title: Elevated preoperative neutrophil to lymphocyte ratio predicts risk of recurrence following curative resection for stage IIA colon cancer.
abstract: OBJECTIVE
  Adjuvant chemotherapy for stage II colon cancer remains controversial but may be considered for patients with high-risk features. Recent studies have shown that elevated neutrophil to lymphocyte ratio (NLR) is a worse prognostic factor and a predictor of response to chemotherapy in patients with advanced colorectal cancer. The purpose of this study was to evaluate whether NLR predicts risk of recurrence in patients with stage IIA colon cancer undergoing curative resection without adjuvant chemotherapy.
  
  
  METHODS
  We retrospectively reviewed 141 consecutive patients with stage IIA colon cancer treated with curative surgery alone from 2002 to 2006. NLR, as well as demographics, clinical, histopathologic, and laboratory data were analyzed. Univariate and multivariate analyses were conducted to identify prognostic factors associated with recurrent-free survival (RFS).
  
  
  RESULTS
  Cox's regression analysis demonstrated that elevated NLR (>4) (hazard ratio, 4.88; P < 0.01) and less lymph node sampling (<15 lymph nodes; hazard ratio, 3.80; P < 0.05) were adverse prognostic factors for RFS. The 5-year RFS was 91.4% (95% CI, 88.6-94.2%) for patients with normal NLR and 63.8% (51.1-76.3%) for patients with elevated NLR. The 5-year RFS for patients with 0, 1, and 2 of the identified risk factors was 95.1%, 87.4%, and 33.3%, respectively (P < 0.001).
  
  
  CONCLUSIONS
  Elevated preoperative NLR is an independent predictor of worse RFS for patients with stage IIA colon cancer and a potential biomarker to identify candidates for adjuvant chemotherapy.
authors.affiliation: State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, 510060, People's Republic of China.
authors.forename: Pei-Rong
authors.initials: PR
authors.lastname: Ding
authors.forename: Xin
authors.initials: X
authors.lastname: An
authors.forename: Rong-Xin
authors.initials: RX
authors.lastname: Zhang
authors.forename: Yu-Jing
authors.initials: YJ
authors.lastname: Fang
authors.forename: Li-Ren
authors.initials: LR
authors.lastname: Li
authors.forename: Gong
authors.initials: G
authors.lastname: Chen
authors.forename: Xiao-Jun
authors.initials: XJ
authors.lastname: Wu
authors.forename: Zhen-Hai
authors.initials: ZH
authors.lastname: Lu
authors.forename: Jun-Zhong
authors.initials: JZ
authors.lastname: Lin
authors.forename: Ling-Heng
authors.initials: LH
authors.lastname: Kong
authors.forename: De-Sen
authors.initials: DS
authors.lastname: Wan
authors.forename: Zhi-Zhong
authors.initials: ZZ
authors.lastname: Pan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001772:Blood Cell Count; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009504:Neutrophils / Q000473:pathology*; D011237:Predictive Value of Tests; D012008:Recurrence; D012189:Retrospective Studies; D055815:Young Adult
references.citation: J Surg Oncol. 2003 Nov;84(3):120-6
references.pmid: 14598354
references.citation: Int J Colorectal Dis. 2009 Mar;24(3):283-8
references.pmid: 18716784
references.citation: Dis Colon Rectum. 2003 Aug;46(8):1054-9
references.pmid: 12907899
references.citation: J Thorac Cardiovasc Surg. 2009 Feb;137(2):425-8
references.pmid: 19185164
references.citation: J Clin Oncol. 2006 Oct 10;24(29):4685-91
references.pmid: 16966692
references.citation: N Engl J Med. 2003 Jul 17;349(3):247-57
references.pmid: 12867608
references.citation: Dis Colon Rectum. 2004 Jul;47(7):1216-24
references.pmid: 15148649
references.citation: World J Surg. 2008 Aug;32(8):1757-62
references.pmid: 18340479
references.citation: Ann Surg Oncol. 2008 Aug;15(8):2120-8
references.pmid: 18481151
references.citation: J Clin Oncol. 2006 Apr 1;24(10):1603-11
references.pmid: 16575011
references.citation: J Surg Oncol. 2005 Sep 1;91(3):181-4
references.pmid: 16118772
references.citation: Ann Surg Oncol. 2009 Mar;16(3):614-22
references.pmid: 19130139
references.citation: Eur J Surg Oncol. 2008 Jan;34(1):55-60
references.pmid: 17448623
references.citation: Cancer Immunol Immunother. 2009 Jan;58(1):15-23
references.pmid: 18414853
references.citation: J Surg Oncol. 2008 May 1;97(6):513-8
references.pmid: 18335453
references.citation: Ann Surg Oncol. 2003 Jan-Feb;10(1):65-71
references.pmid: 12513963
references.citation: Cancer Immun. 2007 Feb 21;7:4
references.pmid: 17311363
references.citation: Ann Surg Oncol. 2003 Oct;10(8):903-9
references.pmid: 14527909
references.citation: J Clin Oncol. 2004 Aug 15;22(16):3408-19
references.pmid: 15199089
references.citation: Cancer. 1983 Jul 1;52(1):126-30
references.pmid: 6850535
references.citation: Dis Colon Rectum. 2007 Sep;50(9):1332-41
references.pmid: 17429709
references.citation: Am J Surg Pathol. 2009 Jan;33(1):134-41
references.pmid: 18971777
references.citation: Lancet. 2007 Dec 15;370(9604):2020-9
references.pmid: 18083404
references.citation: Ann Surg. 2009 Jul;250(1):141-51
references.pmid: 19561458
references.citation: J Clin Oncol. 2005 Aug 20;23(24):5635-43
references.pmid: 16110022
references.citation: Eur J Cancer. 2005 Jan;41(2):272-9
references.pmid: 15661553
references.citation: J Clin Oncol. 2004 May 15;22(10):1797-806
references.pmid: 15067028
references.citation: J Natl Cancer Inst. 2004 Oct 6;96(19):1420-5
references.pmid: 15467030
references.citation: Br J Cancer. 2007 Oct 22;97(8):1021-7
references.pmid: 17895886
references.citation: Eur J Cancer. 2006 Apr;42(6):768-78
references.pmid: 16510280