title: A high preoperative neutrophil-to-lymphocyte ratio is associated with poor survival in patients with colorectal cancer.
abstract: BACKGROUND
  Previous studies have reported that an elevated preoperative neutrophil-to-lymphocyte ratio (NLR) is associated with a poor prognosis in patients with various types of cancers. The aim of this study was to determine the prognostic significance of preoperative NLR in patients with colorectal cancer and to determine an appropriate cut-off value of the NLR.
  
  
  METHODS
  We enrolled 674 patients who underwent surgery for stage I-IV colorectal cancer. The mean NLR was 2.74±2.20. To determine the appropriate cut-off value of the NLR, we used a receiver operating characteristic curve. A total of 262 patients with an NLR of 2.5 or more were classified as high-NLR individuals in this study. The prognostic significance of a high NLR was evaluated using a multivariate analysis.
  
  
  RESULTS
  The cancer-specific survival was significantly (p<0.001) worse in the patients with a high NLR. The multivariate analysis indicated that the tumor diameter, the presence of lymph node or distant metastasis, and a high NLR were independent risk factors for poor survival.
  
  
  CONCLUSIONS
  Preoperative NLR measurement is a convenient biomarker and predictor of a poor prognosis after surgery for colorectal cancer.
authors.affiliation: Osaka City University Graduate School of Medicine, Department of Surgical Oncology, 1-4-3 Asahi-machi Abeno-Ku Osaka City Osaka Prefecture, 545-8585, Japan. tora@med.osaka-cu.ac.jp
authors.forename: Masatsune
authors.initials: M
authors.lastname: Shibutani
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Maeda
authors.forename: Hisashi
authors.initials: H
authors.lastname: Nagahara
authors.forename: Eiji
authors.initials: E
authors.lastname: Noda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ohtani
authors.forename: Yukio
authors.initials: Y
authors.lastname: Nishiguchi
authors.forename: Kosei
authors.initials: K
authors.lastname: Hirakawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000097:blood* / Q000473:pathology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology*; D011300:Preoperative Care; D011379:Prognosis; D012372:ROC Curve
keywords: Colorectal cancer; neutrophil-to-lymphocyte ratio; systemic inflammatory response