The Impact of Neutrophil to Lymphocytic Ratio (NLR) as a Predictor of Treatment Outcomes in Rectal Carcinomas: A Retrospective Cohort Study — Oak Academic Publishing
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The Impact of Neutrophil to Lymphocytic Ratio (NLR) as a Predictor of Treatment Outcomes in Rectal Carcinomas: A Retrospective Cohort Study
Clinical Oncology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
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Clinical Oncology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
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Clinical Oncology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
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Clinical Oncology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
Background and aim : The prognostic role of neutrophil to lymphocyte ratio (NLR) has been shown in many solid tumors included in a recent meta-analysis of one hundred studies. We aimed to evaluate the prognostic value of neutrophil to lymphocyte ratio in treatment outcomes; response and survival of patients with different stages of rectal cancers. Patients and methods : All patients with pathologically confirmed cancer rectum presented to our department during the period from January 2012 to the end of 2014 were included in this retrospective study, these recruited patients were evaluated through their files to determine different objectives of our study . Results : The median overall survival was 31 ± 4.676 months while disease free survival was 40 ± 2.346 for the whole study group; neutrophil to lymphocyte ratio was negatively correlated with overall survival with r = – 0.743 , P < 0.001, also with disease free survival with r = – 0.717, P < 0.0001. Neutrophil to lymphocyte ratio was positively correlated with the number of positive lymph nodes dissected to total number of lymph nodes dissected ratio with r = +0.254, P = 0.028. Roc curve was used to find the accurate cut point of NLR for these patients and was found to be of 4.5. Conclusion : Elevated pre-treatment NLR is a n independent predictor of shorter survival in patients with rectal cancer. This parameter is a simple, easily accessible laboratory test for identifying patients with poorer prognosis.
KeywordsNeutrophil to Lymphocyte RatioOverall SurvivalDisease Free SurvivalRectal Carcinomas
Global Burden of Disease Cancer Collaboration, Fitzmaurice, C., Allen, C., et al. (2017) Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived with Disability, and Disability-Adjusted Life-Years for 32 Cancer Groups, 1990 to 2015: A Systematic Analysis for the Global Burden of Disease Study. JAMA Oncology, 3, 524.
Doubeni, C.A., Laiyemo, A.O., Major, J.M., et al. (2012) Socioeconomic Status and the Risk of Colorectal Cancer: An Analysis of More than a Half Million Adults in the National Institutes of Health-AARP Diet and Health Study. Cancer, 118, 3636-3644. https://doi.org/10.1002/cncr.26677
Ibrahim, A.S., Khalid, H.M., Mikhail, N.N.H., Baraka, H. and Kamel, H. (2014) Cancer Incidence in Egypt: Results of the National Population Based Cancer Registry Program. Journal of Cancer Epidemiology, 2014, Article ID: 437971. https://doi.org/10.1155/2014/437971
Templeton, A.J., McNamara, M.G., Seruga, B., et al. (2014) Prognostic Role of Neutrophil to Lymphocyte Ratio in Solid Tumors: A Systematic Review and Meta-Analysis. Journal of the National Cancer Institute, 106, dju124. https://doi.org/10.1093/jnci/dju124
Templeton, A.J., Pezaro, C., Omlin, A., Amir, E., et al. (2014) Simple Prognostic Score for Metastatic Castration Resistant Prostate Cancer with Incorporation of Neutrophil-to-Lymphocyte Ratio. Cancer, 120, 3346-3352. https://doi.org/10.1002/cncr.28890
Therasse, P., Arbuck, S.G., Eisenhauer, E.A., et al. (2000) New Guidelines to Evaluate the Response to Treatment in Solid Tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of Canada. Journal of the National Cancer Institute, 92, 205-216. https://doi.org/10.1093/jnci/92.3.205
Hanahan, D. and Weinberg, R.A. (2011) Hallmarks of Cancer: The Next Generation. Cell, 144, 646-674. https://doi.org/10.1016/j.cell.2011.02.013
Grivennikov, S.I. and Karin, M. (2010) Dangerous Liaisons: STAT3 and NF-kappaB Collaboration and Crosstalk in Cancer. Cytokine & Growth Factor Reviews, 21, 11-19. https://doi.org/10.1016/j.cytogfr.2009.11.005
Kishimoto, T. (2005) Interleukin-6: From Basic Science to Medicine—40 Years in Immunology. Annual Review of Immunology, 23, 1-21. https://doi.org/10.1146/annurev.immunol.23.021704.115806
Fridman, W.H., Pages, F., Sautes-Fridman, C. and Galon, J. (2012) The Immune Contexture in Human Tumours: Impact on Clinical Outcome. Nature Reviews Cancer, 12, 298-306. https://doi.org/10.1038/nrc3245
Ogino, S., Nosho, K., Irahara, N., et al. (2009) Lymphocytic Reaction to Colorectal Cancer Is Associated with Longer Survival, Independent of Lymph Node Count, Microsatellite Instability, and CpG Island Methylator Phenotype. Clinical Cancer Research, 15, 6412-6420. https://doi.org/10.1158/1078-0432.CCR-09-1438
Mougiakakos, D., Choudhury, A., Lladser, A., Kiessling, R. and Johansson, C.C. (2010) Regulatory T Cells in Cancer. Advances in Cancer Research, 107, 57-117. https://doi.org/10.1016/S0065-230X(10)07003-X
Kwon, H.C., Kim, S.H., Oh, S.Y., et al. (2012) Clinical Significance of Preoperative Neutrophil-Lymphocyte versus Platelet-Lymphocyte Ratio in Patients with Operable Colorectal Cancer. Biomarkers, 17, 216-222. https://doi.org/10.3109/1354750X.2012.656705
Toiyama, Y., Inoue, Y., Kawamura, M., et al. (2015) Elevated Platelet Count as Predictor of Recurrence in Rectal Cancer Patients Undergoing Preoperative Chemoradiotherapy Followed by Surgery. International Surgery, 100, 199-207. https://doi.org/10.9738/INTSURG-D-13-00178.1
Carruthers, R., Tho, L.M., Brown, J., Kakumanu, S., McCartney, E. and McDonald, A.C. (2012) Systemic Inflammatory Response Is a Predictor of Outcome in Patients Undergoing Preoperative Chemoradiation for Locally Advanced Rectal Cancer. Colorectal Disease, 14, e701-e707. https://doi.org/10.1111/j.1463-1318.2012.03147.x
Dong, Y.-W., Shi, Y.-Q., He, L.-W. and Su, P.-Z. (2016). Prognostic Significance of Neutrophil-to-Lymphocyte Ratio in Rectal Cancer: A Meta-Analysis. OncoTargets and Therapy, 9, 3127-3134. https://doi.org/10.2147/OTT.S103031
Shen, J.W., Zhu, Y., Wu, W., Zhang, L.N., Ju, H.X., Fan, Y.T., et al. (2017) Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Locally Advanced Rectal Cancer Treated with Neoadjuvant Chemoradiotherapy. Medical Science Monitor, 23, 315-324. https://doi.org/10.12659/MSM.902752
Pedrazzani, C., Mantovai, G., Fernandes, E., Bagante, F., et al. (2017) Assessment of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Platelet Count as Predictors of Long-Term Outcome after R0 Resection for Colorectal Cancer. Nature, 7, 1494. https://doi.org/10.1038/s41598-017-01652-0
Li, X., Dai, D.N., Chen, B., Tang, H.L., Xie, X.M. and Wei, W.D. (2018) The Value of Neutrophil-to-Lymphocyte Ratio for Response and Prognostic Effect of Neoadjuvant Chemotherapy in Solid Tumors: A Systematic Review and Meta-Analysis. Journal of Cancer, 9, 861-871. https://doi.org/10.7150/jca.23367
Haram, A., Boland, M.R., Kelly, M.E., Bolger, J.C., Waldron, R.M. and Kerin, M.J. (2017) The Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Colorectal Cancer: A Systematic Review. Journal of Surgical Oncology, 115, 470-479. https://doi.org/10.1002/jso.24523
Ward, W.H., Goel, N., Ruth, K.J., Esposito, A.C., Lambreton, F., Sigurdson, E.R., Meyer, J.E. and Farma, J.M. (2018) Predictive Value of Leukocyte-and Platelet-Derived Ratios in Rectal Adenocarcinoma. Journal of Surgical Research, 232, 275-282. https://doi.org/10.1016/j.jss.2018.06.060
Ibrahim, A.S., Khaled, H.M., Mikhail, N.M., Baraka, H. and Kamel, H. (2014) Cancer Incidence in Egypt: Results of the National Population-Based Cancer Registry Program. Journal of Cancer Epidemiology, 2014, Article ID: 437971. https://doi.org/10.1155/2014/437971
Metwally, I.H., Shetiwy, M., Elalfy, A.F., Abouzid, A., Saleh, S.S. and Hamdy, M. (2018) Epidemiology and Survival of Colon Cancer among Egyptians: A Retrospective Study. Journal of Coloproctology, 38, 24-29. https://doi.org/10.1016/j.jcol.2017.09.418
Chua, W., Charles, K.A., Baracos, V.E. and Clarke, S.J. (2011) Neutrophil/Lymphocyte Ratio Predicts Chemotherapy Outcomes in Patients with Advanced Colorectal Cancer. British Journal of Cancer, 104, 1288-1295. https://doi.org/10.1038/bjc.2011.100
Jankova, L., Dent, O.F., Chan, C., Chapuis, P. and Clark, S.J. (2013) Preoperative Neutrophil/Lymphocyte Ratio Predicts Overall Survival But Does Not Predict Recurrence or Cancer-Specific Survival after Curative Resection of Node-Positive Colorectal Cancer. BMC Cancer, 13, 442. https://doi.org/10.1186/1471-2407-13-442
Kim, H., Jung, H.I., Kwon, S.H., Bae, S.H., Kim, H.C., Baek, M.-J. and Lee, M.S. (2019) Preoperative Neutrophil-Lymphocyte Ratio and CEA Is Associated with Poor Prognosis in Patients with Synchronous Colorectal Cancer Liver Metastasis. Annals of Surgical Treatment and Research, 96, 191-200. https://doi.org/10.4174/astr.2019.96.4.191