Advertisement

International Journal of Colorectal Disease

, Volume 25, Issue 12, pp 1427–1433 | Cite as

Elevated preoperative neutrophil to lymphocyte ratio predicts risk of recurrence following curative resection for stage IIA colon cancer

  • Pei-Rong Ding
  • Xin An
  • Rong-Xin Zhang
  • Yu-Jing Fang
  • Li-Ren Li
  • Gong Chen
  • Xiao-Jun Wu
  • Zhen-Hai Lu
  • Jun-Zhong Lin
  • Ling-Heng Kong
  • De-Sen Wan
  • Zhi-Zhong PanEmail author
Original Article

Abstract

Background and Objectives

Adjuvant chemotherapy for stage II colon cancer remains controversial but may be considered for patients with high-risk features. Recent studies have shown that elevated neutrophil to lymphocyte ratio (NLR) is a worse prognostic factor and a predictor of response to chemotherapy in patients with advanced colorectal cancer. The purpose of this study was to evaluate whether NLR predicts risk of recurrence in patients with stage IIA colon cancer undergoing curative resection without adjuvant chemotherapy.

Methods

We retrospectively reviewed 141 consecutive patients with stage IIA colon cancer treated with curative surgery alone from 2002 to 2006. NLR, as well as demographics, clinical, histopathologic, and laboratory data were analyzed. Univariate and multivariate analyses were conducted to identify prognostic factors associated with recurrent-free survival (RFS).

Results

Cox’s regression analysis demonstrated that elevated NLR (>4) (hazard ratio, 4.88; P < 0.01) and less lymph node sampling (<15 lymph nodes; hazard ratio, 3.80; P < 0.05) were adverse prognostic factors for RFS. The 5-year RFS was 91.4% (95% CI, 88.6–94.2%) for patients with normal NLR and 63.8% (51.1–76.3%) for patients with elevated NLR. The 5-year RFS for patients with 0, 1, and 2 of the identified risk factors was 95.1%, 87.4%, and 33.3%, respectively (P < 0.001).

Conclusions

Elevated preoperative NLR is an independent predictor of worse RFS for patients with stage IIA colon cancer and a potential biomarker to identify candidates for adjuvant chemotherapy.

Keywords

Neutrophil to lymphocyte ratio Colon cancer Stage IIA 

Notes

Acknowledgements

The authors would like to acknowledge Jie-Rong Wang, Feng Gan and Chao-Feng Li for acquisition of data.

