A Preoperative High Neutrophil-to-Lymphocyte Ratio Predicts Disease-free Survival in Colorectal Cancer

Abstract

Introduction: The neutrophil to lymphocyte ratio (NLR) is an indicator of systemic inflammatory response and has the potential for use as blood-based biomarker to predict outcomes in patients (pts) with colorectal cancer (CRC).Our aim is to detemrine risk factors associated with CRC recurrence and to determine whether NLR independently correlates with disease free survival (DFS) in CRC pts. Methods: All pts who underwent treatment for stages I-III of CRC at Mayo Clinic, Rochester between 1/2004-12/2014 were identified. Data were obtained on demographics, pre-treatment WBC count and differential, cancer characteristics, and survival outcomes. Time-dependent receiver operating characteristic (ROC) curve analysis determined the best cut-off value of preoperative NLR. DFS was compared between pts with high vs. low NLR, using a log-rank test. Risk factors associated with risk of developing recurrent CRC were assessed using multivariate Cox proportional hazard analysis. Results: A total of 3542 consented pts with CRC were studied, of which 56.7% were males. Mean age was 64.4±14.5 years and 61.6% of the pts had colon cancer, 33.1% had rectal cancer and 5.3% had rectosigmoid cancer. Approximately 40% of the pts received adjuvant chemotherapy. An NLR of 3 was determined as the optimal cutoff value. Pts of stage I, II and III were at 25.8%, 23.5% and 26.9%, respectively. Over a median of 30.9 months, the recurrence rate was 8.6% in stage I, 9.9% in stage II, and 23.0% in stage III. In pts with stage I-III, the median DFS was shorter for those with high NLR as compared to those with low NLR (97.6 vs 125.1 months, P=0.0007) (Figure 1). Multivariate analysis revealed NLR>3, tumor size, tumor grade, tumor stage, and the number of positive lymph nodes to be significant and independent risk factors predictive of recurrent CRC. Additionally, chemotherapy seems to be protective (Table 1).Figure 1Conclusion: Preoperative high NLR is a significant independent predictor of recurrence in patients with CRC.Figure 2