Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2009

01-03-2009 | Hepatobiliary and Pancreatic Cancer

Blood Neutrophil-to-Lymphocyte Ratio Predicts Survival in Patients with Colorectal Liver Metastases Treated with Systemic Chemotherapy

Authors: Yoji Kishi, MD, PhD, Scott Kopetz, MD, Yun Shin Chun, MD, Martin Palavecino, MD, Eddie K. Abdalla, MD, Jean-Nicolas Vauthey, MD

Published in: Annals of Surgical Oncology | Issue 3/2009

Login to get access

Abstract

Background

Whether neutrophil-to-lymphocyte ratio (NLR) predicts survival of patients with colorectal liver metastases (CLM) treated with systemic chemotherapy remains unclear.

Methods

Clinicopathologic data were reviewed for patients with CLM treated with chemotherapy and resection (n = 200) or chemotherapy only (n = 90). Univariate and multivariate analyses for prognostic factors were performed. In the resection group, whether chemotherapy normalizes high NLR and the effect of NLR normalization on survival were evaluated.

Results

In the resection group, patients with preoperative NLR > 5 had a worse 5-year survival rate than patients with NLR ≤ 5 (19% vs. 43%; P = 0.009), and NLR > 5 was the only independent preoperative predictor of worse survival (P = 0.016; hazard ratio [HR] = 2.22; 95% confidence interval [95% CI], 1.16–4.25). In the nonresection group, patients with prechemotherapy NLR > 5 had a worse 3-year survival rate than patients with NLR ≤ 5 (0% vs. 23%; P = 0.0002), and NLR > 5 was the only independent predictor of worse survival (P = 0.001; HR = 2.91; 95% CI, 1.54–5.50). In the resection group, chemotherapy normalized high NLR in 17 of 25 patients, and these 17 patients had better survival than the 8 patients with high NLR both before chemotherapy and before surgery (P = 0.021).

