Neutrophil/lymphocyte ratio predicts chemotherapy outcomes in patients with advanced colorectal cancer (original) (raw)
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prognostic and predictive role of neutrophil/lymphocytes ratio in metastatic colorectal cancer: a
Background Neutrophil/Lymphocyte ratio (NLR), defined as absolute neutrophils count divided by absolute lymphocytes count, has been reported as poor prognostic factor in several neoplastic diseases but only a few data are available about unresectable metastatic colorectal cancer (mCRC) patients (pts). The aim of our study was to evaluate the prognostic and predictive role of NLR in the TRIBE trial.
Annals of Oncology, 2018
Background: Neutrophil/lymphocyte ratio (NLR), defined as absolute neutrophils count divided by absolute lymphocytes count, has been reported as poor prognostic factor in several neoplastic diseases but only a few data are available about unresectable metastatic colorectal cancer (mCRC) patients (pts). The aim of our study was to evaluate the prognostic and predictive role of NLR in the TRIBE trial. Patients and methods: Pts enrolled in TRIBE trial were included. TRIBE is a multicentre phase III trial randomizing unresectable and previously untreated mCRC pts to receive FOLFOXIRI or FOLFIRI plus bevacizumab. A cutoff value of 3 was adopted to discriminate pts with low (NLR < 3) versus high (NLR 3) NLR, as primary analysis. As secondary analysis, NLR was treated as an ordinal variable with three levels based on terciles distribution. Results: NLR at baseline was available for 413 patients. After multiple imputation at univariate analysis, patients with high NLR had significantly shorter progression-free survival (PFS) [hazard ratio (HR) 1.27 (95% CI 1.05-1.55), P ¼ 0.017] and overall survival (OS) [HR 1.56 (95% CI 1.25-1.95), P < 0.001] than patients with low NLR. In the multivariable model, NLR retained a significant association with OS [HR 1.44 (95% CI 1.14-1.82), P ¼ 0.014] but not with PFS [HR 1.18 (95% CI 0.95-1.46), P ¼ 0.375]. No interaction effect between treatment arm and NLR was evident in terms of PFS (P for interaction ¼ 0.536) or OS (P for interaction ¼ 0.831). Patients with low [HR 0.84 (95% CI 0.64-1.08)] and high [HR 0.73 (95% CI 0.54-0.97)] NLR achieved similar PFS benefit from the triplet and consistent results were obtained in terms of OS [HR 0.83 (95% CI 0.62-1.12) for low NLR; HR 0.82 (95% CI 0.59-1.12) for high NLR]. Conclusion: This study confirmed the prognostic role of NLR in mCRC pts treated with bevacizumab plus chemotherapy in the first line, showing the worse prognosis of pts with high NLR. The advantage of the triplet is independent of NLR at baseline.
Annals of surgical oncology, 2014
There is growing evidence suggesting that the neutrophil to lymphocyte ratio (NLR) can act as an independent predictor of long-term outcomes in patients undergoing treatment for colorectal cancer (CRC). This study aims to systematically review the role of NLR in predicting survival for patients with CRC undergoing treatments, and to evaluate its utility within a CRC surveillance program. This meta-analysis was performed according to PRISMA guidelines. Outcomes of interest included disease-free survival (DFS) for patients undergoing treatment with curative intent and progression-free survival (PFS) in patients undergoing treatments with palliative intent. Thirteen observational cohort studies published from 2007 to 2013 evaluated the role of NLR as a predictor of outcome following treatment for CRC. These included (i) patients undergoing surgery to resect the primary cancer (seven studies); (ii) those undergoing palliative chemotherapy (three studies); and (iii) patients undergoing p...
