The association of the neutrophil–lymphocyte ratio with the presence of minimal residual disease and outcome in patients with Stage II colon cancer treated with surgery alone

Abstract

Aim: Despite curative surgery, 25% of patients with Stage II colorectal cancer will relapse due to minimal residual disease (MRD). Markers of immune function, such as the neutrophil to lymphocyte ratio (NLR), may be associated with MRD defined by bone marrow micro-metastasis (mM) and circulating tumour cells (CTCs). Method: A prospective cohort study of consecutive patients with Stage II colon cancer patients attended at a single centre between 2007 and 2014. Blood and bone marrow samples were taken to detect CTCs and mM using immunocytochemistry with anticarcinoembryonic antigen 1 month after surgery. The NLR and absolute neutrophil and lymphocyte counts were determined immediately pre-surgery and 1 month post-surgery. These were compared with the sub-types of MRD: group I MRD(−); group II mM positive and group III CTC positive. Cut-off values of the NLR of >3.0 and >5.0 were used. Follow-up was for up to 5 years or relapse and disease-free survival (DFS) was calculated using Kaplan-Meier analysis. Results: In all, 181 patients (99 women) participated. Mean age was 68 years. Median follow-up was 4.04 years: I, N = 105; II, N = 36; III, N = 40. The NLR significantly decreased post-surgery only in group I patients. The frequency of NLR >3.0 and >5.0 was significantly higher in group III; between groups I and II there was no significant difference.5-year DFS was 98% in group I, 68% in group II and 7% in group III.Conclusions: Patients with a significantly higher immune dysfunction had a shorter time to disease progression, a worse DFS and the presence of CTCs.

Improvement in immune dysfunction after FOLFOX chemotherapy for Stage III colon cancer is associated with improved minimal residual disease prognostic subtype and outcome

“…There was no significant difference in the frequency of LCP between patients in Group I and II before chemotherapy. This is similar to the results reported in Stage II colon cancer after curative resection [41] and in Stage III patients treated with chemotherapy [9,10]. In Group III patients neither the ALC nor the frequency of LCP predicted improvement of MRD subtype and outcome after chemotherapy, which differs from other reports [12]; this suggests that the biological properties of the tumour cells may play an important role.…”

“…With respect to MRD in both Stage II and Stage III colon cancer, two subtypes have been described; patients with CTCs have a worse prognosis and shorter time to treatment failure while those with only bone marrow micrometastases are at risk of late failure [21,22]. Although bone metastases in colon cancer are infrequent, bone marrow micrometastases have been reported in up to 30% of patients with nonmetastatic colon cancer and have been reported to be an independent prognostic factor [23].…”

Evaluation of Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio on Predicting Responsiveness to Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer Patients

“…NLR and PLR have been suggested as potential prognostic biomarker in multiple cancers [9]. The correlations between immunologic biomarkers including NLR and PLR and the prognosis in colorectal cancer patients have also been reported [10][11][12][13][14][15]. However, there seem to be conflicting results that whether NLR and PLR can serve as effective prognostic predictor in rectal cancer [12,16].…”

Is Laparoscopic Complete Mesocolic Excision and Central Vascular Ligation Really Necessary for All Patients With Right-Sided Colon Cancer?

“…Additional analyses, such as immunofluorescence staining and RT-PCR, require a large amount of medical resources. Some studies show contradictory results about patient’s prognoses with isolated tumor cells [ 71 ]. This is likely to be the result of a change in the level of oncological threat posed by the isolated tumor cells according to the patient’s immune response, rather than the therapeutic effect of micrometastasis resection itself [ 72 ].…”