Neutrophil to lymphocyte ratio can predict overall survival in patients with stage II to III colorectal cancer

Abstract

The neutrophil-to-lymphocyte ratio (NLR) is a prognostic inflammatory marker in colorectal cancer (CRC), however, little is known for its prognostic role in stage II to III CRC patients underwent curative resection. This study was aimed to investigate prognostic role of NLR in stage II to III CRC patients underwent surgery. Medical records of 1378 newly diagnosed CRC patients between June 2006 and March 2020 were reviewed. Data were collected by using electronic medical record software. Survival rate were analyzed using the Kaplan–Meier method. The cutoff values of NLR in stage II to III CRC patients were defined by maximally selected log-rank statistics. Multivariable cox proportional-hazard models were performed to find risk factors associated with overall survival (OS) in stage II to III CRC patients underwent surgery. Among 1378 CRC patients enrolled, 910 patients underwent surgery. In entire surgical cohort, age, body mass index (BMI), CEA, carbohydrate antigen 19-9 (CA 19-9), lymphatic invasion, NLR, and albumin-to-globulin ratio (AGR) were found to be risk factors associated with OS (all P < .05). In stage II to III CRC patients underwent curative resection (n = 623), age, BMI, lymphatic invasion, AGR, and NLR were found to be risk factors associated with OS (all P < .05). In the multivariable analysis, CA 19-9 and lymphatic invasion were independent risk factors for OS in entire surgical cohort. In the multivariable analysis for the stage II to III CRC patients, age, BMI, lymphatic invasion and NLR (Hazard ratio = 2.41, 95% confidential interval [CI]: 1.04–5.595, P = .041) were independent risk factors for OS. NLR can be used as a clinically simple and useful parameter for predicting OS in stage II to III CRC patients undergoing curative resection, however, its optimal cutoff value should be further evaluated.

Screening value of methylated Septin9 and lymphocyte-to-monocyte ratio in colorectal cancer

“…[23] Cho et al found that a preoperative NLR over 3.15 is associated with poorer overall survival in patients with stage II to III CRC. [24] Another systematic review of 10,259 patients from 19 studies showed that NLR >5.0 was associated with poorer long-term survival in CRC patients. [22] Despite the difference in cutoff values, various studies have confirmed the correlation between the NLR and prognosis.…”

Personalized prediction of survival rate with combination of penalized Cox models in patients with colorectal cancer

“…We utilized Penalized and Unpenalized Cox models to assess individuals’ survival rates more than 5 years, based on the single hospital database for patients with CRC, which was published in 2023. [ 7 ] To enhance the depth and reliability of our performance evaluation, we developed and evaluated 100 individual ML models, while also focusing on improving interpretability to identify significant variables. We conducted thorough calculations to measure the individual’s survival probability more than 5 years for performance evaluation, and identified solutions to address challenges of the interpretability stemming from the black box nature of ML.…”

“…The database was a medical records of 1378 patients with CRC at a single university hospital between June 2006 and March 2020. [ 7 ] The detailed information about the generation of clinical data and covariates including demographics, blood tests, pathological findings, and immunochemical tests were described in our previous study. [ 7 ] This study followed the key questions for determining the appropriate model type in ML in medicine.…”

“…[ 7 ] The detailed information about the generation of clinical data and covariates including demographics, blood tests, pathological findings, and immunochemical tests were described in our previous study. [ 7 ] This study followed the key questions for determining the appropriate model type in ML in medicine. [ 8 ] This study was approved by the Institutional Review Board of the hospital (KHNMC IRB 2020-10-004), but informed consent was waived as it was reanalysis of previous publication.…”

“…[ 8 ] This study was approved by the Institutional Review Board of the hospital (KHNMC IRB 2020-10-004), but informed consent was waived as it was reanalysis of previous publication. [ 7 ]…”