Abstract
Purpose
We evaluated the effect of neutrophil-to-lymphocyte ratio (NLR) on disease-free survival in patients with stages I to III colorectal cancer (CRC).
Methods
There were 3857 patients identified from our database. We used receiver operating characteristic (ROC) analysis to identify the best cutoff value of NLR. A 5-year disease-free survival was used as end point. Survival analysis was used to assess the NLR effect, after stratification by several clinopathologic factors.
Results
In the ROC analysis, NLR = 3 had the highest sensitivity and specificity. Elevated NLR (>3) in colon cancer seemed to accompany larger tumor size (≧5 cm) and more advanced T stage. By multivariate analysis, elevated NLR in colon cancer was associated with an increased risk of disease progression or cancer death [hazard ratio (HR) 1.377, 95 % confidence interval 1.104–1.717, P = 0.014]. However, elevated NLR in rectal cancer lost its significance in multivariate analysis (HR 1.121, 95 % confidence interval 0.941–1.336, P = 0.200). Patients with elevated NLR had worse outcome, especially for colon cancer.
Conclusions
Preoperative NLR influenced the disease-free survival in patients with stages I to III CRC. Elevated NLR (>3) was associated with worse outcome (5-year disease-free survival 66.3 % vs. 78.9 % in colon cancer, P < 0.001; 60. 5 % vs. 66.2 % in rectal cancer, P = 0.008). The difference was larger in colon cancer than in rectal cancer. NLR should be considered as a prognostic factor for stages I to III CRC patients after curative surgery.
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References
National Cancer Institute. Cancer of the colon and rectum. http://seer.cancer.gov/statfacts/html/colorect.html. Accessed September 7, 2006
Bureau of Health Promotion, Department of Health, R.O.C. (Taiwan). http://www.bhp.doh.gov.tw/BHPnet/Portal/StatisticsShow.aspx?No=200911300001
Horner MJ, Ries LAG, Krapcho M et al (2009) SEER cancer statistics review 1975–2006. National Cancer Institute, Bethesda, MD. http://seer.cancer.gov/csr/1975_2006
Bentzen SM, Balslev I, Pedersen M et al (1992) Time to loco-regional recurrence after resection of Dukes’ B and C colorectal cancer with or without adjuvant postoperative radiotherapy. A multivariate regression analysis. Br J Cancer 65(1):102–107
Morris EJA, Maughan NJ, Forman D, Quirke P (2007) Who to treat with adjuvant therapy in Dukes’ B/stage II colorectal cancer? The need for high quality pathology. Gut 56:1419–1425
Petersen VC, Baxter KJ, Love SB, Shepherd NA (2002) Identification of objective pathological prognostic determinants and models of prognosis in Dukes’ B colon cancer. Gut 51:65–69
Carrato A (2008) Adjuvant treatment of colorectal cancer. Gastrointest Cancer Res 2(4 Suppl):S42–S46
Zahorec R (2001) Ratio of neutrophil to lymphocyte counts—rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 102(1):5–14
Walsh SR, Cook EJ, Goulder F, Justin TA, Keeling NJ (2005) Neutrophil–lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol 91:181–184
Halazun KJ, Aldoori A, Malik HZ, Al-Mukhtar A, Prasad KR, Toogood GJ, Lodge JP (2008) Elevated preoperative neutrophil to lymphocyte ratio predicts survival following hepatic resection for colorectal liver metastases. Eur J Surg Oncol 34:55–60
Jablonska J, Leschner S, Westphal K, Lienenklaus S, Weiss S (2010) Neutrophils responsive to endogenous IFN-β regulate tumor angiogenesis and growth in a mouse tumor model. J Clin Invest 120(4):1151–1164
Hofman PM (2010) Pathobiology of the neutrophil–intestinal epithelial cell interaction: role in carcinogenesis. World J Gastroenterol 16(46):5790–5800
Nozawa H, Chiu C, Hanahan D (2006) Infiltrating neutrophils mediate the initial angiogenic switch in a mouse model of multistage carcinogenesis. Proc Natl Acad Sci USA 103(33):12493–12498
Nind AP, Nairn RC, Rolland JM, Guli EP, Hughes ES (1973) Lymphocyte anergy in patients with carcinoma. Br J Cancer 28:108–117
Calman KC (1975) Tumour immunology and the gut. Gut 16:490–499
Waldner M, Schimanski CC, Neurath MF (2006) Colon cancer and the immune system: The role of tumor invading T cells. World J Gastroenterol 12(45):7233–7238
Ogino S, Nosho K, Irahara N et al (2009) Lymphocytic reaction to colorectal cancer is associated with longer survival, independent of lymph node count, microsatellite instability, and CpG island methylator phenotype. Clin Cancer Res 15(20):6412–6420
McMillan DC, Canna K, McArdle CS (2003) Systemic inflammatory response predicts survival following curative resection of colorectal cancer. Br J Surg 90(2):215–219
Stamatiadis AP, Manouras AJ, Triantos GN, Katergiannakis VA, Apostolidis NS (1992) Combination of serum carcino-embryonic antigen and C-reactive protein—a useful test in preoperative staging of colorectal cancer. Eur J Surg Oncol 18(1):41–43
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Fig. S1A
Kaplan–Meier survival analysis for WBC quartile (A), neutrophil quartile (B), and lymphocyte ratio quartile (C) of patients with colon cancer, and those of patients with rectal cancer (D–F). The complicated group was excluded. The 5-year disease-free survival was shown (JPEG 1 kb)
Fig. S1B
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Fig. S1C
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Fig. S1D
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Fig. S1E
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Fig. S1F
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Fig. S2A
Kaplan–Meier survival analysis for NLR of colon cancer patients (A) and rectal cancer patients (B) after exclusion of the complicated group. The lower the NLR, the better the disease-free survival rate. However, the differences of rectal cancer patients were smaller compared to that of colon cancer patients (JPEG 1 kb)
Fig. S2B
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Fig. S3A
Kaplan–Meier survival analysis for NLR of colon cancer patients after stratification by WBC. The complicated group was excluded. There was no difference in the elevated WBC and the depressed WBC group. The disease-free survival rate of colon cancer patients with normal NLR (≦3) was better in the normal WBC group (JPEG 1 kb)
Fig. S3B
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Chiang, SF., Hung, HY., Tang, R. et al. Can neutrophil-to-lymphocyte ratio predict the survival of colorectal cancer patients who have received curative surgery electively?. Int J Colorectal Dis 27, 1347–1357 (2012). https://doi.org/10.1007/s00384-012-1459-x
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DOI: https://doi.org/10.1007/s00384-012-1459-x