Year 2024 / Volume 116 / Number 8
Original
Prognostic value of neutrophil-to-lymphocyte ratio at diagnosis in colorectal cancer: propensity score analysis

408-415

DOI: 10.17235/reed.2024.10041/2023

David Ortiz López, Joaquín Marchena Gómez, Eva María Nogués Ramia, Yurena Sosa Quesada, Beatriz Arencibia Pérez, Manuel Artiles Armas, Julia Gil García, Cristina Roque Castellano,

Abstract
Introduction: baseline neutrophil-to-lymphocyte ratio (NLR) at the time of colorectal cancer (CRC) diagnosis has been proposed as a predictor of long-term survival. The aim of this study was to analyze its usefulness in a homogeneous population with control of the main confounding factors. Methodology: observational study of 836 patients who underwent surgery for CRC. Patients were divided into two groups: NLR ≤ 3.3 vs NLR > 3.3. To control for confounders, they were matched one-to-one by propensity analysis. A final cohort of 526 patients was included in the study. Results: the two groups were mismatched in terms of age, comorbidity, tumor stage, rectal location, and neoadjuvant therapy. Once matching was performed, baseline NLR was statistically significantly associated with long-term survival (p < 0.001) and behaved as an independent prognostic factor for survival (p = 0.001; HR: 1.99; 95 % CI: 1.32-3.00) when adjusted in a Cox regression model using age (p < 0.001; HR: 1.04; 95 % CI: 1.02-1.06) and the Charlson Comorbidity Index (p < 0.001; HR: 1.40; 95 % CI: 1.27-1.55). Neoadjuvant therapy lost its statistical significance (p = 0.137; HR: 1.59; 95 % CI: 0.86-2.93). Conclusions: a high baseline NLR (> 3.3) in patients with colorectal cancer at diagnosis represents a poor prognostic factor in terms of survival. Its use in routine practice could intensify therapeutic strategies and follow-up in these patients.
Lay Summary
The neutrophil-to-lymphocyte ratio (NLR) is a parameter which is easily calculated using values from a complete blood count. It has been described in the literature that if elevated, it is associated with a proinflammatory state in the body. The main hypothesis of this study is that an elevated NLR is related to a worse prognosis, and therefore poorer survival, in patients diagnosed with colorectal cancer. To demonstrate this, a series of patients who underwent surgical intervention with a diagnosis of colorectal cancer from 2015 to 2021 was analysed. Among other data, we studied the NLR at the time of diagnosis. The patients were divided into two groups: one with a NLR > 3.3 and the other with a NLR ≤ 3.3. The two samples were homogenized to eliminate differences which might exist between the two populations, using what is called a propensity score analysis. After conducting a statistical analysis of the factors influencing the prognosis of colorectal cancer, it was observed that a NLR > 3.3 at the time of diagnosis is an important prognostic factor for survival in these patients. Other factors related to survival include the patient's age and comorbidities. In conclusion, we find that an elevated baseline NLR (> 3.3) in patients with colorectal cancer at the time of diagnosis represents an adverse prognostic factor in terms of survival. Its use in routine practice could lead to the intensification of therapeutic strategies and post-treatment surveillance in these patients.
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Ortiz López D, Marchena Gómez J, Nogués Ramia E, Sosa Quesada Y, Arencibia Pérez B, Artiles Armas M, et all. Prognostic value of neutrophil-to-lymphocyte ratio at diagnosis in colorectal cancer: propensity score analysis. 10041/2023


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Publication history

Received: 25/10/2023

Accepted: 21/12/2023

Online First: 23/01/2024

Published: 01/08/2024

Article revision time: 55 days

Article Online First time: 90 days

Article editing time: 281 days


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