Prognostic utility of neutrophil-to-lymphocyte ratio in patients with metastatic colorectal cancer treated using different modalities

Introduction Inflammation is a critical component in carcinogenesis. The neutrophil-to-lymphocyte ratio (NLR) has been retrospectively studied as a biomarker of prognosis in metastatic colorectal cancer (mCRC). Compared with a low NLR, a high NLR is associated with worse prognosis. In the present study, we compared real-world survival for patients with mCRC based on their NLR group, and we assessed the utility of the NLR in determining first-line chemotherapy and metastasectomy benefit. Methods In this retrospective and descriptive analysis of patients with mcRc undergoing first-line chemotherapy in a single centre, the last systemic absolute neutrophil and lymphocyte count before treatment was used for the NLR. A receiver operating characteristic curve was used to estimate the NLR cut-off value, dividing the patients into low and high NLR groups. Median overall survival (mos) was compared using Kaplan-Meier curves and the log-rank test. A multivariate analysis was performed using a Cox regression model. Results The 102 analyzed patients had a median follow-up of 15 months. Regardless of systemic therapy, approximately 20% of patients underwent metastasectomy. The NLR cut-off was established at 2.35, placing 45 patients in the low-risk group (NLR < 2.35) and 57 in the high-risk group (NLR >= 2.35). The Kaplan-Meier analysis showed a mos of 39.1 months in the low-risk group and 14.4 months in the high-risk group (p < 0.001). Multivariate Cox regression on the NLR estimated a hazard ratio of 3.08 (p = 0.01). Survival analysis in each risk subgroup, considering the history of metastasectomy, was also performed. In the low-risk group, mos was longer for patients undergoing metastasectomy than for those not undergoing the procedure (95.2 months vs. 22.6 months, p = 0.05). In the high-risk group, mos was not statistically different for patients undergoing or not undergoing metastasectomy (24.3 months vs. 12.7 months, p = 0.08). Conclusions Our real-world data analysis of NLR in patients with mCRC confirmed that this biomarker is useful in predicting survival. It also suggests that NLR is an effective tool to choose first-line treatment and to predict the benefit of metastasectomy.