Preoperative neutrophil to lymphocyte ratio >5 is a prognostic factor for recurrent colorectal cancer


  • Presented at the Association of Surgeons in Training (ASiT) Annual Conference, Sheffield, April 2011; Abstract published in Br J Surg 2011; 98: 1–80. Also presented at the ASGBI Annual Conference, Bournemouth, May 2011.

Miss Sreelakshmi Mallappa, Clinical Research Fellow, The Polyposis Registry, St Mark’s Hospital, Watford Road, Harrow HA1 3UJ, UK.


Aim  Previous studies have demonstrated that raised preoperative neutrophil to lymphocyte ratio (NLR) is associated with poor prognosis in colorectal cancer (CRC). The aim of this study was to assess whether preoperative NLR could predict patients at risk of recurrence of CRC.

Method  All consecutive patients who underwent surgical resection for CRC over a 2-year period at our institution were analysed. Demographic data including CRC recurrence were prospectively collected from our institutional cancer database. CRC recurrence was diagnosed on radiological and endoscopic histopathological data. Preoperative NLR was calculated on baseline blood results, with a value >5 being a poor prognostic factor. Parametric survival analysis was used to identify risk factors for CRC recurrence. Hazard ratios (HRs) were calculated for gender, CRC stage using Jass score, preoperative NLR and CRC site. < 0.05 was considered statistically significant.

Results  In all, 297 patients (157 men) underwent CRC resection at a median age of 70 years (range 23–93); 164 patients had colon cancer, 111 rectal cancer and 22 recto-sigmoid cancer. The distribution by stage of CRC was 30.2% for stage 1, 23.8% for stage 2, 19.5% for stage 3 and 26.5% for stage 4. Over a median follow-up period of 3.35 (0.1–8) years, 59 (19.8%) patients had recurrent CRC. Multivariate analysis revealed CRC stage (HR 8.69, 95% CI 3.85–19.6, < 0.0001) and NLR >5 (HR 1.81, 95% CI 1.07–3.07, = 0.028) to be significant and independent risk factors predictive of recurrent CRC.

Conclusion  These data suggest that preoperative NLR >5 is predictive of CRC recurrence.