Assessment of the role of the preoperative neutrophil-lymphocyte ratio as a prognostic biomarker in nonmetastatic rectal cancer


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Manar Almusarhed1,Osamah Al-Asadi1,Azhar Rizvi1,Anil Hermanad1,Qamar Zaman1,Somnath Mukherjee1,Hany Eldeeb1
1Milton Keynes Universiy Hospital



Inflammation has been linked to tumour development and progression. The neutrophil and lymphocyte count has been investigated as a surrogate marker for the systemic inflammatory response to predict the poor prognosis in many tumours. Despite the fact that the neutrophil-lymphocyte ratio (NLR) showed prognostic significance in several tumours, it’s role in rectal cancer remains controversial and understudied. Therefore, We aimed to assess the role of the NLR in nonmetastatic rectal cancer.


We retrospectively evaluated 108 patients who underwent curative resection of primary rectal cancer between July 2011 and July 2016 at Milton Keynes University Hospital, UK. Neutrophil and lymphocyte count was analysed from the blood samples which were taken one week before the surgery. The NLR ratio was determined to be 2.2 by ROC curve analysis. The median follow up period was 36 months.


Univariate analysis revealed no prognostic significance of the NLR in terms of the overall survival (OS) (HR= 1.33, P=0.597) or the disease-free survival (DFS) (HR= 1.52, P= 0.259). Similarly, multivariate analysis did not show a significant impact on the OS (HR=2.084, P= 0.286) and the DFS (HR=1.927, P=0.129). On the other hand, the multivariate analysis showed a significant correlation between TME score and the OS (HR= 9.859, P=0.014) and between Neoadjuvant chemotherapy and DFS (HR=2.792, P= 0.049).


In our study, the NLR was not shown to be a useful independent prognostic marker in non-metastatic rectal cancer. Large-scale prospective studies are still required to further evaluate the clinical significance of this potentially useful biomarker. In addition, the optimal cut-off level for the NLR remains to be ascertained.