Neutrophil to lymphocyte ratio is a strong predictor of tumor recurrence in early colon cancers: A propensity score-matched analysis.

Abstract

BACKGROUND:

Systemic inflammation and immune response play a crucial role in tumor growth, and the neutrophil to lymphocyte ratio (NLR) may be a simple way to assess the host inflammatory response. The NLR has been shown to be a prognostic indicator in many human tumors; in early colon cancers, it has been evaluated only in a few studies and its role remains controversial.

METHODS:

We analyzed data from 503 colon cancer patients. The best cutoff value for NLR was defined by receiver operating characteristic curve analysis. We grouped 276 Dukes A/B colon cancers, not receiving adjuvant chemotherapy, into low (<2.36) and high (>2.36) NLR and subjected to further analyses related to disease-free survival (DFS). A propensity score-matched analysis and the inverse probability of treatment weighting (IPTW) were performed to avoid confounding bias.

RESULTS:

The NLR correlated with tumor stage and oncologic outcome. The best NLR cutoff value was identical in the whole cohort and in Dukes A/B patients. Low NLR patients had a significantly better DFS rate than high NLR patients (hazard ratio [HR], 0.27; P = .0001); along with elevated carcinoembryonic antigen levels and Dukes B stage, high NLR was an independent prognostic factor of worse prognosis (HR, 2.86; P = .0033). Even in Dukes A patients, NLR discriminated between relapsing and nonrelapsing patients. Propensity score and IPTW analyses confirmed such results, thus excluding possible misinterpretation.

CONCLUSION:

Preoperative NLR, an inexpensive and readily available biomarker, can predict tumor relapse and should be assessed for implementation of tailored therapy in early stage colon cancer.

• Authors: Gennaro Galizia, Eva Lieto, Anna Zamboli, Ferdinando De Vita, Paolo Castellano, Ciro Romano, Annamaria Auricchio, Francesca Cardella, Lorenzo De Stefano, Michele Orditura
• Journal: Surgery (Surgery) Vol. 158 Issue 1 Pg. 112-20 (Jul 2015) ISSN: 1532-7361 [Electronic] United States
• PMID: 25818659 (Publication Type: Journal Article)
• Copyright: Copyright © 2015. Published by Elsevier Inc.

Topics

• Aged
• Colonic Neoplasms (blood, pathology)
• Female
• Humans
• Leukocyte Count
• Lymphocytes
• Male
• Neoplasm Recurrence, Local (blood)
• Neutrophils
• Predictive Value of Tests
• Prognosis
• Propensity Score
• ROC Curve