The Neutrophil-to-Lymphocyte Ratio as a Marker of Lymph Node Status in Patients with Rectal Cancer.
OBJECTIVE
The aim of the study was to investigate the role of the neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker of rectal cancers.


METHODS
We undertook a retrospective review of patients with rectal cancer. Pre-treatment NLR was assessed for association and predictive values against clinicopathological staging and post-treatment outcomes.


RESULTS
A total of 140/180 cases were included in the final analysis [male:female 2:1; mean age 68 years (interquartile range 58-75)]. The pre-operative mean NLR was 5.4 ± 6.8. There was a strong positive correlation between NLR and C-reactive protein (Spearman's rho 64.3%, p < 0.001). A high NLR was associated with a positive nodal status on MRI (5.2 vs. 3.8, p = 0.03) and histopathological (4.8 vs. 3.8, p = 0.02) assessment. The NLR showed an average value for predicting MRI and pathological nodal status on receiver operating characteristic analysis [area under the curve = 0.72 (95% CI = 0.54-0.91), p = 0.031 and area under the curve = 0.64 (95% CI = 0.52-0.077), p = 0.021, respectively]. On multivariate analysis, the total lymph node retrieved at operation was the best predictor of pathological nodal involvement; NLR did not show any predictive value. Patients with an NLR >4 showed reduced recurrence-free (60 vs. 86 months, p = 0.52) and overall survival (57 vs. 84 months, p = 0.40) without statistical significance.


CONCLUSIONS
Raised pre-treatment NLR may indicate nodal involvement in patients with rectal cancer.
Department of Academic and Colorectal Surgery, Royal Free Hospital, London, UK.
Aftab A
AA
Khan
Georgios
G
Akritidis
Toby
T
Pring
Swethan
S
Alagarathnam
Geoffrey
G
Roberts
Regina
R
Raymond
Massimo
M
Varcada
Richard
R
Novell
D000368:Aged; D019540:Area Under Curve; D014408:Biomarkers, Tumor / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D018655:Lymphocyte Count; D008214:Lymphocytes; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D011237:Predictive Value of Tests; D012372:ROC Curve; D012004:Rectal Neoplasms / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate
D014408:Biomarkers, Tumor; D002097:C-Reactive Protein