title: Neutrophil count is the most important prognostic component of the differential white cell count in patients undergoing elective surgery for colorectal cancer.
abstract: BACKGROUND
  Systemic inflammatory scoring systems such as the NLR have been reported to have prognostic value in many solid organ cancers. The aim of this study was to examine the relationships between the components of the white cell count (WCC) and survival in patients undergoing elective surgery for colorectal cancer.
  
  
  METHODS
  Patients undergoing elective resection at a single center (1997 to 2008) were identified from a prospective database (n = 508). Patient demographics and preoperative laboratory measurements including the differential WCC and their association with cancer-specific survival (CSS) and overall survival were examined.
  
  
  RESULTS
  There were 172 cancer deaths and 120 noncancer deaths. On Kaplan-Meier analysis of the whole cohort, age, Tumor, Nodal, and Metastasis stage, venous invasion, margin involvement, peritoneal involvement and tumor perforation, and white cell and neutrophil count (all P < .05) were associated with CSS. In those with node-negative colon cancer (n = 226), on multivariate analysis, age, venous invasion, modified Glasgow Prognostic Score, and neutrophil count (all P < .05) were independently associated with CSS.
  
  
  CONCLUSIONS
  Of the components of a differential WCC, only the neutrophil count was independently associated with survival, particularly in node-negative colon cancer.
authors.affiliation: Academic Unit of Surgery, School of Medicine - University of Glasgow, Glasgow Royal Infirmary, G31 2ER, UK. Electronic address: davidwatt1@nhs.net.
authors.forename: David G
authors.initials: DG
authors.lastname: Watt
authors.affiliation: Academic Unit of Surgery, School of Medicine - University of Glasgow, Glasgow Royal Infirmary, G31 2ER, UK.
authors.forename: John C
authors.initials: JC
authors.lastname: Martin
authors.affiliation: Academic Unit of Surgery, School of Medicine - University of Glasgow, Glasgow Royal Infirmary, G31 2ER, UK.
authors.forename: James H
authors.initials: JH
authors.lastname: Park
authors.affiliation: Academic Unit of Surgery, School of Medicine - University of Glasgow, Glasgow Royal Infirmary, G31 2ER, UK.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Horgan
authors.affiliation: Academic Unit of Surgery, School of Medicine - University of Glasgow, Glasgow Royal Infirmary, G31 2ER, UK.
authors.forename: Donald C
authors.initials: DC
authors.lastname: McMillan
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000097:blood / Q000401:mortality* / Q000601:surgery*; D003430:Cross-Sectional Studies; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
keywords: Colorectal cancer; Neutrophil; White cell count