Conclusion

NLR independently predicts survival in patients with CLM treated with chemotherapy followed by resection or chemotherapy only. When chemotherapy normalizes high NLR, improved survival is expected.
Literature
1.
Nordlinger B, Guiguet M, Vaillant JC, et al. Surgical resection of colorectal carcinoma metastases to the liver A prognostic scoring system to improve case selection, based on 1568 patients Association Francaise de Chirurgie. Cancer. 1996;77:1254–62.PubMedCrossRef
2.
Fong Y, Fortner J, Sun RL, et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg. 1999;230:309–18.PubMedCrossRef
3.
Iwatsuki S, Dvorchik I, Madariaga JR, et al. Hepatic resection for metastatic colorectal adenocarcinoma: a proposal of a prognostic scoring system. J Am Coll Surg. 1999;189:291–9.PubMedCrossRef
4.
Minagawa M, Yamamoto J, Kosuge T, et al. Simplified staging system for predicting the prognosis of patients with resectable liver metastasis: development and validation. Arch Surg. 2007;142:269–76.PubMedCrossRef
5.
Domont J, Pawlik TM, Boige V, et al. Catalytic subunit of human telomerase reverse transcriptase is an independent predictor of survival in patients undergoing curative resection of hepatic colorectal metastases: a multicenter analysis. J Clin Oncol. 2005;23:3086–93.PubMedCrossRef
6.
Zakaria S, Donohue JH, Que FG, et al. Hepatic resection for colorectal metastases: value for risk scoring systems? Ann Surg. 2007;246:183–91.PubMedCrossRef
7.
Malik HZ, Prasad KR, Halazun KJ, et al. Preoperative prognostic score for predicting survival after hepatic resection for colorectal liver metastases. Ann Surg. 2007;246:806–14.PubMed
8.
Rees M, Tekkis PP, Welsh FK, et al. Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients. Ann Surg. 2008;247:125–35.PubMedCrossRef
9.
Thirion P, Wolmark N, Haddad E, et al. Survival impact of chemotherapy in patients with colorectal metastases confined to the liver: a re-analysis of 1458 non-operable patients randomised in 22 trials and 4 meta-analyses. Meta-Analysis Group in Cancer. Ann Oncol. 1999;10:1317–20.
10.
Adam R, Delvart V, Pascal G, et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg. 2004;240:644–57.PubMedCrossRef
11.
Okano K, Maeba T, Moroguchi A, et al. Lymphocytic infiltration surrounding liver metastases from colorectal cancer. J Surg Oncol. 2003;82:28–33.PubMedCrossRef
12.
Wong VK, Malik HZ, Hamady ZZ, et al. C-reactive protein as a predictor of prognosis following curative resection for colorectal liver metastases. Br J Cancer. 2007;96:222–5.PubMedCrossRef
13.
Halazun KJ, Aldoori A, Malik HZ, et al. Elevated preoperative neutrophil to lymphocyte ratio predicts survival following hepatic resection for colorectal liver metastases. Eur J Surg Oncol. 2008;34:55–60.PubMed
14.
Walsh SR, Cook EJ, Goulder F, et al. Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol. 2005;91:181–4.PubMedCrossRef
15.
Pawlik TM, Scoggins CR, Zorzi D, et al. Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg. 2005;241:715–22.PubMedCrossRef
16.
Canna K, McArdle PA, McMillan DC, et al. The relationship between tumour T-lymphocyte infiltration, the systemic inflammatory response and survival in patients undergoing curative resection for colorectal cancer. Br J Cancer. 2005;92:651–4.PubMedCrossRef
17.
Bhattacharjya S, Bhattacharjya T, Baber S, et al. Prospective study of contrast-enhanced computed tomography, computed tomography during arterioportography, and magnetic resonance imaging for staging colorectal liver metastases for liver resection. Br J Surg. 2004;91:1361–9.PubMedCrossRef
18.
Bipat S, van Leeuwen MS, Comans EF, et al. Colorectal liver metastases: CT, MR imaging, and PET for diagnosis—meta-analysis. Radiology. 2005;237:123–31.PubMedCrossRef
19.
Nomura K, Kadoya M, Ueda K, et al. Detection of hepatic metastases from colorectal carcinoma: comparison of histopathologic features of anatomically resected liver with results of preoperative imaging. J Clin Gastroenterol. 2007;41:789–95.PubMedCrossRef
20.
Abdalla EK, Vauthey JN, Ellis LM, et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg. 2004;239:818–25.PubMedCrossRef
21.
Kokudo N, Miki Y, Sugai S, et al. Genetic and histological assessment of surgical margins in resected liver metastases from colorectal carcinoma: minimum surgical margins for successful resection. Arch Surg. 2002;137:833–40.PubMedCrossRef
22.
Chun YS, Vauthey JN, Ribero D, et al. Systemic chemotherapy and two-stage hepatectomy for extensive bilateral colorectal liver metastases: perioperative safety and survival. J Gastrointest Surg. 2007;11:1498–504.PubMedCrossRef
23.
Makuuchi M, Thai BL, Takayasu K, et al. Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery. 1990;107:521–7.PubMed
24.
Jaeck D, Oussoultzoglou E, Rosso E, et al. A two-stage hepatectomy procedure combined with portal vein embolization to achieve curative resection for initially unresectable multiple and bilobar colorectal liver metastases. Ann Surg. 2004;240:1037–49.PubMedCrossRef
25.
Leitch EF, Chakrabarti M, Crozier JE, et al. Comparison of the prognostic value of selected markers of the systemic inflammatory response in patients with colorectal cancer. Br J Cancer. 2007;97:1266–70.PubMedCrossRef
26.
Forrest LM, McMillan DC, McArdle CS, et al. Evaluation of cumulative prognostic scores based on the systemic inflammatory response in patients with inoperable non-small-cell lung cancer. Br J Cancer. 2003;89:1028–30.PubMedCrossRef
27.
Klintrup K, Makinen JM, Kauppila S, et al. Inflammation and prognosis in colorectal cancer. Eur J Cancer. 2005;41:2645–54.PubMedCrossRef
28.
Fernandez-Acenero MJ, Galindo-Gallego M, Sanz J, Aljama A. Prognostic influence of tumor-associated eosinophilic infiltrate in colorectal carcinoma. Cancer. 2000;88:1544–8.PubMedCrossRef
29.
Nagtegaal ID, Marijnen CA, Kranenbarg EK, et al. Local and distant recurrences in rectal cancer patients are predicted by the nonspecific immune response; specific immune response has only a systemic effect—a histopathological and immunohistochemical study. BMC Cancer. 2001;1:7.
Metadata
Title
Blood Neutrophil-to-Lymphocyte Ratio Predicts Survival in Patients with Colorectal Liver Metastases Treated with Systemic Chemotherapy
Authors
Yoji Kishi, MD, PhD
Scott Kopetz, MD
Yun Shin Chun, MD
Martin Palavecino, MD
Eddie K. Abdalla, MD
Jean-Nicolas Vauthey, MD
Publication date
01-03-2009
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 3/2009
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-008-0267-6

Other articles of this Issue 3/2009

Annals of Surgical Oncology 3/2009 Go to the issue

Breast Oncology

Preoperative Chemotherapy Decreases the Need for Re-Excision of Breast Cancers Between 2 and 4 cm Diameter

Medical Oncology

Port-A-Cath Implantation Using Percutaneous Puncture Without Guidance

Bone and Soft Tissue Sarcomas

Evaluation of 47 Soft Tissue Sarcoma Resection Specimens after Isolated Limb Perfusion with TNF-α and Melphalan: Histologically Characterized Improved Margins Correlate with Absence of Recurrences

Hepatobiliary and Pancreatic Tumors

Meta-Analysis of the Clamp-Crushing Technique for Transection of the Parenchyma in Elective Hepatic Resection: Back to Where We Started?

Laboratory and Translational Research

Clinical Implications of the Mechanisms Driving Breast Cancer Local Recurrence

Gastrointestinal Oncology

Lymph Node Evaluation and Long-Term Survival in Stage II and Stage III Colon Cancer: A National Study