The Emerging Role of Neutrophil to Lymphocyte Ratio in Determining Colorectal Cancer Treatment Outcomes: A Systematic Review and Meta-Analysis
- 1.1k Downloads
There is growing evidence suggesting that the neutrophil to lymphocyte ratio (NLR) can act as an independent predictor of long-term outcomes in patients undergoing treatment for colorectal cancer (CRC). This study aims to systematically review the role of NLR in predicting survival for patients with CRC undergoing treatments, and to evaluate its utility within a CRC surveillance program.
This meta-analysis was performed according to PRISMA guidelines. Outcomes of interest included disease-free survival (DFS) for patients undergoing treatment with curative intent and progression-free survival (PFS) in patients undergoing treatments with palliative intent.
Thirteen observational cohort studies published from 2007 to 2013 evaluated the role of NLR as a predictor of outcome following treatment for CRC. These included (i) patients undergoing surgery to resect the primary cancer (seven studies); (ii) those undergoing palliative chemotherapy (three studies); and (iii) patients undergoing potentially curative treatments for CRC liver metastases (three studies). When all studies were considered, a high pretreatment NLR independently predicted survival (HR 2.08; 95 % CI 1.64–2.64). A high NLR also predicted significantly poorer survival in each of the three groups. Finally, over a 3-year follow-up period, high NLR became a significant predictor of poor outcome at year 2 (HR 2.76; 95 % CI 2.06–3.69; p < 0.00001) and 3 (HR 2.03; 95 % CI 1.48–2.78; p < 0.0001), but not in the first year of follow-up (HR 1.47; 95 % CI 0.89–2.41; p = 0.13).
Elevated preoperative NLR is associated with poorer survival in CRC patients undergoing treatment and may have a role in CRC surveillance programs as a means of delivering more personalized cancer care.
KeywordsPalliative Chemotherapy Glasgow Prognostic Score Scottish Intercollegiate Guideline Network Neutrophil Lymphocyte Ratio Muscle Mass Depletion
Conflicts of Interest
George Malietzis, Marco Giacometti, Robin H. Kennedy, Thanos Athanasiou, Omer Aziz, and John T. Jenkins declare they have no conflicts of interest.
- 2.Roxburgh CS, Salmond JM, Horgan PG, Oien KA, McMillan DC. Comparison of the prognostic value of inflammation-based pathologic and biochemical criteria in patients undergoing potentially curative resection for colorectal cancer. Ann Surg. 2009;249(5):788–93. doi: 10.1097/SLA.0b013e3181a3e738.PubMedCrossRefGoogle Scholar
- 9.University of York, Centre for Reviews and Dissemination. Welcome to PROSPERO: international prospective register of systematic reviews. Available from: http://www.crd.york.ac.uk/PROSPERO/. Accessed 1 Feb 2014.
- 10.Harbour R, Miller J. A new system for grading recommendations in evidence based guidelines. BMJ. 2001;323(7308):334–6. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1120936&tool=pmcentrez&rendertype=abstract. Accessed 26 Jun 2013.
- 11.Parmar MK, Torri V, Stewart L. Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Stat Med. 1998;17(24):2815–34. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9921604. Accessed 12 Nov 2013.
- 13.Absenger G, Szkandera J, Stotz M, et al. Preoperative neutrophil-to-lymphocyte ratio predicts clinical outcome in patients with stage II and III colon cancer. Anticancer Res. 2013;33(10):4591–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24123035. Accessed 22 Nov 2013.
- 19.Carruthers R, Tho LM, Brown J, Kakumanu S, McCartney E, McDonald AC. Systemic inflammatory response is a predictor of outcome in patients undergoing preoperative chemoradiation for locally advanced rectal cancer. Colorectal Dis. 2012;14(10):e701–7. doi: 10.1111/j.1463-1318.2012.03147.x.PubMedCrossRefGoogle Scholar
- 29.Malietzis G, Johns N, Giacometti M, et al. Myopenia and the systemic inflammatory response in patients with operable colorectal cancer: OP43. Colorectal Dis. 2013;15(Suppl 3):22.Google Scholar
- 31.Sato N, Koeda K, Ikeda K, et al. Randomized study of the benefits of preoperative corticosteroid administration on the postoperative morbidity and cytokine response in patients undergoing surgery for esophageal cancer. Ann Surg. 2002;236(2):184–90. doi: 10.1097/01.SLA.0000022025.67985.53.PubMedCrossRefPubMedCentralGoogle Scholar
- 32.Schmidt SC, Hamann S, Langrehr JM, et al. Preoperative high-dose steroid administration attenuates the surgical stress response following liver resection: results of a prospective randomized study. J Hepatobiliary Pancreat Surg. 2007;14(5):484–92. doi: 10.1007/s00534-006-1200-7.PubMedCrossRefGoogle Scholar