Combined Detection of Preoperative Neutrophil-to-Lymphocyte Ratio and CEA as an Independent Prognostic Factor in Nonmetastatic Patients Undergoing Colorectal Cancer Resection Is Superior to NLR or CEA Alone

Objective. To explore the role of combined detection of carcinoembryonic antigen (CEA) and neutrophil-to-lymphocyte ratio (NLR) in the prognostic assessment of colorectal cancer (CRC). Methods. We investigated preoperative NLR and CEA in 125 surgical CRC patients, determined the patients’ thresholds by receiver operating characteristic (ROC) curve analysis, and assessed their prognostic values by Kaplan–Meier curve and Cox regression models. In addition, we used nomograms of several risk factors to evaluate the risk in survival and predictive accuracy by using Harrell’s concordance index (c-index). Results. Results of multivariate analysis showed high NLR, high CEA, and high COCN (combination of CEA and NLR) were significantly correlated with decreased disease-free survival (DFS) [HR: 2.229, 95% CI: 1.012–4.911, and P=0.047; HR: 3.652, 95% CI: 1.630–8.179, and P=0.002; HR: 3.139, 95% CI: 1.800–5.472, and P<0.001]. But high CEA and COCN remained significant only for decreased overall survival (OS) [HR: 3.713, 95% CI: 1.396–9.873, and P=0.009; HR: 3.106, 95% CI: 1.576–6.123, and P=0.001]. High NLR showed higher mortality rates with worse OS (P=0.058), and nomograms containing NLR improved the predictive accuracy. Area under the curve of COCN was higher than that of CEA or NLR. Conclusion. COCN acts as a better independent prognostic biomarker of CRC than NLR or CEA alone.

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Prognostic utility of the combination of pretreatment monocyte-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in patients with NMIBC after transurethral resection

Biomarkers in Medicine ◽

10.2217/bmm-2019-0398 ◽

2019 ◽

Vol 13 (18) ◽

pp. 1543-1555

Author(s):

Qinghai Wang ◽

Tao Huang ◽

Jianlei Ji ◽

Hongyang Wang ◽

Chen Guo ◽

...

Keyword(s):

Bladder Cancer ◽

Transurethral Resection ◽

Cox Regression ◽

Disease Free Survival ◽

Predictive Biomarker ◽

Neutrophil To Lymphocyte Ratio ◽

Invasive Bladder Cancer ◽

Lymphocyte Ratio ◽

Prognostic Utility ◽

Nonmuscle Invasive Bladder Cancer

Aim: To investigate and validate predictive value of combination of pretreatment monocyte-to-lymphocyte ratio (MLR) and neutrophil-to-lymphocyte ratio (NLR) for disease free survival (DFS) and overall survival (OS) in nonmuscle invasive bladder cancer after transurethral resection. Materials & methods: Total 358 patients enrolled were assigned into three (MLR-NLR 0, 1 and 2) groups per the cut-off values of MLR and NLR. Results: Kaplan–Meier curves showed MLR, NLR and their combination were statistically associated with DFS (p < 0.001) and OS (p < 0.001). Univariate and multivariate COX regression analyses revealed that combination of MLR with NLR was an independent prognostic predictor for both DFS (HR: 3.080; 95% CI: 1.870–5.074; p < 0.001 for MLR-NLR 2 vs MLR-NLR 0) and OS (HR: 2.815; 95% CI: 1.778–4.456; p < 0.001 for MLR-NLR 2 vs MLR-NLR 0). Calibration plots and decision curve analysis exhibited combination of MLR and NLR had good calibration accuracy with potential clinical usefulness. Conclusion: Combined MLR and NLR is a prognostic predictive biomarker in nonmuscle invasive bladder cancer after transurethral resection.

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Optimizing cut-offs for high neutrophil-to-lymphocyte ratio as poor survival prognostic factor in colorectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e15111 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e15111-e15111

Author(s):

Fernando Namuche ◽

Jorge Leon ◽

Paola Catherine Montenegro ◽

Claudio J. Flores

Keyword(s):

Colorectal Cancer ◽

Lymph Node ◽

Prognostic Factor ◽

Cox Regression ◽

Locally Advanced ◽

Lymph Node Involvement ◽

Histologic Grade ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Node Involvement

e15111 Background: The incidence of colorectal cancer (CRC) in Peru has increased in the last decades. Needing to use all the possible tools for an accurate diagnosis and early treatment. Neutrophil-to-lymphocyte ratio (NLR) has been associated as poor prognostic factor in OS and PFS in CRC. There is no data that support this statement in Latin America. It is of a special utility in our country the detection of a simple and reproducible prognostic biomarker that guides the use of more advanced tests. Our objective was to explore the factors associated with OS in the local-locally advanced and metastatic settings. Methods: We retrospectively reviewed the electronic medical records of 609 patients with CRC from one specialized Peruvian cancer center between 2006 and 2016 Descriptive results for numeric variables were presented as means with standard deviation (SD) or medians with interquartile range (IQR), depending on their distributions; otherwise, we expressed the qualitative variables as numbers with percentages. We divided our population into two groups: Local-locally advanced (L-LA) (516 pts) and debut metastatic- recurrence (M-R) (108 pts). We performed a ROC curve analysis to determine an appropriate cut-off value for NLR in both groups (L-LA:NLR ≥3, M-R:NLR ≥5). A univariate survival analysis was performed with Kaplan Meier method, comparing the curves with Log Rank test. A multivariate analysis was performed using the Cox regression model with the statistically significant variables found in the univariate analysis. Results: Pts with high NLR had significantly shorter OS in L-LA [HR, 12.1; 95% CI,5.019-29.211; p < 0.001] M-R [HR, 5.382; 95% CI,2.835-10.217; p < 0.001] than pts with low NLR. In the multivariate model, NLR retained a significant association with OS in both groups. Cox regression demonstrated that in L-LA setting sex, histologic grade and lymph node involvement; and in M-R setting sidedness, histologic grade, LVI and metastasectomy performed were independently risk factors for a shorter OS. Conclusions: High NLR is associated with poor prognosis (with our cut-offs L-LA:NLR ≥3, M-R:NLR ≥5). There are other variables to be considered that affect the OS, as: sex, histologic grade and lymph node involvement, sidedness, histologic grade, LVI and metastasectomy performed.

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Prognostic indices of inflammatory markers, cognitive function and fatigue for survival in patients with localised colorectal cancer

ESMO Open ◽

10.1136/esmoopen-2017-000302 ◽

2018 ◽

Vol 3 (2) ◽

pp. e000302 ◽

Cited By ~ 4

Author(s):

Janette L Vardy ◽

Haryana Mary Dhillon ◽

Gregory R Pond ◽

Corrinne Renton ◽

Stephen J Clarke ◽

...

Keyword(s):

Colorectal Cancer ◽

Cognitive Function ◽

Cox Regression ◽

Disease Free Survival ◽

Full Blood Count ◽

Prognostic Impact ◽

Prospective Longitudinal Study ◽

Lymphocyte Ratio ◽

Markers Of Inflammation ◽

Prospective Longitudinal

BackgroundInflammation promotes the development of malignancy, while a variety of systemic markers of inflammation predict for worse cancer outcomes including recurrence and survival. Here, we evaluate the prognostic impact of cytokine concentrations, full blood count (FBC) differential ratios, cognitive function and fatigue on survival in patients with localised colorectal cancer (CRC).Patients and methodsData are from a prospective longitudinal study comparing cognitive function and fatigue in patients with CRC who did (n=173) and did not (n=116) receive adjuvant/neoadjuvant chemotherapy. Baseline blood results (prior to any chemotherapy) included cytokines and FBC from which neutrophil lymphocyte ratio, lymphocyte monocyte ratio, platelet lymphocyte ratio and platelet monocyte ratio were derived. Fatigue was measured with the Functional Assessment of Cancer Therapy-Fatigue subscale and cognitive function by a neuropsychological test battery. Kaplan-Meier methods were used to estimate disease-free survival (DFS) and overall survival (OS). Univariable and multivariable Cox regression analyses were performed to evaluate factors potentially prognostic of outcomes.ResultsAt a median follow-up of 91.2 months, 227 subjects (79%) are still alive, and 212 (73%) have no evidence of a recurrence. Five-year OS and DFS are 86% (95% CI 81% to 90%) and 77% (95% CI 71% to 82%), respectively. None of the cytokines (interleukin (IL-6), IL-1 and tumour necrosis factor) or differential ratios of blood components, fatigue or cognitive function was statistically related to DFS or OS. Patient educational status (P=0.018), stage of disease (P=0.032), alanine transaminase (P=0.003), lactate dehydrogenase (P=0.008) and carcinoembryonic antigen (P=0.002) were significant as prognostic covariates of OS in univariable analyses, with similar results for DFS.ConclusionNone of the a priori selected markers of inflammation, fatigue or cognitive function was associated with OS or DFS in this cohort of patients.Trial registration numberNCT00188331, Post-results.

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Prognostic value of the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in patients with colorectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.551 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 551-551 ◽

Cited By ~ 1

Author(s):

Jae Hyun Kim ◽

Seun Ja Park

Keyword(s):

Colorectal Cancer ◽

Prognostic Value ◽

Cox Regression ◽

Neutrophil To Lymphocyte Ratio ◽

Platelet To Lymphocyte Ratio ◽

Poor Overall Survival ◽

Cox Regression Analysis ◽

Lymphocyte Ratio ◽

Kaplan Meier ◽

Independent Risk Factors

551 Background: Inflammatory response plays an important role in the pathogenesis of cancer. Some evidence has suggested that elevations in the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are associated with decreased survival in various types of cancer. In this study, we aimed to evaluate the prognostic value of the NLR and PLR in patients with colorectal cancer (CRC). Methods: Between August 1995 and December 2010, medical records from a total of 2,004 patients with CRC were retrospectively reviewed. The values of simple inflammatory markers including NLR and PLR in predicting the long-term outcomes of these patients were evaluated using Kaplan-Meier curves and multivariate Cox regression models. Results: The median follow-up duration was 42 months (interquartile range, 19 – 69). The estimation of NLR and PLR was based on the time of diagnosis. In multivariate Cox regression analysis, high NLR ( ≥ 2.6) [hazard ratio (HR) 2.251, 95% confidence interval (CI) 1.570-3.228, p < 0.001] and high PLR ( ≥ 155) [HR 1.473, 95% CI 1.019 – 2.128, p = 0.039] were independent risk factors predicting poor overall survival (OS) in CRC patients. Combined high NLR and PLR was also an independent risk factor predicting poor OS in patients with CRC [HR 2.316, 95% CI 1.529 – 3.508, p < 0.001]. Conclusions: In this study, we identified that high NLR ( ≥ 2.6), high PLR ( ≥ 155), and combined high NLR and PLR are useful prognostic factors to predict OS in CRC patients.

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

The American Journal of Gastroenterology ◽

10.14309/00000434-201610001-00145 ◽

2016 ◽

Vol 111 ◽

pp. S68-S69

Author(s):

Mohamad Mouchli ◽

Shahrooz Rashtak ◽

Xiaoyang Ruan ◽

Brooke Druliner ◽

Ruth Johnson ◽

...

Keyword(s):

Colorectal Cancer ◽

Disease Free Survival ◽

Neutrophil To Lymphocyte Ratio ◽

Free Survival ◽

Lymphocyte Ratio ◽

Disease Free

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Predictive value of lymphocyte-to-monocyte ratio (LMR) and neutrophil-to-lymphocyte ratio (NLR) in patients with oesophageal cancer undergoing concurrent chemoradiotherapy

BMC Cancer ◽

10.1186/s12885-019-6157-4 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 6

Author(s):

Ke-Jie Li ◽

Xiao-Fang Xia ◽

Meng Su ◽

Hui Zhang ◽

Wen-Hao Chen ◽

...

