title: Neutrophil to lymphocyte ratio is a strong predictor of tumor recurrence in early colon cancers: A propensity score-matched analysis.
abstract: BACKGROUND
  Systemic inflammation and immune response play a crucial role in tumor growth, and the neutrophil to lymphocyte ratio (NLR) may be a simple way to assess the host inflammatory response. The NLR has been shown to be a prognostic indicator in many human tumors; in early colon cancers, it has been evaluated only in a few studies and its role remains controversial.
  
  
  METHODS
  We analyzed data from 503 colon cancer patients. The best cutoff value for NLR was defined by receiver operating characteristic curve analysis. We grouped 276 Dukes A/B colon cancers, not receiving adjuvant chemotherapy, into low (<2.36) and high (>2.36) NLR and subjected to further analyses related to disease-free survival (DFS). A propensity score-matched analysis and the inverse probability of treatment weighting (IPTW) were performed to avoid confounding bias.
  
  
  RESULTS
  The NLR correlated with tumor stage and oncologic outcome. The best NLR cutoff value was identical in the whole cohort and in Dukes A/B patients. Low NLR patients had a significantly better DFS rate than high NLR patients (hazard ratio [HR], 0.27; P = .0001); along with elevated carcinoembryonic antigen levels and Dukes B stage, high NLR was an independent prognostic factor of worse prognosis (HR, 2.86; P = .0033). Even in Dukes A patients, NLR discriminated between relapsing and nonrelapsing patients. Propensity score and IPTW analyses confirmed such results, thus excluding possible misinterpretation.
  
  
  CONCLUSIONS
  Preoperative NLR, an inexpensive and readily available biomarker, can predict tumor relapse and should be assessed for implementation of tailored therapy in early stage colon cancer.
authors.affiliation: Division of Surgical Oncology, Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples School of Medicine, Naples, Italy. Electronic address: gennaro.galizia@unina2.it.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Galizia
authors.affiliation: Division of Surgical Oncology, Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples School of Medicine, Naples, Italy.
authors.forename: Eva
authors.initials: E
authors.lastname: Lieto
authors.affiliation: Division of Surgical Oncology, Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples School of Medicine, Naples, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Zamboli
authors.affiliation: Division of Medical Oncology, 'F. Magrassi - A. Lanzara' Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, Naples, Italy.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: De Vita
authors.affiliation: Division of Surgical Oncology, Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples School of Medicine, Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Castellano
authors.affiliation: Division of Internal Medicine, Allergy and Clinical Immunology, Department of Medical and Surgical Sciences, Second University of Naples School of Medicine, Naples, Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Romano
authors.affiliation: Division of Surgical Oncology, Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples School of Medicine, Naples, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Auricchio
authors.affiliation: Division of Surgical Oncology, Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples School of Medicine, Naples, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Cardella
authors.affiliation: Division of Surgical Oncology, Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples School of Medicine, Naples, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: De Stefano
authors.affiliation: Division of Medical Oncology, 'F. Magrassi - A. Lanzara' Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, Naples, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Orditura
mesh_terms: D000368:Aged; D003110:Colonic Neoplasms / Q000097:blood* / Q000473:pathology; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008214:Lymphocytes; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000097:blood*; D009504:Neutrophils; D011237:Predictive Value of Tests; D011379:Prognosis; D057216:Propensity Score; D012372:ROC Curve