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Neutrophil-Lymphocyte Ratio as a Prognostic Factor in Incurable Stage IV Colorectal Cancer

The number of colorectal cancer (CRC) patients has been increasing rapidly worldwide in recent decades, and the survival rates of CRC patients have increased in the past few years, possibly as a result of progress in diagnostic faculty and improved chemotherapy. The aim of this study was investigating the predictive potential of these available and convenient laboratory dates in stage IV colorectal cancer (CRC) patients.

The authors identified the cases of 114 consecutive patients who underwent the surgery at our Hospital between January 2006 and December 2012 by using the multivariate analysis, the Cox proportional-hazard regression model. They divided the patients in 3 groups: 1) metastatic lesion resection group with primary lesion resection (n = 52 in the Met/Prim lesion group), 2) primary lesion resection without metastatic lesion resection (n = 38 in the Primary lesion group) and 3) palliative operation (n = 24 in the Palliative group). Routine laboratory measurements prior to surgery were also analyzed in this study. And the correlation between overall survival and clinicopathological findings, including GPS, NLR and other general laboratory measurements in the Met/Prim lesion group, was examined.

Multivariate analysis for the predictors of survival showed metastatic lesion resection [hazard ratio (HR) = 3.2, 95% confidence interval (CI) 1.6 - 6.6; p = 0.007] and only primary lesion resection (HR = 1.9, 95% CI 1.1 - 4.0; p = 0.045) remained independently significant prognostic factors. Age was the only independent risk factor in the Met/Prim lesion group. In the Primary lesion group, Neutrophil lymphocyte ratio (NLR) > 5, elevated Alanine aminotransferase and patients without chemotherapy were correlated with poor survival. In the Palliative group, NLR > 5 and patients who could not be treated with chemotherapy remained independent predictors of worse survival.

In summary, the adoption of the pretreatment measurement of the NLR is not only simple and convenient for the classification of patients, but also one of the important predictors of mortality for incurable stage IV CRC patients. Further study is required to test the validity, reliability, reproducibility and clinical usefulness of the results for patients with stage IV CRC.


Article by Shinya Munakata, et al, from Juntendo University, Tokyo, Japan.

Full access: http://mrw.so/10BPc3

Image by Adrian Dan, from Flickr-cc.

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