title: Neutrophil-lymphocyte ratio predicts pathologic tumor response and survival after preoperative chemoradiation for rectal cancer.
abstract: BACKGROUND
  Neutrophil-lymphocyte ratio (NLR) reflects the balance between pro- and anti-tumor immune activities. We evaluated whether NLR is associated with pathologic tumor response and prognosis in rectal cancer patients that underwent preoperative chemoradiaton therapy (CRT) with surgery.
  
  
  METHODS
  One hundred two patients with rectal cancer that were treated by preoperative CRT followed by surgery were enrolled. A total of 50.4 GY of radiation and 5-FU-based chemotherapy were delivered. An NLR ≥ 3 was considered to be elevated. Pathologic tumor response based on ypTNM stage was categorized into two groups, good response (n = 35, pathologic complete response and ypTNM I) and poor response groups (n = 67, ypTNM II, III, and IV).
  
  
  RESULTS
  Twenty-five patients (24.5%) had elevated NLR. Multivariate analysis showed that an elevated CEA level (p = 0.001), larger tumor (p = 0.03), and elevated NLR (p = 0.04) were significant predictors for a poor response. Poor pathological tumor response and elevated NLR were risk factors for cancer-specific and recurrence-free survivals.
  
  
  CONCLUSIONS
  An elevated NLR before CRT can be used as predictors for poor tumor response and unfavorable prognostic factors. Dominant pro-tumor activities of neutrophils or reduced anti-tumor immune response by lymphocytes, as determined by NLR, may have a impact on poor tumor response and unfavorable prognosis.
authors.forename: Ik Yong
authors.initials: IY
authors.lastname: Kim
authors.forename: Sei Hwan
authors.initials: SH
authors.lastname: You
authors.affiliation: Department of Surgery, Yonsei University Wonju College of Medicine, 162 Ilsan-dong, Wonju-si, Gangwon-do (220-701), Korea. youngwkim@yonsei.ac.kr.
authors.forename: Young Wan
authors.initials: YW
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D059248:Chemoradiotherapy; D003082:Colectomy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007958:Leukocyte Count; D008214:Lymphocytes / Q000473:pathology*; D009504:Neutrophils / Q000473:pathology*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors