Optimal cutpoint of preoperative neutrophil–lymphocyte ratio and associated postoperative prognosis in colorectal cancer patients

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Abstract
Purpose As the role of systemic inflammation in cancer progression, the neutrophil-to-lymphocyte ratio (NLR) is easily evaluated and predicts prognosis in solid cancers. However, the optimal cutpoint for NLR in colorectal cancer patients remains unclear. Methods This retrospective cohort study was based on the Chang Gung Research Database. Participants included colorectal cancer patients who received operation and preoperative complete blood counts with differentiation from 2007 to 2017. The cutpoint of NLR was calculated by SAS macro (%FINGCUT). Results A total of 16,990 colorectal patients were included, and 4961 (29.1%) were identified as the high NLR group (≥ 3.59). Poor clinical characteristics were significantly predominant in the patients with high NLR. The patients with high NLR were associated with worse 5-year disease-free survival and overall survival (p < 0.0001). Multivariate Cox regression survival analysis still showed poor 5-year disease-free survival (HR = 1.319, p < 0.0001) and overall survival (HR = 1.611, p < 0.0001) in the high NLR group after adjustment. Patients with high NLR and hypoalbuminemia had the worst disease-free survival and overall survival (p < 0.0001). In subgroup analysis, stage II colon cancer patients with low NLR had better survival than those with high NLR (p < 0.0001). The hazard ratios of without chemotherapy in disease-free survival and overall survival were higher in the patients with high NLR. Conclusions High NLR was associated with worse clinical characteristics and an independent predictor of poor survival. After adjuvant chemotherapy for stage II colon cancer, more benefits of improving survival were demonstrated in the patients with high NLR.

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