Keyword(s):

Oesophageal Cancer ◽

Concurrent Chemoradiotherapy ◽

Cox Regression ◽

Treatment Options ◽

Neutrophil To Lymphocyte Ratio ◽

Regression Analyses ◽

Roc Curve Analysis ◽

Cox Regression Analysis ◽

Lymphocyte Ratio ◽

Lymphocyte To Monocyte Ratio

Abstract Background and objectives The survival rate of patients with advanced oesophageal cancer is very low and can vary significantly, even among patients with the same TNM stage. It is important to look for indicators that are economical and readily available to predict overall survival. The aim of this study was to determine whether lymphocyte-to-monocyte ratio (LMR) and neutrophil-to-lymphocyte ratio (NLR) could be potential predictors of survival in patients with advanced oesophageal squamous cell carcinoma (ESCC) undergoing concurrent chemoradiotherapy. Methods Differences in survival among 204 patients with advanced oesophageal cancer who underwent concurrent chemoradiotherapy were collected and analysed. Univariate and multivariate COX regression analyses were used to investigate the association between blood inflammatory markers and patient survival before treatment. Results Univariate COX regression analyses showed that a history of alcohol use, neutrophil count, LMR, NLR, tumour length, and N stage were significantly associated with the survival of tumour patients receiving concurrent chemoradiotherapy. Multivariate COX regression analysis showed that NLR and LMR were predictors of outcome in tumour patients receiving chemoradiotherapy. According to receiver operating characteristic (ROC) curve analysis, the AUC of LMR and NLR was 0.734 and 0.749, and the best cutoff point for LMR and NLR was 3.03 and 2.64, respectively. Conclusions LMR and NLR can be used to predict the survival of patients with advanced oesophageal cancer receiving concurrent chemoradiotherapy, thereby providing clinicians with suggestions for further treatment options.

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A Preoperative Neutrophil to Lymphocyte Ratio of 3 Predicts Disease-Free Survival After Curative Elective Colorectal Cancer Surgery

Annals of Surgery ◽

10.1097/sla.0000000000000216 ◽

2014 ◽

Vol 260 (2) ◽

pp. 287-292 ◽

Cited By ~ 83

Author(s):

George Malietzis ◽

Marco Giacometti ◽

Alan Askari ◽

Subramanian Nachiappan ◽

Robin H. Kennedy ◽

...

Keyword(s):

Colorectal Cancer ◽

Disease Free Survival ◽

Cancer Surgery ◽

Neutrophil To Lymphocyte Ratio ◽

Colorectal Cancer Surgery ◽

Free Survival ◽

Lymphocyte Ratio ◽

Disease Free

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Neutrophil-to-lymphocyte ratio has limited predictive value for determining outcomes in perforated colon cancer: a retrospective study.

10.21203/rs.3.rs-70836/v1 ◽

2020 ◽

Author(s):

Chunyi Wu ◽

Jy-Ming Chiang ◽

Jeng-Fu You ◽

Reiping Tang ◽

Jinn-Shiun Chen ◽

...

Keyword(s):

Colorectal Cancer ◽

Colon Cancer ◽

Predictive Value ◽

Disease Free Survival ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Emergent Operation ◽

Operation Rate ◽

One To One ◽

Perforated Colon

Abstract Background: The neutrophil-to-lymphocyte ratio (NLR) is a significant prognostic marker in resectable colorectal cancer; however, there are no equivalent findings for perforated colon cancer. Using our colorectal cancer database, we retrospectively analyzed the data from 1995 to 2015 to determine if preoperative NLR was associated with survival outcomes in patients with perforated colon cancer. Methods: One-to-one propensity score matching (PSM) was applied to minimize the difference between the higher- (>5) and lower- (≤5) NLR groups. Clinicopathological factors, long-term overall survival (OS), and disease-free survival (DFS) were analyzed and compared between the two groups. The main outcome measures were OS and DFS. Results: Before PSM, the higher-NLR group had significantly higher prevalence of leukocytosis (lower- vs. higher-NLR groups: 12 [12.9%] vs. 46 [59.7%], p<0.001), lower serum albumin levels (lower- vs. higher-NLR groups: 30 [32.3%] vs. 42 [54.5%], p=0.003), and higher emergent operation rate (lower- vs. higher-NLR groups: 5 [5.4%] vs. 20 [26.0%], p<0.001). After one-to-one PSM, the groups comprised 41 patients each; none of the parameters were significantly different. The mean follow-up period was 76.3 months. Five-year OS and DFS were not significantly different (OS: p=0.637; DFS: p=0.827) between the higher- and lower-NLR groups. Conclusion: NLR have limited predictive value for outcomes in patients with perforated colon cancer.

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