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Erschienen in: International Journal of Colorectal Disease 9/2014

01.09.2014 | Original Article

Impact of the perioperative neutrophil-to-lymphocyte ratio on the long-term survival following an elective resection of colorectal carcinoma

verfasst von: Toru Kubo, Satoshi Ono, Hideki Ueno, Eiji Shinto, Junji Yamamoto, Kazuo Hase

Erschienen in: International Journal of Colorectal Disease | Ausgabe 9/2014

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Abstract

Purposes

The present study was designed to evaluate the prognostic value of the perioperative neutrophil-to-lymphocyte ratio (NLR) for the long-term survival in patients with colorectal cancer.

Methods

This was a retrospective study of 524 patients with histologically proven stage II or III colorectal cancer who underwent curative colorectal resection. We classified patients into a low NLR group or high NLR group base on their NLR values at three time points (before surgery (Pre), on the first postoperative day (POD1), and on the third or fourth postoperative day (POD3)) and evaluated the survival according to the group.

Results

The cancer-specific survival was significantly longer in the groups with a low NLR on POD3. The disease-free survival was significantly longer in the group with a low NLR on Pre. We subsequently allocated a score of 1 to patients with a high NLR at each point and reclassified patients into those with a low perioperative NLR group (score of 0 or 1) and high perioperative NLR group (score of 2 or 3). Both the cancer-specific survival and disease-free survival rates were significantly different between the two perioperative NLR groups. Both univariate and multivariate analyses demonstrated that being in the high perioperative NLR group was an independent risk factor for both the cancer-specific survival and disease-free survival.

Conclusions

Not only the preoperative but also the postoperative NTR is thus considered to be a predictor of the long-time survival in patients with colorectal cancer.
Literatur
1.
2.
Zurück zum Zitat Balkwill F, Mantovani A (2001) Inflammation and cancer: back to Virchow? Lancet 357:539–545PubMedCrossRef Balkwill F, Mantovani A (2001) Inflammation and cancer: back to Virchow? Lancet 357:539–545PubMedCrossRef
5.
Zurück zum Zitat Little D, Regan M, Keane RM, Bouchier-Hayes D (1993) Perioperative immune modulation. Surgery 114:87–91PubMed Little D, Regan M, Keane RM, Bouchier-Hayes D (1993) Perioperative immune modulation. Surgery 114:87–91PubMed
6.
Zurück zum Zitat Tsuchiya Y, Sawada S, Yoshioka I, Ohashi Y, Matsuo M, Harimaya Y, Tsukada Y, Saiki I (2003) Increased surgical stress promotes tumor metastasis. Surgery 133:547–555PubMedCrossRef Tsuchiya Y, Sawada S, Yoshioka I, Ohashi Y, Matsuo M, Harimaya Y, Tsukada Y, Saiki I (2003) Increased surgical stress promotes tumor metastasis. Surgery 133:547–555PubMedCrossRef
7.
Zurück zum Zitat Hiki N, Shimizu N, Yamaguchi H, Imamura K, Kami K, Kubota K, Kaminishi M (2006) Manipulation of the small intestine as a cause of the increased inflammatory response after open compared with laparoscopic surgery. Br J Surg 93:195–204PubMedCrossRef Hiki N, Shimizu N, Yamaguchi H, Imamura K, Kami K, Kubota K, Kaminishi M (2006) Manipulation of the small intestine as a cause of the increased inflammatory response after open compared with laparoscopic surgery. Br J Surg 93:195–204PubMedCrossRef
8.
Zurück zum Zitat Luk JM, Tung PH, Wong KF, Chan KL, Law S, Wong J (2009) Laparoscopic surgery induced interleukin-6 levels in serum and gut mucosa: implications of peritoneum integrity and gas factors. Surg Endosc 23:370–376PubMedCrossRef Luk JM, Tung PH, Wong KF, Chan KL, Law S, Wong J (2009) Laparoscopic surgery induced interleukin-6 levels in serum and gut mucosa: implications of peritoneum integrity and gas factors. Surg Endosc 23:370–376PubMedCrossRef
9.
Zurück zum Zitat Shiromizu A, Suematsu T, Yamaguchi K, Shiraishi N, Adachi Y, Kitano S (2000) Effect of laparotomy and laparoscopy on the establishment of lung metastasis in a murine model. Surgery 128:799–805PubMedCrossRef Shiromizu A, Suematsu T, Yamaguchi K, Shiraishi N, Adachi Y, Kitano S (2000) Effect of laparotomy and laparoscopy on the establishment of lung metastasis in a murine model. Surgery 128:799–805PubMedCrossRef
10.
Zurück zum Zitat Pera M, Nelson H, Rajkumar SV, Young-Fadok TM, Burgat LJ (2003) Influence of postoperative acute-phase response on angiogenesis and tumor growth: open vs. laparoscopic-assisted surgery in mice. J Gastrointest Surg 7:783–790PubMedCrossRef Pera M, Nelson H, Rajkumar SV, Young-Fadok TM, Burgat LJ (2003) Influence of postoperative acute-phase response on angiogenesis and tumor growth: open vs. laparoscopic-assisted surgery in mice. J Gastrointest Surg 7:783–790PubMedCrossRef
11.
Zurück zum Zitat Evans C, Galustian C, Kumar D, Hagger R, Melville DM, Bodman-Smith M, Jourdan I, Gudgeon AM, Dalgleish AG (2009) Impact of surgery on immunologic function: comparison between minimally invasive techniques and conventional laparotomy for surgical resection of colorectal tumors. Am J Surg 197:238–245PubMedCrossRef Evans C, Galustian C, Kumar D, Hagger R, Melville DM, Bodman-Smith M, Jourdan I, Gudgeon AM, Dalgleish AG (2009) Impact of surgery on immunologic function: comparison between minimally invasive techniques and conventional laparotomy for surgical resection of colorectal tumors. Am J Surg 197:238–245PubMedCrossRef
12.
Zurück zum Zitat Proctor MJ, Morrison DS, Talwar D, Balmer SM, Fletcher CD, O’Reilly DS, Foulis AK, Horgan PG, Mcmillan DC (2011) A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow Inflammation Outcome Study. Eur J Cancer 47:2633–2641PubMedCrossRef Proctor MJ, Morrison DS, Talwar D, Balmer SM, Fletcher CD, O’Reilly DS, Foulis AK, Horgan PG, Mcmillan DC (2011) A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow Inflammation Outcome Study. Eur J Cancer 47:2633–2641PubMedCrossRef
13.
Zurück zum Zitat Kwon HC, Kim SH, Oh SY, Lee S, Lee JH, Choi HJ, Park KJ, Roh MS, Kim SG, Kim HJ, Lee JH (2012) Clinical significance of preoperative neutrophil-lymphocyte versus platelet-lymphocyte ratio in patients with operable colorectal cancer. Biomarkers 17:216–222PubMedCrossRef Kwon HC, Kim SH, Oh SY, Lee S, Lee JH, Choi HJ, Park KJ, Roh MS, Kim SG, Kim HJ, Lee JH (2012) Clinical significance of preoperative neutrophil-lymphocyte versus platelet-lymphocyte ratio in patients with operable colorectal cancer. Biomarkers 17:216–222PubMedCrossRef
14.
Zurück zum Zitat Mallappa S, Sinha A, Gupta S, Chadwick SJ (2013) Preoperative neutrophil to lymphocyte ratio >5 is a prognostic factor for recurrent colorectal cancer. Color Dis 15:323–328CrossRef Mallappa S, Sinha A, Gupta S, Chadwick SJ (2013) Preoperative neutrophil to lymphocyte ratio >5 is a prognostic factor for recurrent colorectal cancer. Color Dis 15:323–328CrossRef
15.
Zurück zum Zitat Malietzis G, Giacometti M, Askari A, Nachiappan S, Kennedy RH, Faiz OD, Aziz O, Jenkins JT (2013) A preoperative neutrophil to lymphocyte ratio of 3 predicts disease-free survival after curative elective colorectal cancer surgery. Ann Surg. Epub ahead of print Malietzis G, Giacometti M, Askari A, Nachiappan S, Kennedy RH, Faiz OD, Aziz O, Jenkins JT (2013) A preoperative neutrophil to lymphocyte ratio of 3 predicts disease-free survival after curative elective colorectal cancer surgery. Ann Surg. Epub ahead of print
16.
Zurück zum Zitat Chiang SF, Hung HY, Tang R, Changchien CR, Chen JS, You YT, Chiang JM, Lin JR (2012) Can neutrophil-to-lymphocyte ratio predict the survival of colorectal cancer patients who have received curative surgery electively? Int J Color Dis 27:1347–1357CrossRef Chiang SF, Hung HY, Tang R, Changchien CR, Chen JS, You YT, Chiang JM, Lin JR (2012) Can neutrophil-to-lymphocyte ratio predict the survival of colorectal cancer patients who have received curative surgery electively? Int J Color Dis 27:1347–1357CrossRef
17.
Zurück zum Zitat Zahorec R (2001) Ratio of neutrophil to lymphocyte counts—rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 102:5–14PubMed Zahorec R (2001) Ratio of neutrophil to lymphocyte counts—rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 102:5–14PubMed
18.
Zurück zum Zitat Sobin LH, Compton CC (2010) TNM seventh edition: what’s new, what’s changed: communication from the International Union Against Cancer and the American Joint Committee on Cancer. Cancer 116:5336–5339PubMedCrossRef Sobin LH, Compton CC (2010) TNM seventh edition: what’s new, what’s changed: communication from the International Union Against Cancer and the American Joint Committee on Cancer. Cancer 116:5336–5339PubMedCrossRef
19.
Zurück zum Zitat Petrelli N, Douglass HO Jr, Herrera L, Russell D, Stablein DM, Bruckner HW, Mayer RJ, Schinella R, Green MD, Muggia FM et al (1989) The modulation of fluorouracil with leucovorin in metastatic colorectal carcinoma: a prospective randomized phase III trial. Gastrointestinal Tumor Study Group. J Clin Oncol 7:1419–1426PubMed Petrelli N, Douglass HO Jr, Herrera L, Russell D, Stablein DM, Bruckner HW, Mayer RJ, Schinella R, Green MD, Muggia FM et al (1989) The modulation of fluorouracil with leucovorin in metastatic colorectal carcinoma: a prospective randomized phase III trial. Gastrointestinal Tumor Study Group. J Clin Oncol 7:1419–1426PubMed
20.
Zurück zum Zitat Poon MA, O'Connell MJ, Wieand HS, Krook JE, Gerstner JB, Tschetter LK, Levitt R, Kardinal CG, Mailliard JA (1991) Biochemical modulation of fluorouracil with leucovorin: confirmatory evidence of improved therapeutic efficacy in advanced colorectal cancer. J Clin Oncol 9:1967–1972PubMed Poon MA, O'Connell MJ, Wieand HS, Krook JE, Gerstner JB, Tschetter LK, Levitt R, Kardinal CG, Mailliard JA (1991) Biochemical modulation of fluorouracil with leucovorin: confirmatory evidence of improved therapeutic efficacy in advanced colorectal cancer. J Clin Oncol 9:1967–1972PubMed
21.
Zurück zum Zitat Douillard JY, Hoff PM, Skillings JR, Eisenberg P, Davidson N, Harper P, Vincent MD, Lembersky BC, Thompson S, Maniero A, Benner SE (2002) Multicenter phase III study of uracil/tegafur and oral leucovorin versus fluorouracil and leucovorin in patients with previously untreated metastatic colorectal cancer. J Clin Oncol 20:3605–3616PubMedCrossRef Douillard JY, Hoff PM, Skillings JR, Eisenberg P, Davidson N, Harper P, Vincent MD, Lembersky BC, Thompson S, Maniero A, Benner SE (2002) Multicenter phase III study of uracil/tegafur and oral leucovorin versus fluorouracil and leucovorin in patients with previously untreated metastatic colorectal cancer. J Clin Oncol 20:3605–3616PubMedCrossRef
22.
Zurück zum Zitat Kishi Y, Kopetz S, Chun YS, Palavecino M, Abdalla EK, Vauthey JN (2009) Blood neutrophil-to-lymphocyte ratio predicts survival in patients with colorectal liver metastases treated with systemic chemotherapy. Ann Surg Oncol 16:614–622PubMedCrossRef Kishi Y, Kopetz S, Chun YS, Palavecino M, Abdalla EK, Vauthey JN (2009) Blood neutrophil-to-lymphocyte ratio predicts survival in patients with colorectal liver metastases treated with systemic chemotherapy. Ann Surg Oncol 16:614–622PubMedCrossRef
23.
Zurück zum Zitat Zhang Y, Peng Z, Chen M, Liu F, Huang J, Xu L, Zhang Y, Chen M (2012) Elevated neutrophil to lymphocyte ratio might predict poor prognosis for colorectal liver metastasis after percutaneous radiofrequency ablation. Int J Hyperth 28:132–140CrossRef Zhang Y, Peng Z, Chen M, Liu F, Huang J, Xu L, Zhang Y, Chen M (2012) Elevated neutrophil to lymphocyte ratio might predict poor prognosis for colorectal liver metastasis after percutaneous radiofrequency ablation. Int J Hyperth 28:132–140CrossRef
24.
Zurück zum Zitat Motomura T, Shirabe K, Mano Y, Muto J, Toshima T, Umemoto Y, Fukuhara T, Uchiyama H, Ikegami T, Yoshizumi T, Soejima Y, Maehara Y (2013) Neutrophil-lymphocyte ratio reflects hepatocellular carcinoma recurrence after liver transplantation via inflammatory microenvironment. J Hepatol 58:58–64PubMedCrossRef Motomura T, Shirabe K, Mano Y, Muto J, Toshima T, Umemoto Y, Fukuhara T, Uchiyama H, Ikegami T, Yoshizumi T, Soejima Y, Maehara Y (2013) Neutrophil-lymphocyte ratio reflects hepatocellular carcinoma recurrence after liver transplantation via inflammatory microenvironment. J Hepatol 58:58–64PubMedCrossRef
25.
Zurück zum Zitat Okano K, Maeba T, Moroguchi A, Ishimura K, Karasawa Y, Izuishi K, Goda F, Usuki H, Wakabayashi H, Maeta H (2003) Lymphocytic infiltration surrounding liver metastases from colorectal cancer. J Surg Oncol 82:28–33PubMedCrossRef Okano K, Maeba T, Moroguchi A, Ishimura K, Karasawa Y, Izuishi K, Goda F, Usuki H, Wakabayashi H, Maeta H (2003) Lymphocytic infiltration surrounding liver metastases from colorectal cancer. J Surg Oncol 82:28–33PubMedCrossRef
27.
Zurück zum Zitat Kusumanto YH, Dam WA, Hospers GA, Meijer C, Mulder NH (2003) Platelets and granulocytes, in particular the neutrophils, form important compartments for circulating vascular endothelial growth factor. Angiogenesis 6:283–287PubMedCrossRef Kusumanto YH, Dam WA, Hospers GA, Meijer C, Mulder NH (2003) Platelets and granulocytes, in particular the neutrophils, form important compartments for circulating vascular endothelial growth factor. Angiogenesis 6:283–287PubMedCrossRef
28.
Zurück zum Zitat Park BK, Paik YH, Park JY, Park KH, Bang S, Park SW, Chung JB, Park YN, Song SY (2006) The clinicopathologic significance of the expression of vascular endothelial growth factor-C in intrahepatic cholangiocarcinoma. Am J Clin Oncol 29:138–142PubMedCrossRef Park BK, Paik YH, Park JY, Park KH, Bang S, Park SW, Chung JB, Park YN, Song SY (2006) The clinicopathologic significance of the expression of vascular endothelial growth factor-C in intrahepatic cholangiocarcinoma. Am J Clin Oncol 29:138–142PubMedCrossRef
29.
Zurück zum Zitat Law WL, Choi HK, Lee YM, Ho JW, Seto CL (2007) Anastomotic leakage is associated with poor long-term outcome in patients after curative colorectal resection for malignancy. J Gastrointest Surg 11:8–15PubMedCrossRef Law WL, Choi HK, Lee YM, Ho JW, Seto CL (2007) Anastomotic leakage is associated with poor long-term outcome in patients after curative colorectal resection for malignancy. J Gastrointest Surg 11:8–15PubMedCrossRef
30.
Zurück zum Zitat Tsujimoto H, Ichikura T, Ono S, Sugasawa H, Hiraki S, Sakamoto N, Yaguchi Y, Yoshida K, Matsumoto Y, Hase K (2009) Impact of postoperative infection on long-term survival after potentially curative resection for gastric cancer. Ann Surg Oncol 16:311–318PubMedCrossRef Tsujimoto H, Ichikura T, Ono S, Sugasawa H, Hiraki S, Sakamoto N, Yaguchi Y, Yoshida K, Matsumoto Y, Hase K (2009) Impact of postoperative infection on long-term survival after potentially curative resection for gastric cancer. Ann Surg Oncol 16:311–318PubMedCrossRef
31.
Zurück zum Zitat Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P (2011) Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg 253:890–899PubMedCrossRef Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P (2011) Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg 253:890–899PubMedCrossRef
Metadaten
Titel
Impact of the perioperative neutrophil-to-lymphocyte ratio on the long-term survival following an elective resection of colorectal carcinoma
verfasst von
Toru Kubo
Satoshi Ono
Hideki Ueno
Eiji Shinto
Junji Yamamoto
Kazuo Hase
Publikationsdatum
01.09.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
International Journal of Colorectal Disease / Ausgabe 9/2014
Print ISSN: 0179-1958
Elektronische ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-014-1964-1

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