References

  1. 1.
    Gill S, Loprinzi CL, Sargent DJ, Thome SD et al (2004) Pooled analysis of fluorouracil-based adjuvant therapy for stage II and III colon cancer: who benefits and by how much? J Clin Oncol 22(10):1797–1806CrossRefPubMedGoogle Scholar
  2. 2.
    Quasar Collaborative G, Gray R, Barnwell J, McConkey C et al (2007) Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study. Lancet 370(9604):2020–2029CrossRefGoogle Scholar
  3. 3.
    Schippinger W, Samonigg H, Schaberl-Moser R, Greil R et al (2007) A prospective randomised phase III trial of adjuvant chemotherapy with 5-fluorouracil and leucovorin in patients with stage II colon cancer. Br J Cancer 97(8):1021–1027CrossRefPubMedGoogle Scholar
  4. 4.
    Cianchi F, Messerini L, Comin CE, Boddi V et al (2007) Pathologic determinants of survival after resection of T3N0 (Stage IIA) colorectal cancer: proposal for a new prognostic model. Dis Colon Rectum 50(9):1332–1341CrossRefPubMedGoogle Scholar
  5. 5.
    Benson AB, Schrag D, Somerfield MR, Cohen AM et al (2004) American society of clinical oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol 22(16):3408–3419CrossRefPubMedGoogle Scholar
  6. 6.
    Walsh SR, Cook EJ, Goulder F, Justin TA et al (2005) Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol 91(3):181–184CrossRefPubMedGoogle Scholar
  7. 7.
    Halazun KJ, Aldoori A, Malik HZ, Al-Mukhtar A et al (2008) Elevated preoperative neutrophil to lymphocyte ratio predicts survival following hepatic resection for colorectal liver metastases. Eur J Surg Oncol 34(1):55–60PubMedGoogle Scholar
  8. 8.
    Kishi Y, Kopetz S, Chun YS, Palavecino M et al (2009) Blood neutrophil-to-lymphocyte ratio predicts survival in patients with colorectal liver metastases treated with systemic chemotherapy. Ann Surg Oncol 16(3):614–622CrossRefPubMedGoogle Scholar
  9. 9.
    American Joint Committee on Cancer (2002) AJCC cancer staging manual, 6th edn. Springer-Verlag, New YorkGoogle Scholar
  10. 10.
    O’Connell JB, Maggard MA, Ko CY (2004) Colon cancer survival rates with the new American joint committee on cancer sixth edition staging. J Natl Cancer Inst 96(19):1420–1425CrossRefPubMedGoogle Scholar
  11. 11.
    Sarraf KM, Belcher E, Raevsky E, Nicholson AG et al (2009) Neutrophil/lymphocyte ratio and its association with survival after complete resection in non-small cell lung cancer. J Thorac Cardiovasc Surg 137(2):425–428CrossRefPubMedGoogle Scholar
  12. 12.
    Cho H, Hur HW, Kim SW, Kim SH et al (2009) Pre-treatment neutrophil to lymphocyte ratio is elevated in epithelial ovarian cancer and predicts survival after treatment. Cancer Immunol Immunother 58(1):15–23CrossRefPubMedGoogle Scholar
  13. 13.
    Gomez D, Morris-Stiff G, Toogood GJ, Lodge JP et al (2008) Impact of systemic inflammation on outcome following resection for intrahepatic cholangiocarcinoma. J Surg Oncol 97(6):513–518CrossRefPubMedGoogle Scholar
  14. 14.
    Gomez D, Farid S, Malik HZ, Young AL et al (2008) Preoperative neutrophil-to-lymphocyte ratio as a prognostic predictor after curative resection for hepatocellular carcinoma. World J Surg 32(8):1757–1762CrossRefPubMedGoogle Scholar
  15. 15.
    Gal R, Sadikov E, Sulkes J, Klein B et al (2004) Deleted in colorectal cancer protein expression as a possible predictor of response to adjuvant chemotherapy in colorectal cancer patients. Dis Colon Rectum 47(7):1216–1224CrossRefPubMedGoogle Scholar
  16. 16.
    Dotor E, Cuatrecases M, Martinez-Iniesta M, Navarro M et al (2006) Tumor thymidylate synthase 1494del6 genotype as a prognostic factor in colorectal cancer patients receiving fluorouracil-based adjuvant treatment. J Clin Oncol 24(10):1603–1611CrossRefPubMedGoogle Scholar
  17. 17.
    Westra JL, Schaapveld M, Hollema H, de Boer JP et al (2005) Determination of TP53 mutation is more relevant than microsatellite instability status for the prediction of disease-free survival in adjuvant-treated stage III colon cancer patients. J Clin Oncol 23(24):5635–5643CrossRefPubMedGoogle Scholar
