Kim Ik Yong, You Sei Hwan, Kim Young Wan
Department of Surgery, Yonsei University Wonju College of Medicine, 162 Ilsan-dong, Wonju-si, Gangwon-do (220-701), Korea.
BMC Surg. 2014 Nov 18;14:94. doi: 10.1186/1471-2482-14-94.
Neutrophil-lymphocyte ratio (NLR) reflects the balance between pro- and anti-tumor immune activities. We evaluated whether NLR is associated with pathologic tumor response and prognosis in rectal cancer patients that underwent preoperative chemoradiaton therapy (CRT) with surgery.
One hundred two patients with rectal cancer that were treated by preoperative CRT followed by surgery were enrolled. A total of 50.4 GY of radiation and 5-FU-based chemotherapy were delivered. An NLR ≥ 3 was considered to be elevated. Pathologic tumor response based on ypTNM stage was categorized into two groups, good response (n = 35, pathologic complete response and ypTNM I) and poor response groups (n = 67, ypTNM II, III, and IV).
Twenty-five patients (24.5%) had elevated NLR. Multivariate analysis showed that an elevated CEA level (p = 0.001), larger tumor (p = 0.03), and elevated NLR (p = 0.04) were significant predictors for a poor response. Poor pathological tumor response and elevated NLR were risk factors for cancer-specific and recurrence-free survivals.
An elevated NLR before CRT can be used as predictors for poor tumor response and unfavorable prognostic factors. Dominant pro-tumor activities of neutrophils or reduced anti-tumor immune response by lymphocytes, as determined by NLR, may have a impact on poor tumor response and unfavorable prognosis.
中性粒细胞与淋巴细胞比值（NLR）反映了促肿瘤和抗肿瘤免疫活动之间的平衡。我们评估了NLR是否与接受术前同步放化疗（CRT）及手术的直肠癌患者的病理肿瘤反应和预后相关。
纳入102例接受术前CRT后手术治疗的直肠癌患者。共给予50.4 Gy的放疗及基于5-氟尿嘧啶的化疗。NLR≥3被认为升高。基于ypTNM分期的病理肿瘤反应分为两组，良好反应组（n = 35，病理完全缓解和ypTNM I期）和不良反应组（n = 67，ypTNM II、III和IV期）。
25例患者（24.5%）NLR升高。多因素分析显示，CEA水平升高（p = 0.001）、肿瘤较大（p = 0.03）和NLR升高（p = 0.04）是不良反应的显著预测因素。病理肿瘤反应不良和NLR升高是癌症特异性生存和无复发生存的危险因素。
CRT前NLR升高可作为肿瘤反应不良和不良预后因素的预测指标。由NLR所确定的中性粒细胞的主要促肿瘤活性或淋巴细胞抗肿瘤免疫反应降低，可能对肿瘤反应不良和预后不利产生影响。
