P-066 - Neutrophil/lymphocyte ratio in metastatic colorectal cancer: real-world data for evidence of its prognostic role

Abstract

Introduction: Inflammatory biomarkers have been linked to the evolution of many malignancies. The use of absolute Neutrophil/Lymphocyte ratio (NLR) has been retrospectively analyzed in various trials with metastatic colorectal cancer (mCRC) patients and suggested as a prognostic tool. In several studies, patients with NLR≥3 had worse prognoses than patients with NLR Methods: Retrospective and descriptive analysis of mCRC patients in whom 1st line chemotherapy was initiated between 2015 and 2017 in a Portuguese medical oncology unit was performed. The last absolute Neutrophil and Lymphocyte count before treatment was used to calculate NLR. Based on the literature, patients were then grouped as Low NLR (NLR < 3) or High NLR (NLR ≥ 3). Overall Survival (OS) and Progression Free Survival (PFS) were used for prognostic analysis. Results: A total of 102 patients were analyzed during a median follow-up of 15 months (interquartile range, 7-22). The median age was 68 years (41-84). Sixty-five patients (63.7%) were male. The tumor primary location on the left colon/rectum was observed in 77 patients (75.5%) and on the right colon in 25 (24.5%) patients. Sixty-one patients (59.8%) had synchronous metastasis at diagnosis. Seventy-nine patients (77.5%) underwent resection of a primary tumor at any point and 22 (21.6%) to metastasectomy. Almost one-third (30.4%) received neoadjuvant/adjuvant treatment. RAS mutation was found in 44 patients (43.1%). Monotherapy with fluoropyrimidine (FP) was administered as the 1st line to 11 patients, while 5 received FP associated with anti-VEGF. A doublet of chemotherapy was administered to 33 patients, 23 received doublet+antiEGFR and 29 a doublet+antiVEGF. Only 1 patient was treated with triplet+antiVEGF. The number of patients grouped Low NLR was 59 (57.8%), while 43 (42.2%) patients were High NLR. In the Kaplan Meier analysis, the median PFS (95% CI) was significantly higher in the Low vs. High NLR subgroup: 12.52 (6.32-18.72) vs. 7.79 (4.92-10.66) months (P = .01). In the multivariate Cox regression analysis, High NLR also predicted poorer outcome in PFS: HR 2.73; 95% CI, 1.42-5.23, P < .01. The analysis of the median OS also showed a statistically significantly favorable prognosis in the Low vs. High NLR subgroup: 33.38 (17.26-49.50) vs. 16.33 (12.60-20.01) months (P = .01). The multivariate Cox regression analysis of OS did not achieve statistical significance with NLR: HR 1.51; 95% CI, 0.74-3.09; P = .26. Conclusion: Our real-world data analysis showed better prognosis in mCRC patients with Low NLR compared to High NLR patients, when PFS and OS are analyzed. Therefore, we recommend the use of NLR as an independent prognostic tool before 1st line treatment in all mCRC patients.