Systemic inflammation, as measured by the neutrophil/lymphocyte ratio, may have differential prognostic impact before and during treatment with fluorouracil, irinotecan and bevacizumab in metastatic colorectal cancer patients

Abstract

The inflammatory index neutrophil/lymphocyte ratio (NLR) has an adverse prognostic value in patients with localized colorectal cancer (CRC). We aimed at evaluating its role in metastatic CRC (mCRC) patients treated with standard first-line chemotherapy. Among consecutive CRC patients referred to our Unit, those with metastatic disease eligible for treatment with fluorouracil, irinotecan and bevacizumab (FOLFIRI-Bev) were included in the study. NLR was routinely assessed before each treatment cycle and correlated with outcome together with common clinical, biochemical and histological variables. A sub-analysis focused on patients with stable disease (SD) was also performed to test the net influence of NLR changes independently of tumor shrinkage. At multivariate Cox regression analysis, baseline NLR, taken as continuous variable, was the most powerful prognosticator for survival (HR 1.80, p 0.0019). Surprisingly, among SD patients, the prognostic effect of NLR changes after two cycles of therapy was of opposite sign, and those in whom NLR increased or was maintained had a 67 % reduction in the risk of death as compared with patients with significant NLR decrease: mOS 56 versus 23 months, respectively, p 0.02. In conclusion, we were able to confirm the adverse prognostic value of high baseline NLR for mCRC patients treated with FOLFIRI-Bev. However, FOLFIRI-Bev-induced NLR changes in SD patients seem to differently affect survival. The specific molecular pathways involved in NLR modulation by FOLFIRI-Bev warrant further investigation.

The impact of marital status at diagnosis on cancer survival in patients with differentiated thyroid cancer

“…Chronic stress may elicit prolonged secretion of cortisol 29, which triggers a counter‐regulatory response of white blood cells by downregulating their cortisol receptors. This downregulation, in turn, reduces the cell capacity to respond to anti‐inflammatory signals and allows cytokine‐mediated inflammatory processes to flourish 30, which have been validated as poor prognostic factors in cancers 31, 32. Married persons may also enjoy greater financial resources than those who are widowed or divorced due to gains from economies of scale.…”

The Neutrophil-to-Lymphocyte Ratio as a Marker of Lymph Node Status in Patients with Rectal Cancer

“…The pre-treatment value of NLR has also shown predictive value in guiding treatment regimens: for example, Kim et al [32] reported a poor rate of pathological complete response in patients with high pre-treatment NLR, undergoing preoperative chemoradiotherapy for locally advanced rectal cancers. A high NLR may also indicate treatment resistance and poor survival in patients with primary, metastatic and advanced colorectal cancers [45,46,47]. The total number of lymph nodes retrieved during surgery depends on multiple factors and increases the likelihood of discovering nodal metastasis [48,49].…”

Neutrophil/lymphocyte ratio helps select metastatic pancreatic cancer patients benefitting from oxaliplatin

“…There was no imbalance in KPS between GEM and GEMOXA group (KPS 80 or 90 in 53% and 42% of patients, respectively, chi-square p value = 0.209). Median BMI at treatment start was 23 (range [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34].…”

“…Systemic inflammation is a process associated with a number of pathological conditions, such as metabolic disorders [16], atherosclerosis [17], osteoporosis [18] and cancer [19][20][21][22][23]. It might be considered as a doubleedged weapon in that it represents the first line immune defense but also a source of cytokines and growth factors with potentially adverse effects.…”