ISG Summer Meeting 2016

Poster Prize - First Prize

RM Waldron
NUI Galway

Poster (16S170)

Neutrophil Lymphocyte Ratio: A Valuable Prognostic Tool in Colorectal Cancer


RM Waldron, ME Kelly, BM Molony, C Clancy MR Joyce, MJ Kerin


Discipline of Surgery, Lambe Institute, NUI Galway


Numerous pre-operative screening tools have been reported to aid in determining prognosis of colorectal cancer, but have poor severity prediction and lack accurate estimation of postoperative complications. Assessment of the hosts inflammatory response to thetumour may be easier in clinical practice. The ability of tumours to invade and metastasise is dependent both on the intrinsic characteristics of tumour cells and on the tumour microenvironment. The systemic inflammatory response also features changes in the relative levels of circulating white blood cells. The well-recognised neutrophilia is accompanied by a relative lymphocytopaenia. The neutrophil-lymphocyte ratio (NLR) has been suggested as a simple index of systemic inflammatory response in critically ill patients. We hypothesised that NLR could be used as a prognostic indicator in colorectal cancer patients.


To evaluate the clinical utility of NLR in predicting the grade of the tumour, lymph node positivity, resection modality(elective vs. emergency) and five year survival.


507 patients who underwent a colorectal resection for malignancy over a 5-year period (January 2009-December 2013) were evaluated. Demographics, type of surgical intervention, biochemistry, tumour grading and staging and five-year survival were noted.


A total of 507 patients were included in the study of which 58.4%(n=296) were male. Median (range) age was 70 (27-95) years. There was no statistical difference in NLR across tumour staging and lymph node positivity. Median NLR was statistically different regarding elective vs. emergency resection (3.5 vs. 6.4, p<0.0001,Mann Whitney). NLR was also associated with 5-year survival. Median NLR was 3.2 in patients alive vs. 4.6 in those dead at 5-years(p<0.0001,Mann Whitney). A receiver operating characteristic (ROC) cutoff value of >3.61 was associated with higher 5-year mortality rate (sensitivity 65%, specificity 58% p<0.001) preprocess


We highlight that NLR has valuable clinical utility as a predictor of overall survival in colorectal cancer.