title: Systemic neutrophil-to-lymphocyte ratio in colorectal cancer: the relationship to patient survival, tumour biology and local lymphocytic response to tumour.
abstract: BACKGROUND
  Colorectal cancer (CRC) is a major cause of mortality and morbidity. The impact of inflammatory biomarkers (C-reactive protein etc.) on CRC is increasingly studied including systemic neutrophil-to-lymphocyte ratio (NLR) as they seem to predict outcome.
  
  
  METHODS
  All patients who underwent curative resection for CRC from 2000 to 2004 at Leeds Teaching Hospitals NHS Trust had pre-operative NLR calculated. Demographic, histopathological and survival data were collected. Tissue microarrays were created and stained to determine the mismatch repair (MMR) protein status of each tumour. Local lymphocytic response to the tumour was assessed and graded.
  
  
  RESULTS
  About 358 patients were eligible. Of these 88 had an NLR ⩾5, which predicted lower overall survival and greater disease recurrence. A high NLR is associated with higher pT- and pN-stage and a greater incidence of extramural venous invasion. MMR protein status was not associated with NLR. A pronounced lymphocytic reaction at the invasive margin (IM) indicated a better prognosis and was associated with a lower NLR.
  
  
  CONCLUSIONS
  Neutrophil-to-lymphocyte ratio predicts disease-free and overall survival and is associated with a more aggressive tumour phenotype. The lymphocytic response to tumour at the IM is associated with NLR however dMMR is not. Neutrophil-to-lymphocyte ratio is a cheap, easy-to-access test that predicts outcome in CRC.
authors.affiliation: 1] Department of HPB Surgery, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK [2] Department of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds LS9 7TF, Leeds, UK.
authors.forename: J K
authors.initials: JK
authors.lastname: Pine
authors.affiliation: Cancer Epidemiology Group, Leeds Institute of Cancer and Pathology, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
authors.forename: E
authors.initials: E
authors.lastname: Morris
authors.affiliation: Department of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds LS9 7TF, Leeds, UK.
authors.forename: G G
authors.initials: GG
authors.lastname: Hutchins
authors.affiliation: Department of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds LS9 7TF, Leeds, UK.
authors.forename: N P
authors.initials: NP
authors.lastname: West
authors.affiliation: Department of Colorectal Surgery, Leeds Institute of Biomedical & Clinical Sciences, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
authors.forename: D G
authors.initials: DG
authors.lastname: Jayne
authors.affiliation: Department of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds LS9 7TF, Leeds, UK.
authors.forename: P
authors.initials: P
authors.lastname: Quirke
authors.affiliation: Department of HPB Surgery, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
authors.forename: K R
authors.initials: KR
authors.lastname: Prasad
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000276:immunology* / Q000401:mortality / Q000473:pathology; D053843:DNA Mismatch Repair; D005260:Female; D006801:Humans; D008214:Lymphocytes / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000276:immunology*