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The Prognostic Value of Preoperative Neutrophil-to-Lymphocyte Ratio in Colorectal Cancer

World Journal of Surgery volume 40, pages 2796–2802 (2016)Cite this article

ABSTRACT

Background

The prognostic value of the neutrophil-to-lymphocyte ratio (NLR) has been reported in several cancers included colorectal cancer; however, it is not clear if there is an association between NLR and cancer-specific survival in colorectal cancer. And the optimal cut-off value is controversial. This study was designed to assess the prognostic value of preoperative NLR in colorectal cancer patients.

Methods

Total 823 consecutive patients who underwent surgery for all stages of colorectal cancer in our hospital between January 2006 and December 2011 were included in the study. Preoperative NLR was calculated from their hospital records.

Results

Using the receiver-operating characteristic curve, we found that the optimal preoperative NLR cut-off value that was strongly associated with cancer-specific survival was 2.1. Using this value, 505 patients were identified as having high NLR (≥2.1) and 397 patients were identified as having low NLR (<2.1). High NLR was associated with preoperative serum albumin values <4.0 g/dl (p < 0.001), positive preoperative serum C-reactive protein (CRP; p < 0.001), preoperative carcinoembryonic antigen (CEA) values ≥5.0 ng/dl (p = 0.003), and stage progression (p = 0.002). Cox proportional hazard analyses identified preoperative high NLR as an independent poor prognostic factor (p = 0.020, HR 1.66 (95 % CI: 1.08–2.63)). When comparing stage of disease, preoperative high-NLR patients with Stage III disease (p = 0.024) and Stage IV disease (p = 0.036) had significantly poorer prognoses.

Conclusions

In this study, we have demonstrated that preoperative NLR ≥2.1 was a prognostic indicator for cancer-specific survival of colorectal cancer patients.

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References

  1. Jemal A, Bray F, Center MM et al (2011) Global cancer statistics. CA Cancer J Clin 61:69–90

    Article  PubMed  Google Scholar 

  2. Center for Cancer Control and Information Services, National Cancer Center, Japan. Statistics. http://ganjoho.jp/reg_stat/statistics/index.html

  3. Sobin LH, Gospodarowicz MK, Wittekind C (2009) TNM classification of malignant tumors, 7th edn. Wiley, Chichester

    Google Scholar 

  4. Japanese Society for Cancer of the Colon and Rectum (2013) Japanese classification of colorectal carcinoma, 8th edn. Kanehara & CO., Ltd, Tokyo

    Google Scholar 

  5. Choi KW, Hong SW, Chang YG et al (2014) Inflammation-based score (Glasgow prognostic score) as an independent prognostic factor in colorectal cancer patients. Ann Surg Treat Res 86(6):309–313

    Article  PubMed  PubMed Central  Google Scholar 

  6. Gibbs J, Cull W, Henderson W et al (1999) Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Arch Surg 134:36–42

    CAS  Article  PubMed  Google Scholar 

  7. Walker KG, Bell SW, Rickard MJ et al (2004) Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer. Ann Surg 240(2):255–259

    Article  PubMed  PubMed Central  Google Scholar 

  8. McArdle CS, McMillan DC, Hole DJ (2005) Impact of anastomotic leakage on long-term survival of patients undergoing curative resection for colorectal cancer. Brit J Surg 92(9):1150–1154

    CAS  Article  PubMed  Google Scholar 

  9. Chua W, Clarke SJ, Charles KA (2012) Systemic inflammation and prediction of chemotherapy outcomes in patients receiving docetaxel for advanced cancer. Support Care Cancer 20(8):1869–1874

    Article  PubMed  Google Scholar 

  10. Wang DS, Luo HY, Qiu MZ et al (2012) Comparison of the prognostic values of various inflammation based factors in patients with pancreatic cancer. Med Oncol 29(5):3092–3100

    CAS  Article  PubMed  Google Scholar 

  11. Sarraf KM, Belcher E, Raevsky E 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):425–428

    Article  PubMed  Google Scholar 

  12. Yuan D, Zhu K, Li K et al (2014) The preoperative neutrophil–lymphocyte ratio predicts recurrence and survival among patients undergoing R0 resections of adenocarcinomas of the esophagogastric junction. J Surg Oncol 110(3):333–340

    Article  PubMed  Google Scholar 

  13. Yu L, Lv CY, Yuan AH, Chen W et al (2015) Significance of the preoperative neutrophil-to-lymphocyte ratio in the prognosis of patients with gastric cancer. World J Gastroentero 21(20):6280–6286

    Article  Google Scholar 

  14. Kos FT, Hocazade C, Kos M et al (2014) Assessment of prognostic value of “neutrophil to lymphocyte ratio” and “prognostic nutritional index” as a systemic inflammatory marker in non-small cell lung cancer. Asian Pac J Cancer Prev 16(9):3997–4002

    Article  Google Scholar 

  15. Rachidi S, Wallace K, Wrangle JM, et al (2015) Neutrophil‐to‐lymphocyte ratio and overall survival in all sites of head and neck squamous cell carcinoma. Head Neck

  16. Kishi Y, Kopetz S, Chun YS 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):614–622

    Article  PubMed  Google Scholar 

  17. Chua W, Charles KA, Baracos VE et al (2011) Neutrophil/lymphocyte ratio predicts chemotherapy outcomes in patients with advanced colorectal cancer. Br J Cancer 104(8):1288–1295

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  18. He W, Yin C, Guo G et al (2013) Initial neutrophil lymphocyte ratio is superior to platelet lymphocyte ratio as an adverse prognostic and predictive factor in metastatic colorectal cancer. Med Oncol 30(1):1–6

    Google Scholar 

  19. Formica V, Luccchetti J, Cunningham D et al (2014) 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. Med Oncol 31(9):1–8

    CAS  Article  Google Scholar 

  20. Chen ZY, Raghav K, Lieu CH et al (2015) Cytokine profile and prognostic significance of high neutrophil-lymphocyte ratio in colorectal cancer. Br J Cancer 112(6):1088–1097

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  21. Chiang SF, Hung HY, Tang R et al (2012) Can neutrophil-to-lymphocyte ratio predict the survival of colorectal cancer patients who have received curative surgery electively? Int J Colorectal Dis 27(10):1347–1357

    Article  PubMed  Google Scholar 

  22. Ding PR, An X, Zhang RX et al (2010) Elevated preoperative neutrophil to lymphocyte ratio predicts risk of recurrence following curative resection for stage IIA colon cancer. Int J Colorectal Dis 25(12):1427–1433

    Article  PubMed  Google Scholar 

  23. Hung HY, Chen JS, Yeh CY et al (2011) Effect of preoperative neutrophil–lymphocyte ratio on the surgical outcomes of stage II colon cancer patients who do not receive adjuvant chemotherapy. Int J Colorectal Dis 26(8):1059–1065

    Article  PubMed  Google Scholar 

  24. Walsh SR, Cook EJ, Goulder F et al (2005) Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol 91(3):181–184

    CAS  Article  PubMed  Google Scholar 

  25. Li MX, Liu XM, Zhang XF et al (2014) Prognostic role of neutrophil-to-lymphocyte ratio in colorectal cancer: a systematic review and meta-analysis. Int J Cancer 134(10):2403–2413

    CAS  Article  PubMed  Google Scholar 

  26. Park JJ, Jang HJ, Oh IY et al (2013) Prognostic value of neutrophil to lymphocyte ratio in patients presenting with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol 111(5):636–642

    Article  PubMed  Google Scholar 

  27. Akobeng AK (2007) Understanding diagnostic tests 3: receiver operating characteristic curves. Acta Paediatr 96:644–647

    Article  PubMed  Google Scholar 

  28. Watanabe T, Itabashi M, Shimada Y et al (2015) Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2014 for treatment of colorectal cancer. Int J Clin Oncol 20(2):207–239

    Article  PubMed  PubMed Central  Google Scholar 

  29. Mantovani A, Allavena P, Sica A et al (2008) Cancer-related inflammation. Nature 454(7203):436–444

    CAS  Article  PubMed  Google Scholar 

  30. Triantafillidis JK, Nasioulas G, Kosmidis PA (2009) Colorectal cancer and inflammatory bowel disease: epidemiology, risk factors, mechanisms of carcinogenesis and prevention strategies. Anticancer Res 29(7):2727–2737

    PubMed  Google Scholar 

  31. Ropponen K, Tammi M, Parkkinen J et al (1998) Tumor cell-associated hyaluronan as an unfavorable prognostic factor in colorectal cancer. Cancer Res 58(2):342–347

    CAS  PubMed  Google Scholar 

  32. Ohtani H (2007) Focus on TILs: prognostic significance of tumor infiltrating lymphocytes in human colorectal cancer. Cancer Immun 7(1):4

    PubMed  PubMed Central  Google Scholar 

  33. Omran ML, Morley JE (2000) Assessment of protein energy malnutrition in older persons, part II: laboratory evaluation. Nutrition 16(2):131–140

    CAS  Article  PubMed  Google Scholar 

  34. Mohri Y, Inoue Y, Tanaka K et al (2013) Prognostic nutritional index predicts postoperative outcome in colorectal cancer. World J of Surg 37(11):2688–2692. doi:10.1007/s00268-013-2156-9

    Article  Google Scholar 

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Author notes

    Affiliations

    1. Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan

      Hidemasa Kubo, Yasutoshi Murayama, Tomohiro Arita, Yoshiaki Kuriu, Masayoshi Nakanishi & Eigo Otsuji

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    1. Hidemasa Kubo
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    2. Yasutoshi Murayama
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    3. Tomohiro Arita
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    4. Yoshiaki Kuriu
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    5. Masayoshi Nakanishi
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    6. Eigo Otsuji
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    Corresponding author

    Correspondence to Yasutoshi Murayama.

    Additional information

    Hidemasa Kubo and Yasutoshi Murayama have equally contributed to this work.

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    Cite this article

    Kubo, H., Murayama, Y., Arita, T. et al. The Prognostic Value of Preoperative Neutrophil-to-Lymphocyte Ratio in Colorectal Cancer. World J Surg 40, 2796–2802 (2016). https://doi.org/10.1007/s00268-016-3595-x

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    • DOI: https://doi.org/10.1007/s00268-016-3595-x

    Keywords

    • Colorectal Cancer Patient
    • Prognostic Nutritional Index
    • Glasgow Prognostic Score
    • Serum Albumin Concentration
    • Independent Poor Prognostic Factor