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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References
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71:209-49.
2. Naszai M, Kurjan A, Maughan TS. The prognostic utility of pre-treatment neutrophil-to-lymphocyte-ratio (NLR) in colorectal cancer: A systematic review and meta-analysis. Cancer Med. 2021;10:5983-97.
3. van den Berg, I., Coebergh van den Braak, R. R. J., van Vugt, J. L. A., Ijzermans, J. N. M., & Buettner, S. (2021). Actual survival after resection of primary colorectal cancer: results from a prospective multicenter study. World journal of surgical oncology, 19(1), 96. https://doi.org/10.1186/s12957-021-02207-4
4. Yahagi M, Okabayashi K, Hasegawa H, Tsuruta M, Kitagawa Y. The Worse Prognosis of Right-Sided Compared with Left-Sided Colon Cancers: a Systematic Review and Meta-analysis. Journal of Gastrointestinal Surgery. 2016;20:648-55.
5. Skancke M, Arnott SM, Amdur RL, Siegel RS, Obias VJ, Umapathi BA. Lymphovascular invasion and perineural invasion negatively impact overall survival for stage II adenocarcinoma of the colon. Dis Colon Rectum. 2019;62:181-8.
6. Puerta-Garcia E, Canadas-Garre M, Calleja-Hernandez MA. Molecular biomarkers in colorectal carcinoma. Pharmacogenomics. 2015;16:1189-222.
7. Ortiz-López D, Marchena-Gómez J, Nogués-Ramía E, Sosa-Quesada Y, Arencibia-Pérez B, Artiles-Armas M, et al. Utility of a new prognostic score based on the Comprehensive Complication Index (CCI®) in patients operated on for colorectal cancer (S-CRC-PC score). Surg Oncol. 2022;42.
8. Balkwill, F., & Mantovani, A. (2001). Inflammation and cancer: back to Virchow?. Lancet (London, England), 357(9255), 539–545. https://doi.org/10.1016/S0140-6736(00)04046-0
9. Yashiro M. Ulcerative colitis-associated colorectal cancer. World J Gastroenterol. 2014;20:16389-97.
10. Li M-X, Liu X-M, Zhang X-F, Zhang J-F, Wang W-L, Zhu Y, et al. Prognostic role of neutrophil-to-lymphocyte ratio in colorectal cancer: a systematic review and meta-analysis. Int J Cancer. 2014;134:2403-13.
11. Yu Y, Wang H, Yan A, Wang H, Li X, Liu J, et al. Pretreatment neutrophil to lymphocyte ratio in determining the prognosis of head and neck cancer: a meta-analysis. BMC Cancer. 2018;18.
12. Mjaess G, Chebel R, Karam A, Moussa I, Pretot D, Abi Tayeh G, et al. Prognostic role of neutrophil-to-lymphocyte ratio (NLR) in urological tumors: an umbrella review of evidence from systematic reviews and meta-analyses. Acta Oncol (Madr). 2021;60.
13. He X, Su A, Xu Y, Ma D, Yang G, Peng Y, et al. Prognostic Role of Lymphocyte-C-Reactive Protein Ratio in Colorectal Cancer: A Systematic Review and Meta Analysis. Front Oncol. 2022;12:905144.
14. Mei Z, Shi L, Wang B, Yang J, Xiao Z, Du P, et al. Prognostic role of pretreatment blood neutrophil-to-lymphocyte ratio in advanced cancer survivors: A systematic review and meta-analysis of 66 cohort studies. Cancer Treat Rev. 2017;58.
15. Haram A, Boland MR, Kelly ME, Bolger JC, Waldron RM, Kerin MJ. The prognostic value of neutrophil-to-lymphocyte ratio in colorectal cancer: A systematic review. J Surg Oncol. 2017;115:470-9.
16 Naszai M, Kurjan A, Maughan TS. The prognostic utility of pre-treatment neutrophil-to-lymphocyte-ratio (NLR) in colorectal cancer: A systematic review and meta-analysis. Cancer Med. 2021;10:5983-97.
17. Balde AI, Fang S, He L, Cai Z, Han S, Wang W, et al. Propensity score analysis of recurrence for neutrophil-to-lymphocyte ratio in colorectal cancer. J Surg Res. 2017;219:244-52.
18. Mazaki J, Katsumata K, Kasahara K, Tago T, Wada T, Kuwabara H, et al. Neutrophil-to-lymphocyte ratio is a prognostic factor for colon cancer: A propensity score analysis. BMC Cancer. 2020;20.
19. Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017;67:93-9.
20. Youden WJ. Index for rating diagnostic tests. Cancer. 1950;3:32-5.
21. Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47:1245-51.
22. Weiser MR. AJCC 8th Edition: Colorectal Cancer. Ann Surg Oncol. 2018;25:1454-5.
23. Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien PA. The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg. 2013;258:1-7.
24. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205-13.
25. Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res. 2011;46:399-424.
26. Austin PC. Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat. 2011;10:150-61.
27. Bai Z, Zhou Y, Ye Z, Xiong J, Lan H, Wang F. Tumor-Infiltrating Lymphocytes in Colorectal Cancer: The Fundamental Indication and Application on Immunotherapy. Front Immunol. 2022;12.
28. Schmitt M, Greten FR. The inflammatory pathogenesis of colorectal cancer. Nat Rev Immunol. 2021;21:653-67.
29. Tuomisto AE, Mäkinen MJ, Väyrynen JP. Systemic inflammation in colorectal cancer: Underlying factors, effects, and prognostic significance. World J Gastroenterol. 2019;25:4383-404.
30. Gui W, Wang X, Luo Y, Wang J. Platelet to lymphocyte ratio as a prognostic factor in patients with advanced colorectal cancer undergoing palliative treatment. Ann Palliat Med. 2020;9.
31. Allin KH, Nordestgaard BG. Elevated C-reactive protein in the diagnosis, prognosis, and cause of cancer. Crit Rev Clin Lab Sci. 2011;48:155-70.
32. Chiang SF, Hung HY, Tang R, et al. Can neutrophil-to-lymphocyte ratio predict the survival of colorectal cancer patients who have received curative surgery electively?. Int J Colorectal Dis. 2012;27(10):1347-1357. doi:10.1007/s00384-012-1459-x
33. Forget P, Khalifa C, Defour JP, Latinne D, Van Pel MC, De Kock M. What is the normal value of the neutrophil-to-lymphocyte ratio?. BMC Res Notes. 2017;10(1):12. Published 2017 Jan 3. doi:10.1186/s13104-016-2335-5
34. Youden WJ. Index for rating diagnostic tests. Cancer. 1950;3.
35. Li Y, Jia H, Yu W, Xu Y, Li X, Li Q, et al. Nomograms for predicting prognostic value of inflammatory biomarkers in colorectal cancer patients after radical resection. Int J Cancer. 2016;139:220-31.
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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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