Shen Lijun, Zhang Hui, Liang Liping, Li Guichao, Fan Ming, Wu Yongxin, Zhu Ji, Zhang Zhen
Department of Radiation Oncology, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
Radiat Oncol. 2014 Dec 18;9:295. doi: 10.1186/s13014-014-0295-2.
The neutrophil-lymphocyte ratio (NLR) has been proposed as an indicator of systemic inflammatory response and may predict the clinical outcome in some cancers, such as head and neck cancer and gastric cancer. However, the value of this ratio is variable in different cancers. Studies of the relationship between NLR and both survival and response to chemoradiation have been limited with respect to locally advanced rectal cancer.
From 2006 to 2011, 199 consecutive locally advanced rectal cancer patients who were treated with neoadjuvant chemoradiation in the Shanghai Cancer Center were enrolled and analysed retrospectively. Tumor response was evaluated by pathological findings. The baseline total white blood cell count (WBC) and the neutrophil, lymphocyte, platelet counts were recorded. The neutrophil-lymphocyte ratio (NLR) and the relationship with clinical outcomes such as overall survival (OS) and disease-free survival (DFS) was analyzed.
With ROC analysis, the baseline NLR value was found to significantly predict prognosis in terms of OS well in locally advanced rectal cancer patients. A multivariate analysis identified that a cut-off value of NLR ≥ 2.8 could be used as an independent factor to indicate decreased OS (HR, 2.123; 95% CI, 1.140-3.954; P = 0.018). NLR ≥ 2.8 was also associated with worse DFS in univariate analysis (HR, 1.662; 95% CI, 1.037-2.664; P = 0.035), though it was not significant in the multivariate analysis (HR, 1.363; 95% CI, 0.840-2.214; P = 0.210). There was no observed significant correlation of mean value of NLR to the response to neoadjuvant chemoradiation. The mean NLR in the ypT0-2 N0 group was 2.68 ± 1.38, and it was 2.77 ± 1.38 in the ypT3-4/N+ group, with no statistical significance (P = 0.703). The mean NLR in the TRG 0-1 group was 2.68 ± 1.42, and it was 2.82 ± 1.33 in the TRG 2-3 group with no statistical significance (P = 0.873).
An elevated baseline NLR is a valuable and easily available prognostic factor for OS in addition to tumor response after neoadjuvant therapy. Baseline NLR could be a useful candidate factor for stratifying patients and making treatment decisions in locally advanced rectal cancer.
中性粒细胞与淋巴细胞比值（NLR）已被提议作为全身炎症反应的指标，并且在某些癌症（如头颈癌和胃癌）中可能预测临床结局。然而，该比值在不同癌症中的价值存在差异。关于局部晚期直肠癌，NLR与生存及放化疗反应之间关系的研究有限。
2006年至2011年，对在上海癌症中心接受新辅助放化疗的199例连续局部晚期直肠癌患者进行回顾性纳入和分析。通过病理结果评估肿瘤反应。记录基线全白细胞计数（WBC）以及中性粒细胞、淋巴细胞、血小板计数。分析中性粒细胞与淋巴细胞比值（NLR）及其与总生存（OS）和无病生存（DFS）等临床结局的关系。
通过ROC分析，发现基线NLR值在局部晚期直肠癌患者的OS方面能显著预测预后。多因素分析确定NLR≥2.8的临界值可作为指示OS降低的独立因素（HR，2.123；95%CI，1.140 - 3.954；P = 0.018）。在单因素分析中，NLR≥2.8也与较差的DFS相关（HR，1.662；95%CI，1.037 - 2.664；P = 0.035），尽管在多因素分析中不显著（HR，1.363；95%CI，0.840 - 2.214；P = 0.210）。未观察到NLR平均值与新辅助放化疗反应之间存在显著相关性。ypT0 - 2 N0组的平均NLR为2.68±1.38，ypT3 - 4/N +组为2.77±1.38，无统计学意义（P = 0.703）。TRG 0 - 1组的平均NLR为2.68±1.42，TRG 2 - 3组为2.82±1.33，无统计学意义（P = 0.873）。
除了新辅助治疗后的肿瘤反应外，基线NLR升高是OS的一个有价值且易于获得的预后因素。基线NLR可能是局部晚期直肠癌患者分层和制定治疗决策的一个有用候选因素。
