Ann Coloproctol.  2019 Apr;35(2):100-106. 10.3393/ac.2018.10.01.

Neutrophil to Lymphocyte Ratio: A Predictive Marker for Treatment Outcomes in Patients With Rectal Cancer Who Underwent Neoadjuvant Chemoradiation Followed by Surgery

• Jeon BH
• Shin US
• Moon SM
• Choi JI
• Kim MS
• Kim KH
• Sung SJ

• KMID: 2448270
• DOI: http://doi.org/10.3393/ac.2018.10.01

Abstract

PURPOSE
In this study, we investigated the role of neutrophil to lymphocyte ratio (NLR) as a predictor of tumor response and as a prognostic factor in patients with rectal cancer who had undergone curative surgery after neoadjuvant chemoradiation therapy (nCRT).
METHODS
Between January 2009 and July 2016, we collected 140 consecutive patients who had undergone curative intent surgery after nCRT due to rectal adenocarcinoma. We obtained the pre- and post-nCRT NLR by dividing the neutrophil count by the lymphocyte count. The cutoff value was obtained using receiver operating characteristic analysis for tumor response and using maximally selected rank analysis for recurrence-free survival (RFS). The relationship among NLR, tumor response, and RFS was assessed by adjusting the possible clinico-pathological confounding factors.
RESULTS
The possibility of pathologic complete response (pCR) was significantly decreased in high pre- (>2.77) and postnCRT NLR (>3.23) in univariate regression analysis. In multivariate analysis, high post-nCRT NLR was an independent negative predictive factor for pCR (adjusted odds ratio, 0.365; 95% confidence interval [CI], 0.145-0.918). The 5-year RFS of all patients was 74.6% during the median 37 months of follow-up. Patients with higher pre- (>2.66) and post-nCRT NLR (>5.21) showed lower 5-year RFS rates (53.1 vs. 83.3%, P = 0.006) (69.2 vs. 75.7%, P = 0.054). In multivariate Cox analysis, high pre-nCRT NLR was an independent poor prognostic factor for RFS (adjusted hazard ratio, 2.300; 95% CI, 1.061-4.985).
CONCLUSION
Elevated NLR was a negative predictive marker for pCR and was independently associated with decreased RFS. For confirmation, a large-scale study with appropriate controls is needed.

Keyword

Neutrophile lymphocyte ratio; Rectal neoplasms; Chemoradiotherapy; Biomarkers; Prognosis

MeSH Terms

Adenocarcinoma
Biomarkers
Chemoradiotherapy
Follow-Up Studies
Humans
Lymphocyte Count
Lymphocytes*
Multivariate Analysis
Neutrophils*
Odds Ratio
Polymerase Chain Reaction
Prognosis
Rectal Neoplasms*
ROC Curve
Biomarkers