title: Preoperative Neutrophil-to-Lymphocyte Ratio is a Better Prognostic Serum Biomarker than Platelet-to-Lymphocyte Ratio in Patients Undergoing Resection for Nonmetastatic Colorectal Cancer.
abstract: BACKGROUND
  Current risk stratification tools for patients with colorectal cancer (CRC) rely on final surgical pathology but may be improved with the addition of novel serum biomarkers. The objective of this study was to evaluate the utility of preoperative NLR and PLR in predicting long-term oncologic outcomes in patients with operable CRC.
  
  
  METHODS
  All patients who underwent curative resection for adenocarcinoma at a large tertiary academic hospital were identified. High NLR/PLR was evaluated preoperatively and defined by maximizing log-rank statistics. Recurrence-free survival (RFS) and overall survival (OS) were calculated using the Kaplan-Meier method and compared by the log-rank test. Univariate and multivariable Cox proportional hazard regression was used to identify associations with outcome measures.
  
  
  RESULTS
  A total of 549 patients were included in the study. High NLR (≥2.6) was associated with worse RFS (hazard ratio [HR] 2.03, 95 % confidence interval [CI] 1.48-2.79, p < 0.001) and OS (HR 2.25, 95 % CI 1.54-3.29, p < 0.001). High PLR (≥295) also was associated with worse RFS (HR 1.68, 95 % CI 1.06-2.65, p = 0.028) and OS (HR 1.81, 95 % CI 1.06-3.06, p = 0.028). In the multivariable model, high NLR retained significance for reduced RFS (HR 1.59, 95 % CI 1.1-2.28, p = 0.013) and OS (HR 1.91, 95 % CI 1.26-2.9, p = 0.002). Significantly more patients in the high NLR group were older at diagnosis, had mucinous adenocarcinoma, higher T stage, and advanced cancer stage.
  
  
  CONCLUSIONS
  High preoperative NLR in this series was shown to be a negative independent prognostic factor in patients undergoing surgical resection for nonmetastatic CRC. The prognostic utility of this serum biomarker may help to guide use of adjuvant therapies and patient counselling.
authors.affiliation: Division of General Surgery, Toronto Western Hospital - University Health Network, Toronto, ON, Canada.
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Choi
authors.affiliation: Division of General Surgery, Toronto Western Hospital - University Health Network, Toronto, ON, Canada.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Cleghorn
authors.affiliation: Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada.
authors.forename: Haiyan
authors.initials: H
authors.lastname: Jiang
authors.affiliation: Division of General Surgery, Toronto Western Hospital - University Health Network, Toronto, ON, Canada.|Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Jackson
authors.affiliation: Division of General Surgery, Toronto Western Hospital - University Health Network, Toronto, ON, Canada.|Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Allan
authors.initials: A
authors.lastname: Okrainec
authors.affiliation: Division of General Surgery, Toronto Western Hospital - University Health Network, Toronto, ON, Canada. Fayez.Quereshy@uhn.ca.|Department of Surgery, University of Toronto, Toronto, ON, Canada. Fayez.Quereshy@uhn.ca.|Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada. Fayez.Quereshy@uhn.ca.
authors.forename: Fayez A
authors.initials: FA
authors.lastname: Quereshy
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis*; D001792:Blood Platelets / Q000473:pathology*; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D009504:Neutrophils / Q000473:pathology*; D011300:Preoperative Care; D011379:Prognosis; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor