title: Activated systemic inflammatory response at diagnosis reduces lymph node count in colonic carcinoma.
abstract: OBJECTIVE
  To investigate a link between lymph node yield and systemic inflammatory response in colon cancer.
  
  
  METHODS
  A prospectively maintained database was interrogated. All patients undergoing curative colonic resection were included. Neutrophil lymphocyte ratio (NLR) and albumin were used as markers of SIR. In keeping with previously studies, NLR ≥ 4, albumin < 35 was used as cut off points for SIR. Statistical analysis was performed using 2 sample t-test and χ(2) tests where appropriate.
  
  
  RESULTS
  Three hundred and two patients were included for analysis. One hundred and ninety-five patients had NLR < 4 and 107 had NLR ≥ 4. There was no difference in age or sex between groups. Patients with NLR of ≥ 4 had lower mean lymph node yields than patients with NLR < 4 [17.6 ± 7.1 vs 19.2 ± 7.9 (P = 0.036)]. More patients with an elevated NLR had node positive disease and an increased lymph node ratio (≥ 0.25, P = 0.044).
  
  
  CONCLUSIONS
  Prognosis in colon cancer is intimately linked to the patient's immune response. Assuming standardised surgical technique and sub specialty pathology, lymph node count is reduced when systemic inflammatory response is activated.
authors: Rory P Kennelly, Brenda Murphy, John O Larkin, Brian J Mehigan, Paul H McCormick, Department of Colorectal Surgery, St James Hospital, Dublin 8, Ireland.
authors: Rory P
authors: RP
authors: Kennelly
authors: Rory P Kennelly, Brenda Murphy, John O Larkin, Brian J Mehigan, Paul H McCormick, Department of Colorectal Surgery, St James Hospital, Dublin 8, Ireland.
authors: Brenda
authors: B
authors: Murphy
authors: Rory P Kennelly, Brenda Murphy, John O Larkin, Brian J Mehigan, Paul H McCormick, Department of Colorectal Surgery, St James Hospital, Dublin 8, Ireland.
authors: John O
authors: JO
authors: Larkin
authors: Rory P Kennelly, Brenda Murphy, John O Larkin, Brian J Mehigan, Paul H McCormick, Department of Colorectal Surgery, St James Hospital, Dublin 8, Ireland.
authors: Brian J
authors: BJ
authors: Mehigan
authors: Rory P Kennelly, Brenda Murphy, John O Larkin, Brian J Mehigan, Paul H McCormick, Department of Colorectal Surgery, St James Hospital, Dublin 8, Ireland.
authors: Paul H
authors: PH
authors: McCormick
keywords: Colon cancer; Colonic cancer; Lymph node count; Lymph node ratio; Lymph node yield; Neutrophil to lymphocyte ratio; Neutrophil-lymphocyte ratio; Systemic inflammatory response