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Can neutrophil-to-lymphocyte ratio predict the survival of colorectal cancer patients who have received curative surgery electively?

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International Journal of Colorectal Disease Aims and scope Submit manuscript

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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Correspondence to Sum-Fu Chiang.

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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)

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Fig. S1B

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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)

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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)

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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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