Neutrophil-to-lymphocyte ratio and clinical outcomes in liver resection for metastatic colorectal cancer.

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233 Background: The neutrophil-to-lymphocyte ratio (NLR) has been shown to correlate with overall and disease-free survival in patients with colorectal cancer. The data about prognostic value of the NLR in patients undergoing liver resection for colorectal liver metastases (CRLM) is limited. We aimed to describe the relationship between the NLR, overall survival and disease progression in patients who underwent liver resection for CRLM in a safety-net hospital. Methods: We identified patients who underwent liver resection with curative intent for metastatic colorectal cancer at a large safety net hospital between 2008 and 2020. All patients had a complete blood count with differential available within three months prior to resection. We compared patients who had a pre-operative NLR ≤3 with those who had a NLR > 3, a cut-off based on ROC analysis. We used the Chi-squared statistic and t-test to compare the frequencies of categorical variables and the means of continuous variables, respectively. Multivariate survival analyses were performed using the Cox-regression model after adjusting for sex, age at liver resection, race/ethnicity, body mass index, insurance status, initial presentation of colorectal cancer (emergency room vs outpatient), primary malignancy (colon vs. rectal), temporality of CRLM (synchronous vs metachronous presentation with primary), staged vs simultaneous removal of primary mass and CRLM, number and size of liver CRLM, other metastatic sites at the time of liver resection, carcinoembryonic antigen (at initial diagnosis, before and after resection), and receipt of at least six months of peri-liver resection chemotherapy. Results: We identified 76 patients who underwent liver resection with curative intent for CRLM with a median follow up of 40.7 months. The population had a mean age of 56.2 (SD 9.9), was 50% female, and predominantly non-White (73.7%). Compared with patients who had a NLR ≤3 (N = 50), patients with a NLR > 3 (N = 26) were more likely to be white (46.2% vs 16.0%) and have rectal cancer (61.5% vs 28.0%). In unadjusted analysis, patients with NLR > 3 had 1.87 times (95% CI 1.01-3.47) increased risk of mortality, compared with patients who had an NLR ≤3. In adjusted analysis, patients with NLR > 3 had 6.88 times (95% CI 1.61-29.42), increased risk of mortality, compared with patients who had an NLR ≤ 3. There was no significant difference in risk of CRLM recurrence or overall disease progression among patients with NLR ≤3 vs patients with NLR > 3. Conclusions: An elevated pre-operative NLR > 3 is a potential predictor of overall survival among patients undergoing liver resection for metastatic colorectal cancer. This widely available test may aid clinicians in pre-operative risk stratification.