The Role of Neutrophil-to-lymphocyte Ratio on the Effect of CRT for Patients With Rectal Cancer

Abstract

Background/Aim: Neutrophil-to-lymphocyte ratio (NLR) is an indicator of systemic inflammation and could be a predictive factor in malignant tumors. The aim of this study was to investigate the impact of NLR in patients with lower rectal cancer who received preoperative chemo-radiotherapy (CRT). Patients and Methods: Forty-eight patients with lower rectal cancer who underwent preoperative CRT and curative resection were enrolled. Blood samples were obtained before and after CRT. The relationship of NLR with clinical outcome was investigated. Results: Post-CRT NLR was higher compared to pre-CRT NLR. The patients with higher post-CRT NLR tended to have worse pathological response to CRT compared to those with low post-CRT NLR. The patients with high post-CRT NLR showed poorer 5-year overall survival and 3-year disease free survival while there was no correlation according to pre-CRT NLR. The univariate analysis showed that post-CRT stage and post-CRT NLR were associated with a poorer 5-year overall survival. Conclusion: NLR after preoperative CRT could be a potential prognostic indicator for patients with lower rectal cancer. Patients and MethodsPatients. Forty-eight patients newly diagnosed with lower RC who underwent CRT at the Department of Surgery in Tokushima University Hospital between 2004 and 2012 were enrolled in this study. The study protocol was approved by the Tokushima University Hospital Institutional Ethics Committee and informed consent was obtained from all the participating patients. The patients' clinical data, including medical history, physical examination, laboratory analysis and clinical staging were retrospectively reviewed from the medical records. Blood examinations for pre-CRT and post-CRT were 863

Systemic inflammation-based predictors of pathological response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer patients: A propensity score matching analysis

“…Therefore, it is possible to predict tumor response by NLR, PLR and MLR after CRT. Caputo and Ishikawa have suggested that NLR > 3.80 and 3.85 after CRT are predictors of poor tumor response (12,28). However, no relationship between hematological factors and tumor response after CRT was observed in our study, which may be related to the uncontrolled factors that affect the systemic in ammatory response in the case enrollment phase.…”

“…Local and systemic in ammatory response is an important prognostic factor for colorectal cancer patients (10). In recent years, several studies have paid more attention on systemic in ammatory response indicators for predicting the prognosis of rectal cancer after CRT (11)(12)(13). In particular, neutrophil-lymphocyte-ratio (NLR), monocytelymphocyte-ratio (MLR) and platelet-lymphocyte-ratio (PLR) are considered as prognostic biomarkers for patients with rectal cancer (13)(14)(15)(16).…”

“…Some studies have suggested that pre-CRT NLR and PLR, or NLR alone are independently related to tumor response (17,18). Ishikawa et al have suggested that NLR after CRT is more meaningful than that before treatment (12). Whereas Shen et al reveled no statistical signi cance between hematologic parameters and tumor response (19).…”

Lymphocyte to C-reactive protein ratio predicts long-term outcomes for patients with lower rectal cancer

“…Previous reports have demonstrated that various combinations of systemic inflammatory markers (e.g., serum C-reactive protein [CRP]), nutritional markers (total serum protein, serum albumin), and immune markers (neutrophil count, platelet count, and total lymphocyte count [TLC]), can be used to generate predictive indexes such as the lymphocyte to CRP ratio (LCR), neutrophil to lymphocyte ratio (NLR), prognostic nutritional index (PNI, based on serum albumin and TLC), CRP to albumin ratio, and Glasgow prognostic score (based on serum albumin and CRP) [ 4 – 13 ]. We previously reported that post-CRT NLR correlated with overall survival (OS) after surgery in patients with lower RC [ 9 ], highlighting the potential prognostic utility of such combination marker indexes.…”

Prognostic implications of lymphocyte/C-reactive protein ratio with tumor-infiltrating lymphocytes in resected intrahepatic cholangiocarcinoma

“…Various combinations of blood test indicators have been studied in recent years as prognostic indicators for cancer patients, including the neutrophil/lymphocyte ratio (NLR) [3,4], Modi ed Glasgow Prognostic Score (mGPS) [5,6], and the Prognostic Nutrition Index (PNI) [7,8], among others. These combinations can represent systemic in ammation, immune function, and/or nutritional status.…”