Prognostic utility of neutrophil-to-lymphocyte ratio in patients with metastatic colorectal cancer treated using different modalities

  • G. Nogueira-Costa Centro Hospitalar Barreiro-Montijo
  • I. Fernandes Centro Hospitalar Barreiro-Montijo
  • R. Gameiro Centro Hospitalar Barreiro-Montijo
  • J. Gramaça Centro Hospitalar Barreiro-Montijo
  • A.T. Xavier Centro Hospitalar Barreiro-Montijo
  • I. Pina *Centro Hospitalar Barreiro-Montijo
Keywords: Metastatic Colorectal cancer, neutrophil, lymphocyte, NLR, metastasectomy


Introduction Inflammation is a critical component in carcinogenesis. The neutrophil-to-lymphocyte ratio (nlr) has been retrospectively studied as a biomarker of prognosis in metastatic colorectal cancer (mcrc). Compared with a low nlr, a high nlr is associated with worse prognosis. In the present study, we compared real-world survival for patients with mcrc based on their nlr group, and we assessed the utility of the nlr in determining first-line chemo­therapy and metastasectomy benefit.

Methods In this retrospective and descriptive analysis of patients with mcrc undergoing first-line chemotherapy in a single centre, the last systemic absolute neutrophil and lymphocyte count before treatment was used for the nlr. A receiver operating characteristic curve was used to estimate the nlr cut-off value, dividing the patients into low and high nlr groups. Median overall survival (mos) was compared using Kaplan–Meier curves and the log-rank test. A multivariate analysis was performed using a Cox regression model.

Results The 102 analyzed patients had a median follow-up of 15 months. Regardless of systemic therapy, approx­imately 20% of patients underwent metastasectomy. The nlr cut-off was established at 2.35, placing 45 patients in the low-risk group (nlr < 2.35) and 57 in the high-risk group (nlr ≥ 2.35). The Kaplan–Meier analysis showed a mos of 39.1 months in the low-risk group and 14.4 months in the high-risk group (p < 0.001). Multivariate Cox regression on the nlr estimated a hazard ratio of 3.08 (p = 0.01). Survival analysis in each risk subgroup, considering the history of metastasectomy, was also performed. In the low-risk group, mos was longer for patients undergoing metastasectomy than for those not undergoing the procedure (95.2 months vs. 22.6 months, p = 0.05). In the high-risk group, mos was not statistically different for patients undergoing or not undergoing metastasectomy (24.3 months vs. 12.7 months, p = 0.08).

Conclusions Our real-world data analysis of nlr in patients with mcrc confirmed that this biomarker is useful in predicting survival. It also suggests that nlr is an effective tool to choose first-line treatment and to predict the benefit of metastasectomy.

How to Cite
Nogueira-Costa, G., Fernandes, I., Gameiro, R., Gramaça, J., Xavier, A., & Pina, I. (2020). Prognostic utility of neutrophil-to-lymphocyte ratio in patients with metastatic colorectal cancer treated using different modalities. Current Oncology, 27(5).
Biomarkers in Oncology