The preoperative neutrophil to lymphocyte ratio is a superior indicator of prognosis compared with other inflammatory biomarkers in resectable colorectal cancer

Yongxi Song, Yuchong Yang, Peng Gao, Xiaowan Chen, Dehao Yu, Yingying Xu, Junhua Zhao, Zhenning Wang, Yongxi Song, Yuchong Yang, Peng Gao, Xiaowan Chen, Dehao Yu, Yingying Xu, Junhua Zhao, Zhenning Wang

Abstract

Background: Growing evidence has indicated that some inflammatory markers, including lymphocyte to monocyte ratio (LMR), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and prognostic nutritional index (PNI), can be used as indicators in the prognosis of colorectal cancer (CRC). However, there is controversy concerning what is the best predictor of prognosis in CRC.

Methods: A cohort of 1744 CRC patients in our institution was analyzed retrospectively. Harrell's concordance index (c-index) and Bayesian information criterion (BIC) were used to determine the optimal cut-off values of inflammatory markers and compare their predictive capacity. The association of inflammatory markers with overall survival (OS) and cancer-specific survival (CSS) was analyzed using Kaplan-Meier methods with log-rank test, followed by multivariate Cox proportional hazards model.

Results: The multivariate analysis indicated that among these inflammatory markers, NLR (< 2.0 vs. ≥ 2.0) was the only independent prognostic factor for poor OS [hazard ratio (HR) = 0.758, 95% confidence intervals (CI) = 0.598-0.960, P = 0.021)] and CSS (HR = 0.738, 95% CI = 0.573-0.950, P = 0.018). Among these inflammatory markers, the c-index and BIC value for NLR were maximum and minimum for OS, respectively. In addition, the c-index was higher and the BIC value was smaller in TNM staging combined with NLR compared with the values obtained in TNM staging alone.

Conclusion: NLR is a superior indicator of prognosis compared with LMR, PLR, and PNI in CRC patients, and NLR may serve as an additional indicator based on the current tumor staging system.

Keywords: Colorectal neoplasms; Lymphocyte to monocyte ratio; Neutrophil to lymphocyte ratio; Platelet to lymphocyte ratio; Prognosis; Prognostic nutritional index; TNM staging.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Research Ethics Committee of China Medical University. Written informed consent was obtained from all patients. For the minors, written informed consent was obtained by the parents or legal guardians.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no conflict of interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Kaplan-Meier curves of overall survival (OS) and cancer-specific survival (CSS) in CRC patients based on inflammatory biomarkers: a LMR; b NLR; c PLR; d PNI
Fig. 2
Fig. 2
Comparison of the c-index and BIC values for inflammatory biomarkers on overall survival (OS) and cancer-specific survival (CSS): a c-index value; b BIC values

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Source: PubMed

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