Journal de recherche sur les tumeurs
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Neutrophilic Lymphocytic Ratio as Predictive Biomarker in Advanced Rectal Cancer Patients

Amrou Shabaan, Mohamed Ashour and Amany A Elbasmy

Background: Preoperative Neutrophil-Lymphocytic ratio has been suggested in many studies in resected colorectal cancer as predictive marker for recurrence and survival. This study investigated impact of pretreatment Neutrophil-Lymphocytic ratio on treatment outcome in rectal cancer patients.

Methods: Retrospective analysis of pretreatment Neutrophil-Lymphocytic ratio for one hundred and forty two patients with locally advanced rectal carcinoma (LARC) treated by neoadjuvant concomitant chemo-radiotherapy followed by surgical resection, between June 2006 and June 2011 in Minia University Hospital and Al-Hussein University Hospital. In order to study neutrophil lymphocytic ratio as a predictive factor for disease free survival and overall survival, other factors like age, sex, tumor length, tumor distance from anal verge, number of resected lymph nodes, positive lymph nodes, excision margin, tumor differentiation and circumferential resection margin with their impact on disease free survival and overall survival were also studied.

Results: One hundred forty two patients with mean age of 65.1 ± 10.8. 64% were females; more than one third (34.5%) underwent colostomy and 61.3% ≤ 5 cm from anal verge. Pretreatment CEA was above 3 ng/ml in 57.7% of patients. Mean NLR was 4.1 ± 2.87. NLR of 58.4% patients were >3. Regarding disease free survival, In a univariate analysis, only involved excisional margin seen in 8 patients and positive CRM seen in 15 patients show significant impact on DFS (p-value 0,01, 0.001), respectively. On other hand, NLR didn’t show significance on DFS. None of the studied factors showed impact on overall survival in a univariate analysis. However, Neutrophil lymphocytic ratio at cut-off 3 showed significance. Population group with NLR ratio ≥ 3 showed less survival with a mean of 52.5 month compared to those with NLR ratio <3 that showed mean survival of 60.7 (p-value 0.05).

Conclusion: Pretreatment NLR is a simple, easily accessible laboratory finding for identifying LARC patients who had poorer prognosis for the standard line of treatment.