title: Neutrophil to lymphocyte ratio predicts pattern of recurrence in patients undergoing liver resection for colorectal liver metastasis and thus the overall survival.
abstract: OBJECTIVE
  We investigate the neutrophil to lymphocyte ratio (NLR) as a potential prognostic factor for patients undergoing curative liver resection for colorectal liver metastasis (CRLM).
  
  
  METHODS
  We identified patients who underwent liver resection, via our prospectively accumulated surgical database at the Royal Marsden Hospital and The London Clinic, by two liver surgeons (SM and AZK) between January 2005 and December 2012 and patients included had liver resection for CRLM and received preoperative chemotherapy with an NLR > 2.5 considered elevated. NLR's role in disease-free, post-recurrence and overall survival was determined by univariate and multivariate Cox regression models.
  
  
  RESULTS
  One hundred and sixty nine patients were enrolled. Seventy-one patients (42%) demonstrated NLR > 2.5. Elevated NLR was associated with decreased OS in univariate and multivariate analysis (HR 2.12; 95% CI, 1.18-3.82; P = 0.012) but not with DFS. Analyzed as continuous variable, higher NLR was associated with decreased OS(HR 1.17; 95% CI, 1.03-132; P = 0.011) and associated with increased risk of extrahepatic/multifocal recurrence (P = 0.007), linked in this way with a decreased post-recurrence survival (HR 1.24, 95% CI, 1.02-1.52; P = 0.032).
  
  
  CONCLUSIONS
  Elevated NLR in patients who undergo hepatectomy following neoadjuvant chemotherapy for CRLM increases risk of extrahepatic/multifocal recurrence and is an independent predictor of overall survival.
authors.affiliation: Department of Academic Surgery, The Royal Marsden NHS Trust, UK; Department of Surgery, The London Clinic, UK.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Giakoustidis
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Neofytou
authors.forename: Aamir Z
authors.initials: AZ
authors.lastname: Khan
authors.forename: Satvinder
authors.initials: S
authors.lastname: Mudan
mesh_terms: D000368:Aged; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood* / Q000401:mortality* / Q000556:secondary / Q000628:therapy; D018655:Lymphocyte Count; D008297:Male; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D009504:Neutrophils / Q000378:metabolism*
keywords: colorectal; liver; lymphocyte; metastasis; neutrophil; ratio