International Journal of Colorectal Disease

, Volume 34, Issue 7, pp 1303–1315 | Cite as

Prognostic impact of the combination of neutrophil-to-lymphocyte ratio and Glasgow prognostic score in colorectal cancer: a retrospective cohort study

  • Susumu Inamoto
  • Kenji KawadaEmail author
  • Ryosuke Okamura
  • Koya Hida
  • Yoshiharu Sakai
Original Article



Although neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte count, and Glasgow prognostic score (GPS) are well-known prognostic markers in cancer, their prognostic importance is still controversial. We evaluated the prognostic value of NLR, PLR, monocyte count, and GPS in colorectal cancer (CRC).


We retrospectively evaluated 448 CRC patients undergoing curative resection. We compared overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS) between dichotomized groups by the optimal cutoff point. Univariate and multivariate analyses were applied to identify prognostic factors.


High NLR, high monocyte count, and high GPS exhibited significantly worse prognosis in OS, CSS, and DFS compared with low NLR, low monocyte count, and low GPS, respectively. In contrast, PLR was not significantly associated with OS, CSS, and DFS. The univariate and multivariate analyses indicated that poor OS was significantly associated with age ≥ 69 and high NLR; that poor CSS was significantly associated with age ≥ 69, M factor, high CA19-9, adjuvant chemotherapy, and high GPS; and that poor DFS was significantly associated with venous invasion, high NLR, and high GPS. When 448 patients were classified into three groups based on NLR and GPS, there was a significant difference in OS, CSS, and DFS between all the three groups. Patients with NLR ≥ 2.05 and GPS = 1/2 exhibited remarkably poorer prognosis, whereas those with both NLR < 2.05 and GPS = 0 exhibited remarkably better prognosis.


Combination of NLR and GPS can be a novel scoring system to effectively stratify outcome in CRC.


Systemic inflammatory response Colorectal cancer Neutrophil-to-lymphocyte ratio Glasgow prognostic score 


Grant supports

This work was supported by grants from the Ministry of Education, Culture, Sports, Science and Technology of Japan (to KK and SI).

Authors’ contribution

KK, SI and YS planned the study concept and design. Acquisition of data was done by SI. Analysis and interpretation of data was done by SI, KK, RO, and HK. KK and SI wrote the manuscript, and edited by all the authors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

384_2019_3316_Fig7_ESM.png (123 kb)
Supplementary Figure 1

Receiver operating characteristics (ROC) curve analysis of NLR, monocyte count, and PLR for the prediction of overall survival (OS). a, NLR. b, monocyte count. c, PLR. (PNG 122 kb)

384_2019_3316_MOESM1_ESM.eps (177 kb)
High Resolution Image (EPS 176 kb)


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Copyright information

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

Authors and Affiliations

  1. 1.Department of Surgery, Graduate School of MedicineKyoto UniversityKyotoJapan

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