Pre- and Post-operative Variation of Neutrophil-to-lymphocyte Ratio (NLR) Predict Prognosis factor in Rectal Cancer Patients with Radical Primary Tumor Resection: a monoinstitutional retrospective study

Abstract Purpose The pre- and post-operative variation of neutrophil to lymphocyte ratio is reportedly related to postoperative prognosis. This research was undertaken to evaluate the potential of ΔNLR= (ΔNeutrophil to lymphocyte ratio = postoperative extreme neutrophil to lymphocyte ratio - preoperative neutrophil to lymphocyte ratio) to predict the prognosis based on its relationship with overall survival and relapse-free survival in patients with rectal cancer treated with radical operation. Methods This study was single institution retrospective study that conducted in colorectal surgery at a tertiary teaching hospital. The 584 patients with pathologically confirmed rectal cancer and treated with primary tumor resection between 2012 and 2014 in a single university-affiliated tertiary academic hospital were involved. To assessment the veracity of ΔNLR for rectal carcinoma prediction, a receiver operating characteristic curve was plotted. Patients were divided into two groups, high and low ΔNLR, according to the optimal cutoff value. The proportional risk regression model was performed univariate and multivariate analysis for rectal carcinoma prediction. Results Multivariate analysis showed that a high pretreated serum carcinoembryonic antigen ( p = 0.005), Tumor stage ( III VS I( p < 0.001), II VS I( p = 0.006)), chemotherapy ( p < 0.001) and ΔNLR ( p = 0.002) was an independent prognostic factor for poor overall survival. Conclusion Our research shows that the ΔNLR might be a prognostic marker in RC patients with operative treatment.