Neutrophil-lymphocyte ratio predicts pathologic tumor response and survival after preoperative chemoradiation for rectal cancer

Ik Yong Kim, Sei Hwan You, Young Wan Kim

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84 Citations (Scopus)


Background: Neutrophil-lymphocyte ratio (NLR) reflects the balance between pro-and anti-Tumor immune activities. We evaluated whether NLR is associated with pathologic tumor response and prognosis in rectal cancer patients that underwent preoperative chemoradiaton therapy (CRT) with surgery. Methods: One hundred two patients with rectal cancer that were treated by preoperative CRT followed by surgery were enrolled. A total of 50.4 GY of radiation and 5-FU-based chemotherapy were delivered. An NLR ?3 was considered to be elevated. Pathologic tumor response based on ypTNM stage was categorized into two groups, good response (n = 35, pathologic complete response and ypTNM I) and poor response groups (n = 67, ypTNM II, III, and IV). Results: Twenty-five patients (24.5%) had elevated NLR. Multivariate analysis showed that an elevated CEA level (p = 0.001), larger tumor (p = 0.03), and elevated NLR (p = 0.04) were significant predictors for a poor response. Poor pathological tumor response and elevated NLR were risk factors for cancer-specific and recurrence-free survivals. Conclusion: An elevated NLR before CRT can be used as predictors for poor tumor response and unfavorable prognostic factors. Dominant pro-Tumor activities of neutrophils or reduced anti-Tumor immune response by lymphocytes, as determined by NLR, may have a impact on poor tumor response and unfavorable prognosis.

Original languageEnglish
Article number94
JournalBMC Surgery
Issue number1
Publication statusPublished - 2014

Bibliographical note

Funding Information:
This study was supported by a grant from the Korea Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (No. A100054) and a research grant from Yonsei University Wonju College of Medicine (YUWCM-2012-16).

Publisher Copyright:
© 2014 Kim et al.; licensee BioMed Central Ltd.

All Science Journal Classification (ASJC) codes

  • Surgery


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