Significance of the 7th postoperative day neutrophil-to-lymphocyte ratio in colorectal cancer

  • Tamuro HayamaEmail author
  • Yojiro Hashiguchi
  • Yuka Okada
  • Kohei Ono
  • Kentaro Nemoto
  • Ryu Shimada
  • Tsuyoshi Ozawa
  • Tetsutaka Toyoda
  • Takeshi Tsuchiya
  • Hisae Iinuma
  • Keijiro Nozawa
  • Keiji Matsuda
Original Article



High neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation and is associated with poor survival in localized or metastatic cancer. Preoperative NLR in colorectal cancer reportedly correlates with recurrence-free survival and is useful as a recurrence prediction factor. No reports have yet investigated recurrence factors using postoperative NLR. This study assessed the predictive value of NLR preoperatively and on the first (NLR1) and seventh day (NLR7) postoperatively in patients with stage II colorectal cancer.


We performed a retrospective cohort study involving patients undergoing colorectal resection at a single institution between January 2012 and December 2016; we used medical records of 176 consecutive patients with stage II colorectal cancer undergoing curative tumor resection. NLRs as well as clinical, histopathologic, and laboratory data were analyzed. Univariate and multivariate analyses were conducted to identify prognostic factors associated with recurrence-free survival (RFS).


Univariate analysis revealed that elevated NLR, NLR7, and lymphatic invasion were significantly associated with decreased RFS (p < 0.05). NLR7 was revealed as significant via multivariate analysis (p = 0.013). The 3-year RFS rate was 87.1% for patients with normal NLR7 and 70.3% for those with elevated NLR7.


Elevated seventh-day postoperative NLR is a significant independent predictor of reduced RFS for patients with stage II colorectal cancer and may be a potential biomarker for identifying candidates for adjuvant chemotherapy.


Neutrophil-to-lymphocyte ratio Stage II colorectal cancer Curative tumor resection Recurrence-free survival 



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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Tamuro Hayama
    • 1
    Email author
  • Yojiro Hashiguchi
    • 1
  • Yuka Okada
    • 1
  • Kohei Ono
    • 1
  • Kentaro Nemoto
    • 1
  • Ryu Shimada
    • 1
  • Tsuyoshi Ozawa
    • 1
  • Tetsutaka Toyoda
    • 2
  • Takeshi Tsuchiya
    • 1
  • Hisae Iinuma
    • 1
  • Keijiro Nozawa
    • 1
  • Keiji Matsuda
    • 1
  1. 1.Department of SurgeryTeikyo University School of MedicineTokyoJapan
  2. 2.Department of SurgeryNippon Medical SchoolTokyoJapan

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