Pre-operative Neutrophils/Lymphocyte Ratio in Rectal Cancer Patients with Preoperative Chemoradiotherapy

Abstract

Background:Several studies have reported that an elevation in neutrophils/lymphocyte ratio (NLR) is correlated with poor survival in patients with colorectal cancer, but in rectal cancer (RC), it has been reported only in a few studies. It is necessary to separate colon cancer and rectal cancer to clarify the prognostic significance of NLR, especially in patients who received chemoradiotherapy.Methods:It is a comparative, observational retrospective study of a cohort of 175 patients. We grouped the patients into two based on their NLR (0-3 vs. > 3) to correlate with disease-specific survival (DSS) and pathologic complete response (pCR).Results:The average NLR was 2.65 + 1.32 (range 0.58-6.89), and 144 (82.3%) patients had an NLR of 0-3. The median follow-up was 33.53 months. There were no differences in pCR between the two groups. The 5-year DSS was 78.8%. NLR did not correlate with survival. Mesorectal quality, pT3-4 tumors, lymph node metastasis, lymphovascular invasion, perineural invasion, positive margins and recurrence were statistically significant predictors of increased mortality in univariate analysis. In multivariate analysis, only overall recurrence correlated with poor survival. The analysis of the association of NLR with outcomes with different cut points (2.0, 2.5, 4 and 5) did not show differences in DSS and pCR.Conclusion:In our cohort, the NLR did not serve as a prognostic marker in patients with locally advanced rectal cancer and who received chemoradiotherapy and did not correlate with pCR as well.

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

“…In the ROC analysis, we failed to identify an appropriate cut-off value because the area under the curve for NLR was 0.555 [95% confidence interval (CI), 0.467–0.642; P=0.223] for the 3-year OS and 0.558 (95% CI, 0.477–0.638; P=0.159) for the 3-year DFS. Finally, an NLR ≥3.0 was considered as elevated NLR on the basis of previous studies [ 20 , 21 ]. There were 63 (31.2%) patients with NLR ≥3.0 and 139 (68.8%) patients with NLR <3.0.…”

“…We did not find an association of NLR with OS (HR, 1.066; 95% CI, 0.681–1.668; P=0.779) or DFS (HR, 0.863; 95% CI, 0.536–1.390; P=0.542) using 3.0 as a cut-off value ( Figures 1 , 2 ). Furthermore, we repeated survival analyses using different cut-off values (2.0 [ 21 ] and 4.0 [ 22 ]) and again did not find an association between NLR and survival outcomes.…”

“…Leonardo et al reviewed a cohort of 175 patients, and analyzed the association between NLR and survival outcomes using different cut-off values (2.0, 2.5, 3.0, 4.0, and 5.0). The results did not show differences in disease-specific survival, recurrent-free survival, or pCR [ 21 ]. In our present study, we also found no association of the NLR with either OS or DFS.…”

The clinical use of the platelet/lymphocyte ratio and lymphocyte/monocyte ratio as prognostic predictors in colorectal cancer: a meta-analysis

“…Recent studies [ 49 – 51 ] have shown correlation between the SIR and clinical outcomes in various cancers; However, conflicting evidence exists regarding the effects of PLR and LMR on the prognosis of CRC patients. In this meta-analysis of 33 studies which includes 15,404 cases, we reevaluated the prognostic roles of the PLR and LMR in CRC.…”

Prognostic impact of persistent lower neutrophil-to-lymphocyte ratio during preoperative chemoradiotherapy in locally advanced rectal cancer patients: A propensity score matching analysis

“…Lino-Silva and colleagues reported that there were no differences in survival outcomes or pCR rate according to NLR cut-off point (2.0, 2.5, 4, and 5) in 175 patients who underwent preop-CRT. [ 26 ] Shen and colleagues also reported that NLR measured in pre-CRT did not predict OS or disease-free survival (DFS) in patients with locally advanced rectal cancer who underwent preop-CRT. [ 27 ] Jung et al reported that NLR measured before commencement of preop-CRT could not discriminate recurrence-free survival (p = 0.07) among 984 patients who underwent preop-CRT.…”