NEUTROPHIL TO LYMPHOCYTE RATIO AS A PREDICTOR OF SEVERITY IN COLORECTAL ADENOCARCINOMA
Keywords:cancer, oncology, hematology, histopathology, pathology, colorectal
AbstractBackground: Colorectal cancers are slowly developing cancers of which more than 95% are adenocarcinomas, beginning in the mucus-producing glands lining the colon and rectum. In Pakistan, colorectal carcinoma is ranked as the seventh most common malignancy in men and the ninth most common in women with a male to female ratio of 9 to 1. This study aimed at investigating Neutrophil to Lymphocyte Ratio (NLR) as a potential marker for predicting severity of disease in terms of tumour histological grade in patients with pre-operative colorectal adenocarcinoma.Methods: Retrospective cross-sectional study design was adopted and this study was conducted at the Department of Pathology, Pakistan Institute of Medical Sciences Islamabad. Sixty patients of all age-groups and both genders, diagnosed as colorectal adenocarcinoma on histopathological examination of resected specimens, were selected by consecutive non-probability sampling. Separately, 60 healthy subjects, age and sex-matched, were selected as control.Results: Results revealed that the most common age group was 41–60 years showing 29 cases (48%) followed by the age group 61–80 years with 17 cases (28%). The most common site was the rectum having 24 cases (40%) followed by the right hemicolon with 13 cases (21.7%). The mean of neutrophil to lymphocyte ratio rose in direct proportion to the grade of colorectal carcinoma, showing a mean value of 4.5 in well differentiated low grade carcinoma, 5.0 in moderately differentiated and 6.0 in high grade poorly differentiated carcinoma. All patients had higher total leukocyte count, higher absolute neutrophil count, higher total neutrophil percentage and higher NLR as compared to their normal healthy counterparts.Conclusion: It is concluded that the NLR is directly proportional to tumour grade so it can be used preoperatively to assess whether the tumour is advanced so that it can be dealt with accordingly. This ratio can also be used as an independent screening marker for colorectal carcinoma since it shows very low levels in normal colonic epithelium.
Marley AR, Nan H. Epidemiology of colorectal cancer. Int J Mol Epidemiol Genet 2016;7(3):105–14.
Kuipers EJ, Grady WM, Lieberman D, Seufferlein T, Sung JJ, Boelens PG, et al. Colorectal cancer. Nat Rev Dis Primers 2015;1(1):1–25.
Rawla P, Sunkara T, Barsouk A. Epidemiology of colorectal cancer: Incidence, mortality, survival, and risk factors. Prz Gastroenterol 2019;14(2):89–103.
Anwar N, Badar F, Yusuf MA. Profile of Patients with Colorectal Cancer at a Tertiary Care Cancer Hospital in Pakistan. Ann N Y Acad Sci 2008;1138(1):199–203.
Hislop G. Trends and risk factors for colorectal cancer. Br COLUMBIA Med J 2000;42(3):131–5.
Poornakala S, Prema N. A study of morphological prognostic factors in colorectal cancer and survival analysis. Indian J Pathol Microbiol 2019;62(1):36–42.
Fleming M, Ravula S, Tatishchev SF, Wang HL. Colorectal carcinoma: Pathologic aspects. J Gastrointest Oncol 2012;3(3):153–73.
Gürağaç A, Demirer Z. The neutrophil-to-lymphocyte ratio in clinical practice. Can Urol Assoc J 2016;10(3-4):141.
Howard R, Kanetsky PA, Egan KM. Exploring the prognostic value of the neutrophil-to-lymphocyte ratio in cancer. Sci Rep 2019;9(1):1–10.
Favoriti P, Carbone G, Greco M, Pirozzi F, Pirozzi RE, Corcione F. et al. Worldwide burden of colorectal cancer: a review. Updates Surg 2016;68(1):7–11.
Pine JK, Morris E, Hutchins GG, West NP, Jayne DG, Quirke P, et al. Systemic neutrophil-to-lymphocyte ratio in colorectal cancer: The relationship to patient survival, tumour biology and local lymphocytic response to tumour. Br J Cancer 2015;113(2):204–11.
Haram A, Boland MR, Kelly ME, Bolger JC, Waldron RM, Kerin MJ. The prognostic value of neutrophil-to-lymphocyte ratio in colorectal cancer: A systematic review. J Surg Oncol 2017;115(4):470–9.
Han F, Shang X, Wan F, Liu Z, Tian W, Wang D, et al. Clinical value of the preoperative neutrophil-to-lymphocyte ratio and red blood cell distribution width in patients with colorectal carcinoma. Oncol Lett 2018;15(3):3339–49.
Zhang J, Zhang HY, Li J, Shao XY, Zhang CX. The elevated NLR, PLR and PLT may predict the prognosis of patients with colorectal cancer: a systematic review and meta-analysis. Oncotarget 2017;8(40):68837–46.
Özgehan G, Kahramanca Ş, Kaya IO, Bilgen K, Bostanci H, Güzel H, et al. Neutrophil-lymphocyte ratio as a predictive factor for tumor staging in colorectal cancer. Turkish J Med Sci 2014;44(3):365–8.
