Prognostic Value of Preoperative Neutrophil-lymphocyte/ Platelet-lymphocyte Ratio in Patients with Stage II-III Rectal Cancer Who Underwent Curative Resection

Abstract

Introduction:This study aimed to evaluate the prognostic value and survival effects of the neutrophil-lymphocyte/ platelet-lymphocyte ratio (NLR/PLR) in the preoperative peripheral blood count of patients who underwent curative resection due to stage II-III rectal cancer.Methods:Between 2011 and 2017, a total of 156 patients with stage II-III rectal cancer who underwent curative resection were evaluated. Before the curative resection, complete blood counts were obtained within 3 days. The last follow-up was in December 2018. NLR and PLR were calculated by dividing the absolute neutrophil or platelet count by the absolute lymphocyte count, respectively.Results:Postoperatively, adenocarcinoma histology (p=0.025), R1 resection (p<0.001), T4 stage (p=0.001), N stage positivity (p=0.003), tumor-node-metastasis (TNM) stage III disease (p=0.002), presence of lenfovascular invasion (p<0.001), presence of perineural invasion (p<0.001), preoperative NLR ≥3.6 (p<0.001) and PLR ≥192 (p<0.001) were identified in the rectal cancer patients as factors that influence survival in univariate analysis. In our study, R1 resection [hazard ratio (HR): 0.341; 95% confidence interval (CI): 0.157-0.740; p=0.007]; T4 stage (HR: 0.261; 95% CI: 0.129-0.527; p<0.001), N0 stage vs N1 positivity (HR: 0.071; 95% CI: 0.010-0.525; p=0.010), N0 stage vs N2 positivity (HR: 0.068; 95% CI: 0.008- 0.565; p=0.013), presence of metastases (HR: 0.130; 95% CI: 0.054-0.309, p<0.001), TNM stage III (HR: 0.261; 95% CI: 0.129- 0.527, p<0.001) and preoperative NLR ≥3.6 (HR: 0.378; 95% CI: 0.154-0.930, p=0.034) were identified as independent factors affecting survival in multivariate analysis.Conclusion:In our study, due to the low cost, it extensive use, and association with overall survival, NLR was found to be a better prognostic marker. Besides, R1 resection, T4 stage, lymph node positivity, presence of metastases, TNM stage III were found to be prognostic factors that negatively affect overall survival. NLR is a biomarker that is thought to be an indicator of the systemic inflammatory response and can be easily obtained as a prognostic biomarker candidate.

Keywords

• stage ii
• iii rectum cancer
• neutrophil-lymphocyte
• platelet-lymphocyte ratio
• prognosis