Neutrophil to Lymphocyte Ratio: A Predictive Marker for Treatment Outcomes in Patients With Rectal Cancer Who Underwent Neoadjuvant Chemoradiation Followed by Surgery

Abstract

Purpose In this study, we investigated the role of neutrophil to lymphocyte ratio (NLR) as a predictor of tumor response and as a prognostic factor in patients with rectal cancer who had undergone curative surgery after neoadjuvant chemoradiation therapy (nCRT). Methods Between January 2009 and July 2016, we collected 140 consecutive patients who had undergone curative intent surgery after nCRT due to rectal adenocarcinoma. We obtained the pre- and post-nCRT NLR by dividing the neutrophil count by the lymphocyte count. The cutoff value was obtained using receiver operating characteristic analysis for tumor response and using maximally selected rank analysis for recurrence-free survival (RFS). The relationship among NLR, tumor response, and RFS was assessed by adjusting the possible clinico-pathological confounding factors. Results The possibility of pathologic complete response (pCR) was significantly decreased in high pre- (>2.77) and postnCRT NLR (>3.23) in univariate regression analysis. In multivariate analysis, high post-nCRT NLR was an independent negative predictive factor for pCR (adjusted odds ratio, 0.365; 95% confidence interval [CI], 0.145–0.918). The 5-year RFS of all patients was 74.6% during the median 37 months of follow-up. Patients with higher pre- (>2.66) and post-nCRT NLR (>5.21) showed lower 5-year RFS rates (53.1 vs. 83.3%, P = 0.006) (69.2 vs. 75.7%, P = 0.054). In multivariate Cox analysis, high pre-nCRT NLR was an independent poor prognostic factor for RFS (adjusted hazard ratio, 2.300; 95% CI, 1.061–4.985). Conclusion Elevated NLR was a negative predictive marker for pCR and was independently associated with decreased RFS. For confirmation, a large-scale study with appropriate controls is needed.

Neutrophil-to-Lymphocyte Ratio is a Prognostic Predictive Factor for Local Advanced Lower Rectal Cancer Treated with Curative Surgical Treatment after Neoadjuvant Chemoradiotherapy: A Single-Center Retrospective Cohort Study

“…Various cutoff values have been used to de ne elevated NLR in previous studies. Although some studies used cutoff values calculated by statistical methods, the reported NLR cutoff values on patients with rectal cancer who underwent nCRT are inconsistent [27][28][29][30]. In this study, a cut-off value of 3.20 for the pre-CRT NLR was signi cantly related to RFS.…”

High Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Low Lymphocyte Levels Are Correlated With Worse Pathological Complete Response Rates

“…NLR consists of a combination of neutrophils and lymphocytes, and anti-tumor activity and activation of the inflammatory response impact this ratio [ 30 , 31 ]. Low NLR levels are associated with higher tumor response [ 30 , 32 ]. Like NLR, PLR is also a considerable marker of the inflammatory response, and anti-tumor efficacy and treatment response is better at low PLR levels in locally advanced rectal cancer [ 17 , 29 ].…”

Predictive Ability of Neutrophil-Lymphocyte Ratio in Determining Tumor Staging in Colorectal Cancer

“…There have been numerous other studies that have utilized NLR to assess prognostic outcome in colorectal cancer. Jeon BH et al [15] used NLR to assess predictive outcomes in patients with rectal cancer who underwent chemotherapy followed by surgery and found that preoperative elevated NLR was independently associated with decreased five-year disease-free survival. Mazaki J et al [16] and Dell'Aquila E et al [17] showed that an elevated NLR is an important prognostic marker in advanced colorectal disease.…”