title: Neutrophil/lymphocyte ratio predicts chemotherapy outcomes in patients with advanced colorectal cancer.
abstract: BACKGROUND
  Advances in the treatment of metastatic colorectal cancer (mCRC) in the last decade have significantly improved survival; however, simple biomarkers to predict response or toxicity have not been identified, which are applicable to all community oncology settings worldwide. The use of inflammatory markers based on differential white-cell counts, such as the neutrophil/lymphocyte ratio (NLR), may be simple and readily available biomarkers.
  
  
  METHODS
  Clinical information and baseline laboratory parameters were available for 349 patients, from two independent cohorts, with unresectable mCRC receiving first-line palliative chemotherapy. Associations between baseline prognostic variables, including inflammatory markers such as the NLR and tumour response, progression and survival were investigated.
  
  
  RESULTS
  In the training cohort, combination-agent chemotherapy (P=0.001) and NLR ≤ 5 (P=0.003) were associated with improved clinical benefit. The ECOG performance status 1 (P=0.002), NLR>5 (P=0.01), hypoalbuminaemia (P=0.03) and single-agent chemotherapy (P<0.0001) were associated with increased risk of progression. The ECOG performance status ≥ 1 (P=0.004) and NLR>5 (P=0.002) predicted worse overall survival (OS). The NLR was confirmed to independently predict OS in the validation cohort (P<0.0001). Normalisation of the NLR after one cycle of chemotherapy in a subset of patients resulted in improved progression-free survival (P=0.012).
  
  
  CONCLUSIONS
  These results have highlighted NLR as a potentially useful clinical biomarker of systemic inflammatory response in predicting clinically meaningful outcomes in two independent cohorts. Results of this study have also confirmed the importance of a chronic systemic inflammatory response influencing clinical outcomes in patients with mCRC.
authors: Sydney Cancer Centre, Concord Repatriation General Hospital, Hospital Road, Concord, New South Wales 2139, Australia.
authors: W
authors: W
authors: Chua
authors: K A
authors: KA
authors: Charles
authors: V E
authors: VE
authors: Baracos
authors: S J
authors: SJ
authors: Clarke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001772:Blood Cell Count; D002277:Carcinoma / Q000097:blood* / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D015179:Colorectal Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009504:Neutrophils / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome