described in the literature, such as PLR, LMR and SII 27 .…”

Implications of Rectal Cancer Radiotherapy on the Immune Microenvironment: Allies and Foes to Therapy Resistance and Patients’ Outcome

“…Furthermore, the neutrophil-to-lymphocyte ratio (NLR) has gained attention in recent years as prognostic marker for rectal cancer [126][127][128], which underlines the important role of neutrophils in anti-tumor immunity. Recently, a meta-analysis revealed that elevated NLR before CRT, but not after CRT, is associated with poorer prognosis [126]. Nonetheless, the prognostic impact of intratumoral neutrophils in rectal cancer remains uncertain [129][130][131][132].…”

“…High neutrophil blood counts were shown to be associated with worse survival of rectal cancer patients [125]. Furthermore, the neutrophil-to-lymphocyte ratio (NLR) has gained attention in recent years as prognostic marker for rectal cancer [126][127][128], which underlines the important role of neutrophils in anti-tumor immunity. Recently, a meta-analysis revealed that elevated NLR before CRT, M1, which is characterized as immune-activating, anti-tumorigenic and M2 with immunosuppressive, pro-tumorigenic properties.…”

Prognostic Significance of Neutrophil-to-Lymphocyte Ratio in Predicting Complete Pathological Response in Rectal Cancer Patients Receiving Neoadjuvant Chemoradiotherapy

“…Various studies have demonstrated that the neutrophil-to-lymphocyte ratio (NLR), a hematologic inflammatory marker, could be a predictive marker for oncological outcomes and response to neoadjuvant chemoradiotherapy (nCRT) in patients with rectal cancer [ 6 – 9 ]. In a recent meta-analysis of 22 studies comprising 6316 patients, elevated pre-nCRT NLR was found to be strongly associated with worse treatment outcomes in patients with rectal cancer [ 10 ]. Although many studies have explored the correlation between NLR and outcome, few have examined the relationship between NLR and pathologic responses.…”