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

Abstract

Introduction: In locally advanced rectal cancers (LARC), TNM staging is far from optimal. We aimed to investigate the value of previously described circulating biomarkers as predictors of prognosis. Methods: Retrospective analysis of 245 LARC patients diagnosed between January 2010 and December 2022, who underwent neoadjuvant chemoradiotherapy and surgery at two centers. A Cox regression and Kaplan-Meier analysis were performed. Results: Posttreatment platelet-to-lymphocyte ratio (PLR) predicted pCR. Neutrophil-to-lymphocyte ratio (NLR) in two timepoints of the treatment significantly predicted overall survival, whereas platelet-neutrophil (PN) index significantly predicted disease-free survival. In pathological stage II, PN index predicted patients of higher risk of disease-free survival. Conclusion: Blood parameters might allow the definition of subgroups of risk, beyond TNM, for the application of different therapeutic strategies.