Journal of Cancer Therapy, 2023
Background: In developed countries, colon cancer is the second most prevalent cancer, only exceeded by prostate cancer in men and breast cancer in women. After Hepatocellular carcinoma, breast cancer, bladder cancer, lung cancer, Non-Hodgkin Lymphoma and brain tumors, colon cancer is the 7 th most common cancer in Egypt, in both sexes, representing 3.47% and 3%, in both male and female cancers, respectively. Aim of the Work: The aim of this study was to evaluate the prognostic and predictive significance of pretreatment Neutrophil/lymphocytes ratio (NLR), in terms of disease-free survival (DFS) and recurrence, in high-risk stage II and stage III Colorectal cancer patients who underwent curative resection. Patients and Methods: We retrospectively evaluated 103 patients, who were submitted to upfront surgery as first therapeutic option in curative intent, between January 2017 and December 2018. Pretreatment Neutrophil/lymphocytes ratio (NLR), as well as demographics, clinical, histopathologic, and laboratory data were analyzed. Univariate and multivariate analyses were conducted to identify prognostic factors associated with disease free survival (DFS) and recurrence. Results: The cutoff point of Neutrophils/lymphocytes ratio (NLR) was calculated with Kaplan-Meier curves and log-rank test to 3. This study revealed that neutrophils/lymphocytes ratio (NLR) was significantly associated with disease free survival (p < 0.001*). Also, there was no difference in efficacy between both chemotherapy regimens FOLFOX and XELOX in both high-risk stage II and stage III colon cancer regarding disease free survival & the toxicity profile associated with each regimen and its grades between patients. Conclusion: Our study suggests that preoperative Neutrophils/lymphocytes ratio (NLR) more than 3 may be an independent prognostic marker for TTR (time to recurrence) in high-risk stage II and stage III colon cancer patients.
Neutrophil to Lymphocyte Ratio as a Predictor of Severity in Colorectal Adenocarcinoma
Journal of Ayub Medical College Abbottabad
Background: Colorectal cancers are slowly developing cancers of which more than 95% are adenocarcinomas, beginning in the mucus-producing glands lining the colon and rectum. In Pakistan, colorectal carcinoma is ranked as the seventh most common malignancy in men and the ninth most common in women with a male to female ratio of 9 to 1. This study aimed at investigating Neutrophil to Lymphocyte Ratio (NLR) as a potential marker for predicting severity of disease in terms of tumour histological grade in patients with pre-operative colorectal adenocarcinoma.Methods: Retrospective cross-sectional study design was adopted and this study was conducted at the Department of Pathology, Pakistan Institute of Medical Sciences Islamabad. Sixty patients of all age-groups and both genders, diagnosed as colorectal adenocarcinoma on histopathological examination of resected specimens, were selected by consecutive non-probability sampling. Separately, 60 healthy subjects, age and sex-matched, were se...
Annals of Surgical Oncology, 2009
Background. Whether neutrophil-to-lymphocyte ratio (NLR) predicts survival of patients with colorectal liver metastases (CLM) treated with systemic chemotherapy remains unclear. Methods. Clinicopathologic data were reviewed for patients with CLM treated with chemotherapy and resection (n = 200) or chemotherapy only (n = 90). Univariate and multivariate analyses for prognostic factors were performed. In the resection group, whether chemotherapy normalizes high NLR and the effect of NLR normalization on survival were evaluated. Results. In the resection group, patients with preoperative NLR [ 5 had a worse 5-year survival rate than patients with NLR B 5 (19% vs. 43%; P = 0.009), and NLR [ 5 was the only independent preoperative predictor of worse survival (P = 0.016; hazard ratio [HR] = 2.22; 95% confidence interval [95% CI], 1.16-4.25). In the nonresection group, patients with prechemotherapy NLR [ 5 had a worse 3-year survival rate than patients with NLR B 5 (0% vs. 23%; P = 0.0002), and NLR [ 5 was the only independent predictor of worse survival (P = 0.001; HR = 2.91; 95% CI, 1.54-5.50). In the resection group, chemotherapy normalized high NLR in 17 of 25 patients, and these 17 patients had better survival than the 8 patients with high NLR both before chemotherapy and before surgery (P = 0.021).
Turkish Journal of Surgery
INTRODUCTION Colorectal cancer is the third most common malignancy worldwide. The number of deaths from colorectal cancer is 15.9 per 100,000 individuals per year. Approximately 4.7% of men and women are diagnosed with colon and rectal cancer at some point during their lifetime (1). Estimated preoperative prognosis for colorectal cancer patients will help the choice and modality of the surgical and medical treatment. An improved lifespan has been shown with an intensive lymphocytic infiltration in localized tumors in the colorectal cancer patients (2-4). Additionally, some parameters, such as C-reactive protein and hypoalbuminemia, which show a poor prognostic association between systemic inflammatory response and colorectal cancer have been discussed (5, 6). Systemic inflammation has been reported to be an independent determining factor for prognosis in colorectal patients after surgery (5). A high neutrophillymphocyte ratio (NLR) has been reported to estimate poor outcomes in colorectal cancer patients who are exposed to primary resection (7). Ding (8) reported that a high NLR may establish the risk groups and in such patients NLR may be a marker in response at adjuvant cancer therapy. Considering the histopathology of colorectal diseases, it is known that lymphovascular and perineural invasion have an adverse effect on prognosis. The most important prognostic variable in colorectal carcinoma is the presence or absence of lymph node metastases. In a study of more than 1000 operative specimens, Morson and Dawson (9) found regional venous involvement in 35% of cases. Submucosal venous spread occurred in 10% of cases, and there was an evidence of permeation of extramural vessels in 25% cases. In the former cases, there was little or no effect on prognosis; however, extramural venous involvement reduced five-year survival rates from 55% to approximately 30%. Perineural invasion (PNI) has been shown to have a detrimental effect on the prognosis (10). Its presence may be a part of overall penetration of the bowel wall. The relationship between PNI and the advanced colorectal cancer patients was reported in 1981 (11). Krasna et al. (12) found that the three-year survival rate decreased from 57.7% in patients without neural invasion to 29.6% in patients with neural invasion.
ESMO open, 2018
In the RAISE trial, ramucirumab+leucovorin/fluorouracil/irinotecan (FOLFIRI) improved the median overall survival (mOS) of patients with previously treated metastatic colorectal cancer versus patients treated with placebo+FOLFIRI but had a higher incidence of neutropaenia, leading to more chemotherapy dose modifications and discontinuations. Thus, we conducted an exploratory post-hoc analysis of RAISE and a retrospective, observational analysis of electronic medical record (EMR) data to determine and verify the association of neutropaenia, baseline absolute neutrophil count (ANC) and survival. The RAISE analysis used the study safety population (n=1057). IMS Health Oncology Database (IMS EMR) was the source for the real-world data set (n=617). RAISE patients with treatment-emergent neutropaenia had improved mOS compared with those without (ramucirumab arm: 16.1 vs 10.7 months, HR=0.57, p<0.0001; placebo arm: 12.7 vs 10.7 months, HR=0.76, p=0.0065). RAISE patients with low ANC ver...
Neutrophil-lymphocyte ratio as a predictive factor for tumor staging in colorectal cancer
Turkish Journal of Medical Sciences, 2014
Background/aim: In the preoperative period, simple methods to identify the tumor stage of colorectal cancer patients are needed. In recent years, the neutrophil-lymphocyte ratio (NLR) has been used as a predictive parameter for systemic inflammatory response in many different clinical entities. This study aims to determine if the NLR predicts the tumor stage in colorectal cancer patients in the preoperative period. Materials and methods: A total of 206 patients diagnosed with colorectal cancer and admitted for surgical treatment over a 6-year period were identified from a retrospectively maintained database. NLR was calculated from preoperative full blood counts. NLRs were compared with the tumor stages as determined in histopathological reports and scanning tests to determine the extent of metastasis. Results: We found NLRs to be statistically higher in patients with T3 and T4 tumors than in patients with T1 and T2 tumors (mean: 5.261 vs. 4.499, respectively, P = 0.010). Similarly, we found statistically higher NLR values in the N1 and N2 groups than in the N0 group (mean: 6.597 vs. 4.501, respectively, P < 0.001). Additionally, NLRs were statistically higher in M1 patients than in M0 patients (mean: 8.261 vs. 5.158, respectively, P = 0.004). Conclusion: In the preoperative period, NLR was found to be a valuable predictive parameter for tumor staging in patients with colorectal cancer, thus informing us as to the kind of tumor we will meet when we open the abdomen.
Frontiers in Oncology
IntroductionEmerging evidence is pointing towards a relevant role of immunity in cancer development. Alterations in leukocytes count and neutrophil-to-lymphocyte ratio (NLR) at diagnosis of colorectal cancer (CRC) seems to predict poor prognosis, but no data is available for the pre-diagnostic values.MethodsRetrospective analysis of patients who underwent surgery for CRC at our center (2005 – 2020). 334 patients with a complete blood count dating at least 24 months prior to diagnosis were included. Changes in pre-diagnosis values of leukocytes (Pre-Leu), lymphocytes (Pre-Lymph), neutrophils (Pre-Neut), and NLR (Pre-NLR) and their correlation with overall- (OS) and cancer-related survival (CRS) were analyzed.ResultsPre-Leu, Pre-Neut and Pre-NLR showed an increasing trend approaching the date of diagnosis, while Pre-Lymph tended to decrease. The parameters were tested for associations with survival after surgery through multivariable analysis. After adjusting for potential confounding...