He W, Zheng C, Wang Y, Dan J, Zhu M, Wei M, et al. Prognosis of synchronous colorectal carcinoma compared to solitary colorectal carcinoma: A matched pair analysis. Eur J Gastroenterol Hepatol 2019;31(12):1489–95.
Khalil Kh, Al-Hassawi BA, Abdo JM. Histopathological evaluation of Colorectal Carcinoma. Duhok Med J 2018;12(2):45–67.
Galceran J, Ameijide A, Carulla M, Mateos A, Quirós JR, Rojas D,et al. Cancer incidence in Spain, 2015. Clin Transl Oncol 2017;19(7):799–825.
Roshan MHK, Tambo A, Pace NP. The role of testosterone in colorectal carcinoma: Pathomechanisms and open questions. EPMA J 2016;7(1):22.
Abd ElLateef AAE, Mohamed AES, Elhakeem AA, Ahmed SF. Estrogen and progesterone expression in colorectal carcinoma: A clinicopathological study. Asian Pacific J Cancer Prev 2020;21(4):1155–62.
González-Trejo S, Carrillo JF, Carmona-Herrera DD, Baz-Gutiérrez P, Herrera-Goepfert R, Núñez G,et al. Baseline serum albumin and other common clinical markers are prognostic factors in colorectal carcinoma: A retrospective cohort study. Medicine (Baltimore) 2017;96(15):e6610.
Díaz Del Arco C, Garré P, Molina Roldán E, Lorca V, Cerón Nieto MÁ, Fernández Aceñero MJ. MUC1 expression in colorectal carcinoma: Clinicopathological correlation and prognostic significance. Rev Esp Patol 2018;51(4):204–9.
Remo A, Grillo F, Mastracci L, Fassan M, Sina S, Zanella C,et al. Clear cell colorectal carcinoma: Time to clarify diagnosis. Pathol Res Pract 2017;213(5):447–52.
Alipour S, Kennecke HF, Lim HJ, Cheung WY. Gender differences in outcomes for early-stage colon cancer. J Clin Oncol 2012;30(4):605.
Berger MD, Yang D, Sunakawa Y, Zhang W, Ning Y, Matsusaka S, et al. Impact of sex, age, and ethnicity/race on the survival of patients with rectal cancer in the United States from 1988 to 2012. Oncotarget 2016;7(33):53668–78.
Arshad HM, Tetangco E, Shah N, Kabir C, Raddawi H. Racial Disparities in Colorectal Carcinoma Incidence, Severity and Survival Times Over 10 Years: A Retrospective Single Center Study. J Clin Med Res 2016;8(11):777–86.
Tamhankar AS, Ingle P, Engineer R, Bal M, Ostwal V, Saklani A. Signet ring colorectal carcinoma: Do we need to improve the treatment algorithm? World J Gastrointest Oncol 2016;8(12):819–25.
Mima K, Cao Y, Chan AT, Qian ZR, Nowak JA, Masugi Y, et al. Fusobacterium nucleatum in Colorectal Carcinoma Tissue According to Tumor Location. Clin Transl Gastroenterol 2016;7(11):e200.
Al-Maghrabi J. Vimentin immunoexpression is associated with higher tumor grade, metastasis, and shorter survival in colorectal cancer. Int J Clin Exp Pathol 2020;13(3):493–500.
Jaiswal M, Ganapathy A, Singh S, Sarwar S, Quadri JA, Rani N, et al. Morphology of enteric glia in colorectal carcinoma: A comparative study of tumor site and its proximal normal margin. Morphologie 2021;105(35):267–74.
Ahnen DJ, Wade SW, Jones WF, Sifri R, Mendoza Silveiras J, Greenamyer J, et al. The increasing incidence of young-onset colorectal cancer: A call to action. Mayo Clin Proc 2014;89(2):216–24.
Riaz R, Masood N, Benish A. Red flag symptoms: Detailed account of clinicopathological features in young-onset colorectal cancer. Intest Res 2017;15(2):203–7.
Amini AQ, Samo KA, Memon AS. Colorectal cancer in younger population: Our experience. J Pak Med Assoc 2013;63(10):1275–7.
Watanabe T, Muro K, Ajioka Y, Hashiguchi Y, Ito Y, Saito Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol 2018;23(1):1–34.
Stojkovic Lalosevic M, Pavlovic Markovic A, Stankovic S, Stojkovic M, Dimitrijevic I, Radoman Vujacic I, et al. Combined Diagnostic Efficacy of Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Mean Platelet Volume (MPV) as Biomarkers of Systemic Inflammation in the Diagnosis of Colorectal Cancer. Dis Markers 2019;2019:6036979.
Dimitriou N, Felekouras E, Karavokyros I, Alexandrou A, Pikoulis E, Griniatsos J. Neutrophils to lymphocytes ratio as a useful prognosticator for stage II colorectal cancer patients. BMC Cancer 2018;18(1):1202.