Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China.
J Gastrointest Surg. 2019 Mar;23(3):563-570. doi: 10.1007/s11605-018-3796-8. Epub 2018 Jul 31.
The neutrophil to lymphocyte ratio (NLR) is a marker of inflammation and is associated with poor outcomes. We aimed to evaluate the role of the pretreatment NLR in predicting the outcomes after preoperative chemotherapy in patients with colorectal liver metastases (CRLM).
A retrospective review was performed for 183 patients with CRLM. The NLR was measured before chemotherapy, and a receiver operating characteristic (ROC) curve was used to estimate the cutoff value. Logistic regressions were applied to analyze potential predictors of the pathological response. The Cox proportional hazard method was used to analyze survival.
The pre-chemotherapy NLR was 2.4 ± 1.1, whereas the post-chemotherapy NLR was 2.1 ± 1.6 (p < 0.001). The pretreatment NLR of 2.3 was a significant predictive marker for the pathological response. The pathological response rates were 67.1% in the patients with an NLR ≤ 2.3 and 48.1% in patients with an NLR > 2.3 (p = 0.01). Multivariate analysis revealed that the factors independently associated with pathological responses were a low pretreatment NLR (p = 0.043), radiological response to chemotherapy (p < 0.001), first-line chemotherapy (p = 0.001), and targeted therapy (p = 0.002). The median overall survival (OS) and recurrence-free survival (RFS) were worse in the increased NLR cohort than in the low NLR cohort (OS: 31.1 vs. 43.1 months, p = 0.012; RFS: 6.5 vs. 9.4 months, p = 0.06). According to multivariate analyses, a high pretreatment NLR was a significant predictor for both worse OS (HR = 2.43, 95%CI = 1.49-3.94, p < 0.001) and RFS (HR = 1.53, 95%CI = 1.08-2.18, p = 0.017).
An increased pretreatment NLR was a significant predictor of a poor pathological response and worse prognosis after preoperative chemotherapy. The NLR is a simple biomarker for assessing chemotherapy efficacy.
中性粒细胞与淋巴细胞比值（NLR）是炎症的标志物，与不良预后相关。本研究旨在评估术前化疗前 NLR 在预测结直肠癌肝转移（CRLM）患者化疗后结局中的作用。
对 183 例 CRLM 患者进行回顾性分析。在化疗前测量 NLR，并使用受试者工作特征（ROC）曲线估计截断值。应用逻辑回归分析潜在的病理反应预测因素。采用Cox 比例风险方法分析生存情况。
化疗前 NLR 为 2.4±1.1，化疗后 NLR 为 2.1±1.6（p<0.001）。NLR 值为 2.3 是预测病理反应的显著指标。NLR≤2.3 的患者病理反应率为 67.1%，NLR>2.3 的患者病理反应率为 48.1%（p=0.01）。多因素分析显示，与病理反应相关的独立因素包括化疗前 NLR 较低（p=0.043）、化疗后影像学反应（p<0.001）、一线化疗（p=0.001）和靶向治疗（p=0.002）。NLR 升高组的中位总生存（OS）和无复发生存（RFS）均差于 NLR 降低组（OS：31.1 与 43.1 个月，p=0.012；RFS：6.5 与 9.4 个月，p=0.06）。多因素分析显示，化疗前 NLR 较高是 OS（HR=2.43，95%CI=1.49-3.94，p<0.001）和 RFS（HR=1.53，95%CI=1.08-2.18，p=0.017）不良的显著预测因子。
术前化疗前 NLR 升高是预测病理反应不良和预后较差的重要指标。NLR 是评估化疗疗效的简单生物标志物。
