Predictive value of neutrophil-to-lymphocyte ratio before chemotherapy in the prognosis of patients with unresectable metastatic colorectal cancer

HUANG Xiwen; PENG Shunqing

doi:10.3969/j.issn.1009-0460.2025.08.006

Abstract：Objective To investigate the significance of pre-chemotherapy peripheral blood neutrophil-to-lymphocyte ratio(NLR)in patients diagnosed with unresectable metastatic colorectal cancer(mCRC)who are undergoing first-line chemotherapy.Methods A total of 198 mCRC patients undergoing initial chemotherapy were chosen as the subjects of the study and were stratified into two groups based on their NLR levels before treatment:a low NLR group(<2.81,n=99)and a high NLR group(≥2.81,n=99)using the median value as the cutoff point.The χ2 test was used to analyze and compare the clinicopathological characteristics of the two groups of patients,the Kaplan-Meier method was used to draw the survival curves,the Log-rank test was used to compare the survival of the two groups of patients and the Cox proportional risk regression model was used to analyze the factors affecting the overall survival time(OS)of the patients.Results There were no significant differences in baseline clinicopathological characteristics,including age,sex,tumor location,tumor size,histological differentiation,ECOG performance status,CEA and CA199 levels between the low NLR group and the high NLR group(all P>0.05).Univariate Cox regression analysis identified histological differentiation(HR=1.837,95%CI:1.197-2.819,P=0.005),ECOG performance status(HR=4.267,95%CI:3.033-6.003,P<0.001),CA199(HR=1.619,95%CI:1.193-2.198,P=0.002),and NLR(HR=1.436,95%CI:1.061-1.945,P=0.019)were all significantly associated with OS in mCRC patients.Multivariate Cox regression confirmed that histological differentiation(HR=2.089,95%CI:1.351-3.231,P=0.001),ECOG performance status(HR=4.264,95%CI:3.002-6.057,P<0.001),CA199(HR=1.381,95%CI:1.009-1.889,P=0.044)and NLR(HR=1.390,95%CI:1.023-1.887,P=0.035)were independent prognostic factors for OS in patients with mCRC.Kaplan-Meier survival analysis demonstrated that patients in the high NLR group had a significantly lower 5-year survival rate(7.07%)compared to the low NLR group(21.21%),and the differences were statistically significant(P=0.013).Conclusion The presence of a higher peripheral blood NLR prior to chemotherapy is indicative of an unfavorable prognosis and can serve as a valuable prognostic marker for patients with unresectable mCRC.