Nagasaki Toshiya, Akiyoshi Takashi, Fujimoto Yoshiya, Konishi Tsuyoshi, Nagayama Satoshi, Fukunaga Yosuke, Ueno Masashi
Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Dig Surg. 2015;32(6):496-503. doi: 10.1159/000441396. Epub 2015 Nov 7.
The neutrophil-to-lymphocyte ratio (NLR) is considered an indicator of systemic inflammation and may predict prognosis in colorectal cancer. In this study, we examined the prognostic impact of NLR in patients with locally advanced low rectal cancer treated with neoadjuvant chemoradiotherapy (NACRT) followed by surgery.
From 2004 to 2012, we analyzed 201 consecutive patients with locally advanced low rectal cancer below the peritoneal reflection who underwent NACRT and curative resection. Blood samples were obtained before NACRT. NLRs were dichotomized using a cut-off value of 3.0, which was chosen based on receiver operating characteristic analysis and previous studies, and we analyzed their relationship with clinical outcomes.
Forty-four (21.9%) patients had a high NLR. Moreover, a high NLR was significantly associated with elevated carcinoembryonic antigen levels before NACRT (p = 0.0154). Multivariate analysis showed that a high NLR was independently associated with worse overall survival (hazard ratio (HR) 3.38, p = 0.012). In contrast, a high NLR was not significantly associated with relapse-free survival (HR 1.073, p = 0.8438). The post-recurrence survival between patients with high and low NLRs was significantly different (p = 0.0370).
A high NLR (≥3.0) prior to NACRT was independently associated with poor prognosis in patients with locally advanced low rectal cancer treated with NACRT and radical resection.
中性粒细胞与淋巴细胞比值（NLR）被认为是全身炎症的一个指标，可能预测结直肠癌的预后。在本研究中，我们探讨了NLR对接受新辅助放化疗（NACRT）后手术的局部晚期低位直肠癌患者预后的影响。
2004年至2012年，我们分析了201例腹膜反折以下局部晚期低位直肠癌患者，这些患者均接受了NACRT和根治性切除术。在NACRT前采集血样。根据受试者工作特征分析和既往研究，将NLR分为两组，临界值为3.0，我们分析了其与临床结局的关系。
44例（21.9%）患者NLR较高。此外，NLR较高与NACRT前癌胚抗原水平升高显著相关（p = 0.0154）。多因素分析显示，NLR较高与较差的总生存期独立相关（风险比（HR）3.38，p = 0.012）。相反，NLR较高与无复发生存期无显著相关性（HR 1.073，p = 0.8438）。NLR高、低患者的复发后生存期有显著差异（p = 0.0370）。
对于接受NACRT和根治性切除术的局部晚期低位直肠癌患者，NACRT前NLR较高（≥3.0）与预后不良独立相关。
