title: Effect of preoperative neutrophil-lymphocyte ratio on the surgical outcomes of stage II colon cancer patients who do not receive adjuvant chemotherapy.
abstract: OBJECTIVE
  Selection of appropriate stage II colon cancer patients for adjuvant chemotherapy is critical for improving survival outcome. With the aim of identifying more high risk factors for stage II colon cancer, this study aimed to determine whether the neutrophil-lymphocyte ratio (NLR) is a predictor of surgical outcomes in patients with stage II colon cancer who do not receive adjuvant chemotherapy.
  
  
  METHODS
  We enrolled 1,040 stage II colon cancer patients who had undergone colectomy at a single institution between January 1995 and December 2005 and did not receive adjuvant chemotherapy.
  
  
  RESULTS
  Of these 1,040 patients, 785 (75.5%) patients had a normal NLR and 255 (24.5%) had an elevated NLR. Those with an elevated NLR included patients ≥65 years, T4b cancer, carcinoembryonic antigen ≥5 ng/mL, and tumor obstruction or perforation. Patients with an elevated NLR had a significantly worse overall survival (OS) and worse disease-free survival (DFS) than did patients with a normal NLR. Cox regression analysis revealed that elevated NLR was an independent predictor of OS (P=0.012) but not DFS (P=0.255).
  
  
  CONCLUSIONS
  An elevated NLR is an independent predictor of OS but not DFS in stage II colon cancer patients who did not receive adjuvant chemotherapy. Preoperative NLR measurement in stage II colon cancer patients may be a simple method for identifying patients with a poor prognosis who can be enrolled in further trials of adjuvant chemotherapy.
authors.affiliation: Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing St., Kuei-Shan, Linko, Tao-Yuan, Taiwan.
authors.forename: Hsin-Yuan
authors.initials: HY
authors.lastname: Hung
authors.forename: Jinn-Shiun
authors.initials: JS
authors.lastname: Chen
authors.forename: Chien Yuh
authors.initials: CY
authors.lastname: Yeh
authors.forename: Chung-Rong
authors.initials: CR
authors.lastname: Changchien
authors.forename: Reiping
authors.initials: R
authors.lastname: Tang
authors.forename: Pao-Shiu
authors.initials: PS
authors.lastname: Hsieh
authors.forename: Wen-Sy
authors.initials: WS
authors.lastname: Tasi
authors.forename: Jeng-Fu
authors.initials: JF
authors.lastname: You
authors.forename: Yau-Tong
authors.initials: YT
authors.lastname: You
authors.forename: Chung-Wei
authors.initials: CW
authors.lastname: Fan
authors.forename: Jeng-Yi
authors.initials: JY
authors.lastname: Wang
authors.forename: Jy-Ming
authors.initials: JM
authors.lastname: Chiang
mesh_terms: D000368:Aged; D002452:Cell Count; D017024:Chemotherapy, Adjuvant; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008214:Lymphocytes / Q000166:cytology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009504:Neutrophils / Q000166:cytology*; D011300:Preoperative Care; D012307:Risk Factors; D016896:Treatment Outcome