  18. 18.
    Ribic CM, Sargent DJ, Moore MJ, Thibodeau SN et al (2003) Tumor microsatellite-instability status as a predictor of benefit from fluorouracil-based adjuvant chemotherapy for colon cancer. N Engl J Med 349(3):247–257CrossRefPubMedGoogle Scholar
  19. 19.
    Barrier A, Boelle PY, Roser F, Gregg J et al (2006) Stage II colon cancer prognosis prediction by tumor gene expression profiling. J Clin Oncol 24(29):4685–4691CrossRefPubMedGoogle Scholar
  20. 20.
    Uen YH, Lu CY, Tsai HL, Yu FJ et al (2008) Persistent presence of postoperative circulating tumor cells is a poor prognostic factor for patients with stage I-III colorectal cancer after curative resection. Ann Surg Oncol 15(8):2120–2128CrossRefPubMedGoogle Scholar
  21. 21.
    Ohtani H (2007) Focus on TILs: prognostic significance of tumor infiltrating lymphocytes in human colorectal cancer. Cancer Immun 7:4PubMedGoogle Scholar
  22. 22.
    Ownby HE, Roi LD, Isenberg RR, Brennan MJ (1983) Peripheral lymphocyte and eosinophil counts as indicators of prognosis in primary breast cancer. Cancer 52(1):126–130CrossRefPubMedGoogle Scholar
  23. 23.
    Strieter RM, Burdick MD, Mestas J, Gomperts B et al (2006) Cancer CXC chemokine networks and tumour angiogenesis. Eur J Cancer 42(6):768–778CrossRefPubMedGoogle Scholar
  24. 24.
    Halazun KJ, Hardy MA, Rana AA, Woodland DC et al (2009) Negative impact of neutrophil-lymphocyte ratio on outcome after liver transplantation for hepatocellular carcinoma. Ann Surg 250(1):141–151CrossRefPubMedGoogle Scholar
  25. 25.
    Swanson RS, Compton CC, Stewart AK, Bland KI (2003) The prognosis of T3N0 colon cancer is dependent on the number of lymph nodes examined. Ann Surg Oncol 10(1):65–71CrossRefPubMedGoogle Scholar
  26. 26.
    Vather R, Sammour T, Zargar-Shoshtari K, Metcalf P et al (2009) Lymph node examination as a predictor of long-term outcome in Dukes B colon cancer. Int J Colorectal Dis 24(3):283–288CrossRefPubMedGoogle Scholar
  27. 27.
    Sarli L, Bader G, Iusco D, Salvemini C et al (2005) Number of lymph nodes examined and prognosis of TNM stage II colorectal cancer. Eur J Cancer 41(2):272–279CrossRefPubMedGoogle Scholar
  28. 28.
    Wright FC, Law CH, Last L, Khalifa M et al (2003) Lymph node retrieval and assessment in stage II colorectal cancer: a population-based study. Ann Surg Oncol 10(8):903–909CrossRefPubMedGoogle Scholar
  29. 29.
    Law CH, Wright FC, Rapanos T, Alzahrani M et al (2003) Impact of lymph node retrieval and pathological ultra-staging on the prognosis of stage II colon cancer. J Surg Oncol 84(3):120–126CrossRefPubMedGoogle Scholar
  30. 30.
    Tanaka M, Hashiguchi Y, Ueno H, Hase K et al (2003) Tumor budding at the invasive margin can predict patients at high risk of recurrence after curative surgery for stage II, T3 colon cancer. Dis Colon Rectum 46(8):1054–1059CrossRefPubMedGoogle Scholar
  31. 31.
    Wang LM, Kevans D, Mulcahy H, O’Sullivan J et al (2009) Tumor budding is a strong and reproducible prognostic marker in T3N0 colorectal cancer. Am J Surg Pathol 33(1):134–141CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Pei-Rong Ding
    • 1
    • 2
  • Xin An
    • 1
    • 3
  • Rong-Xin Zhang
    • 1
    • 2
  • Yu-Jing Fang
    • 1
    • 2
  • Li-Ren Li
    • 1
    • 2
  • Gong Chen
    • 1
    • 2
  • Xiao-Jun Wu
    • 1
    • 2
  • Zhen-Hai Lu
    • 1
    • 2
  • Jun-Zhong Lin
    • 1
    • 2
  • Ling-Heng Kong
    • 1
    • 2
  • De-Sen Wan
    • 1
    • 2
  • Zhi-Zhong Pan
    • 1
    • 2
    Email author
  1. 1.State Key Laboratory of Oncology in South ChinaGuangzhouPeople’s Republic of China
  2. 2.Department of Colorectal SurgeryCancer Center, Sun Yat-sen UniversityGuangzhouPeople’s Republic of China
  3. 3.Department of Medical OncologyCancer Center, Sun Yat-sen UniversityGuangzhouPeople’s Republic of China

Personalised recommendations