title: Can neutrophil-to-lymphocyte ratio predict the survival of colorectal cancer patients who have received curative surgery electively?
abstract: OBJECTIVE
  We evaluated the effect of neutrophil-to-lymphocyte ratio (NLR) on disease-free survival in patients with stages I to III colorectal cancer (CRC).
  
  
  METHODS
  There were 3857 patients identified from our database. We used receiver operating characteristic (ROC) analysis to identify the best cutoff value of NLR. A 5-year disease-free survival was used as end point. Survival analysis was used to assess the NLR effect, after stratification by several clinopathologic factors.
  
  
  RESULTS
  In the ROC analysis, NLR = 3 had the highest sensitivity and specificity. Elevated NLR (>3) in colon cancer seemed to accompany larger tumor size (~5 cm) and more advanced T stage. By multivariate analysis, elevated NLR in colon cancer was associated with an increased risk of disease progression or cancer death [hazard ratio (HR) 1.377, 95  % confidence interval 1.104-1.717, P = 0.014]. However, elevated NLR in rectal cancer lost its significance in multivariate analysis (HR 1.121, 95  % confidence interval 0.941-1.336, P = 0.200). Patients with elevated NLR had worse outcome, especially for colon cancer.
  
  
  CONCLUSIONS
  Preoperative NLR influenced the disease-free survival in patients with stages I to III CRC. Elevated NLR (>3) was associated with worse outcome (5-year disease-free survival 66.3  % vs. 78.9  % in colon cancer, P < 0.001; 60. 5 % vs. 66.2  % in rectal cancer, P = 0.008). The difference was larger in colon cancer than in rectal cancer. NLR should be considered as a prognostic factor for stages I to III CRC patients after curative surgery.
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, 5 Fu-Hsing St., Kuei-Shan Hsiang, Taoyuan, Linkou, Taiwan. sumfu@adm.cgmh.org.tw
authors.forename: Sum-Fu
authors.initials: SF
authors.lastname: Chiang
authors.forename: Hsin-Yuan
authors.initials: HY
authors.lastname: Hung
authors.forename: Reiping
authors.initials: R
authors.lastname: Tang
authors.forename: Chung Rong
authors.initials: CR
authors.lastname: Changchien
authors.forename: Jinn-Shiun
authors.initials: JS
authors.lastname: Chen
authors.forename: Yau-Tong
authors.initials: YT
authors.lastname: You
authors.forename: Jy-Ming
authors.initials: JM
authors.lastname: Chiang
authors.forename: Jr-Rung
authors.initials: JR
authors.lastname: Lin
mesh_terms: D015179:Colorectal Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009504:Neutrophils / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome