Annals of Coloproctology

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Neutrophil to Lymphocyte Ratio: A Predictive Marker for Treatment Outcomes in Patients With Rectal Cancer Who Underwent Neoadjuvant Chemoradiation Followed by Surgery: Byong Ho Jeon, Ui Sup Shin, Sun Mi Moon, Jung Il Choi, Mi-Sook Kim, Kie Hwan Kim, Se-Jin Sung; Ann Coloproctol. 2019;35(2):100-106. Published online April 30, 2019; DOI: https://doi.org/10.3393/ac.2018.10.01

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Purpose
In this study, we investigated the role of neutrophil to lymphocyte ratio (NLR) as a predictor of tumor response and as a prognostic factor in patients with rectal cancer who had undergone curative surgery after neoadjuvant chemoradiation therapy (nCRT).
Methods
Between January 2009 and July 2016, we collected 140 consecutive patients who had undergone curative intent surgery after nCRT due to rectal adenocarcinoma. We obtained the pre- and post-nCRT NLR by dividing the neutrophil count by the lymphocyte count. The cutoff value was obtained using receiver operating characteristic analysis for tumor response and using maximally selected rank analysis for recurrence-free survival (RFS). The relationship among NLR, tumor response, and RFS was assessed by adjusting the possible clinico-pathological confounding factors.
Results
The possibility of pathologic complete response (pCR) was significantly decreased in high pre- (>2.77) and postnCRT NLR (>3.23) in univariate regression analysis. In multivariate analysis, high post-nCRT NLR was an independent negative predictive factor for pCR (adjusted odds ratio, 0.365; 95% confidence interval [CI], 0.145–0.918). The 5-year RFS of all patients was 74.6% during the median 37 months of follow-up. Patients with higher pre- (>2.66) and post-nCRT NLR (>5.21) showed lower 5-year RFS rates (53.1 vs. 83.3%, P = 0.006) (69.2 vs. 75.7%, P = 0.054). In multivariate Cox analysis, high pre-nCRT NLR was an independent poor prognostic factor for RFS (adjusted hazard ratio, 2.300; 95% CI, 1.061–4.985).
Conclusion
Elevated NLR was a negative predictive marker for pCR and was independently associated with decreased RFS. For confirmation, a large-scale study with appropriate controls is needed.

Citations

Citations to this article as recorded by

Recurrence risk following rectal cancer surgery: a survival analysis of key predictors
Neda Gorjizadeh, Reza Hajebi, Matin Vahedi, Mahsa Mottahedi, Elham Nazar
Japanese Journal of Clinical Oncology.2025; 55(8): 880. CrossRef
Circulating Markers of Systemic Inflammation, Measured After Completion of Neoadjuvant Therapy, Associated With Response in Locally Advanced Rectal Cancer
Ross K. McMahon, Sean M. O’Cathail, Colin W. Steele, Harikrishnan S. Nair, Jonathan J. Platt, Donald C. McMillan, Paul G. Horgan, Campbell S. Roxburgh
Diseases of the Colon & Rectum.2025; 68(6): 713. CrossRef
Response Prediction to Neoadjuvant Chemoradiotherapy in Rectal Cancer Based on Systemic Inflammatory Markers (NLR, PLR, and LMR)
Roger Beltrati Coser, Caio Sergio R. Nahas, Alex Jones Flores Cassenote, Omar S. T. Ghani, Rafaela B. B. Pinheiro, Sergio Carlos Nahas, Carlos Frederico S. Marques
Journal of Gastrointestinal Cancer.2025;[Epub] CrossRef
Prognostic Value of Dynamic Changes in Immune-Inflammatory and Tumor Biomarkers Following Chemoradiotherapy in Locally Advanced Rectal Cancer
Mahmoud Al-Masri, Yasmin Safi, Mohammad Almasri, Ramiz Kardan, Daliana Mustafa, Osama Alayyan, Bilal Kahalah, Rama AlMasri
Cancers.2025; 17(20): 3383. CrossRef
Hematological markers as prognostic predictors in patients undergoing colon cancer surgery
Jessica Patricia Gonzales Stuva, Carlos Pérez-López, Marcelo Sebastian Ramírez Romero, Ana Bernabeu García, Pamela Vivas Angeles, Diana Escolà Ripoll, Sandra López Gordo
Scientific Reports.2025;[Epub] CrossRef
Landscape of Biomarkers and Pathologic Response in Rectal Cancer: Where We Stand?
Abrahams Ocanto, Macarena Teja, Francesco Amorelli, Felipe Couñago, Ariel Gomez Palacios, Diego Alcaraz, Ramón Cantero
Cancers.2024; 16(23): 4047. CrossRef
Prognostic role of platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte, and lymphocyte-to-monocyte ratio in operated rectal cancer patients: systematic review and meta-analysis
Giuseppe Portale, Patrizia Bartolotta, Danila Azzolina, Dario Gregori, Valentino Fiscon
Langenbeck's Archives of Surgery.2023;[Epub] CrossRef
NEUTROPHIL-LYMPHOCYTE RATIO (NLR) AND LYMPHOPENIAAS PROGNOSTIC FACTORS OF OVERALL SURVIVAL IN LOCALADVANCED RECTAL CANCER
Ocanto A, Morera R, Rodríguez I, Cantero R
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH.2023; : 11. CrossRef
Neutrophil-to-lymphocyte ratio predicts survival of patients with rectal cancer receiving neo-adjuvant chemoradiation followed by radical resection: a meta-analysis
Giuseppe Colloca, Antonella Venturino, Domenico Guarneri
Expert Review of Anticancer Therapy.2023; 23(4): 421. CrossRef
Efficacy of concurrent radiotherapy in patients with locally advanced rectal cancer and synchronous metastasis receiving systemic therapy
Tzu-Chieh Yin, Po-Jung Chen, Yung-Sung Yeh, Ching-Chun Li, Yen-Cheng Chen, Wei-Chih Su, Tsung-Kun Chang, Ching-Wen Huang, Chun-Ming Huang, Hsiang-Lin Tsai, Jaw-Yuan Wang
Frontiers in Oncology.2023;[Epub] CrossRef
The Crying Need for a Better Response Assessment in Rectal Cancer
Samuel Amintas, Nicolas Giraud, Benjamin Fernandez, Charles Dupin, Quentin Denost, Aurelie Garant, Nora Frulio, Denis Smith, Anne Rullier, Eric Rullier, Te Vuong, Sandrine Dabernat, Véronique Vendrely
Current Treatment Options in Oncology.2023; 24(11): 1507. CrossRef
Prognostic Role of Peripheral Neutrophil-Lymphocyte Ratio (NLR) and Platelet-Lymphocyte Ratio (PLR) in Patients with Rectal Cancer Undergoing Neoadjuvant Chemoradiotherapy
Şefika Arzu Ergen, Ceren Barlas, Cumhur Yıldırım, Didem Çolpan Öksüz
Journal of Gastrointestinal Cancer.2022; 53(1): 151. CrossRef
Deep regional hyperthermia combined with modern concurrent chemoradiotherapy increases T-downstaging rate in locally advanced rectal cancer
Yuxia Wang, Siyi Lu, Yuxia Shao, Ran Peng, Xuemin Li, Junjie Wang, Hao Wang
International Journal of Hyperthermia.2022; 39(1): 431. CrossRef
High Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Low Lymphocyte Levels Are Correlated With Worse Pathological Complete Response Rates
Serdar Karakaya, İbrahim Karadağ, Mehmet Emin Yılmaz, Ömür Berna Çakmak Öksüzoğlu
Cureus.2022;[Epub] CrossRef
Pretreatment inflammatory markers predicting treatment outcomes in colorectal cancer
Sanghyun An, Hongjin Shim, Kwangmin Kim, Bora Kim, Hui-Jae Bang, Hyejin Do, Hyang-Rae Lee, Youngwan Kim
Annals of Coloproctology.2022; 38(2): 97. CrossRef
Watch and wait strategies for rectal cancer: A systematic review
In Ja Park
Precision and Future Medicine.2022; 6(2): 91. CrossRef
Histopathological and Haemogram Features Correlate with Prognosis in Rectal Cancer Patients Receiving Neoadjuvant Chemoradiation without Pathological Complete Response
Yu-Ming Huang, Hsi-Hsien Hsu, Chien-Kuo Liu, Ching-Kuo Yang, Po-Li Tsai, Tzu-Yin Tang, Shih-Ming Hsu, Yu-Jen Chen
Journal of Clinical Medicine.2022; 11(17): 4947. CrossRef
Prognostic and predictive value of neutrophil-to-lymphocyte ratio after curative rectal cancer resection: A systematic review and meta-analysis
Hytham K.S. Hamid, George N. Davis, Mario Trejo-Avila, Patrick O. Igwe, Andrés Garcia-Marín
Surgical Oncology.2021; 37: 101556. CrossRef
The prognostic utility of pre‐treatment neutrophil‐to‐lymphocyte‐ratio (NLR) in colorectal cancer: A systematic review and meta‐analysis
Mate Naszai, Alina Kurjan, Timothy S. Maughan
Cancer Medicine.2021; 10(17): 5983. CrossRef
Predictive Ability of Neutrophil-Lymphocyte Ratio in Determining Tumor Staging in Colorectal Cancer
Chirag Pereira, Jiju Mohan, Shankar Gururaj, Prajwal Chandrashekhara
Cureus.2021;[Epub] CrossRef
An inflammation index-based prediction of treatment response to neoadjuvant chemoradiotherapy for rectal mucinous adenocarcinoma
Yanwu Sun, Zhekun Huang, Pan Chi
International Journal of Clinical Oncology.2020; 25(7): 1299. CrossRef

Is the Location of the Tumor Another Prognostic Factor for Patients With Colon Cancer?: Myung-Kyu Jung, Ui Sup Shin, Young-Jun Ki, Yong-Bae Kim, Sun-Mi Moon, Se-Jin Sung; Ann Coloproctol. 2017;33(6):210-218. Published online December 31, 2017; DOI: https://doi.org/10.3393/ac.2017.33.6.210

6,366 View
94 Download
16 Web of Science
16 Citations

Abstract PDF

Purpose

In this study, we investigated both the characteristics of right colon cancer (RTCC) in comparison with those of left colon cancer (LTCC) and the impact of the location of the colon cancer on the prognosis.

Methods

We retrospectively analyzed the cases of 974 patients with nonmetastatic colon cancer who had undergone surgery with a curative intent from January 2001 to December 2011. RTCC was defined as a tumor located proximal to the splenic flexure. The characteristics of RTCC cancer were investigated by using descriptive analyses, and their impacts on the prognosis were assessed by using a Cox multivariate regression.

Results

Compared to LTCC, RTCC showed a female-dominant feature, and an undifferentiated pathology was more frequently observed. The number of lymph nodes retrieved from patients with RTCC was significantly higher than that retrieved from patients with LTCC. During 75 months of follow-up, peritoneal recurrence was more common in patients with RTCC than it was in patients with LTCC, and among the patients with stage III colon cancer, the disease-free and the overall survival rates were significantly worse in patients with RTCC. After adjustments with the other prognostic factors associated with colon cancer had been made, a tumor located at the right colon was found to be independently associated with poor prognosis.

Conclusion

RTCC showed unique clinicopathologic features and was associated with a poorer prognosis.

Citations

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