Prognostic value of neutrophil-to-lymphocyte ratios pre- and post-surgery in stage III CRC: a study of 2,742 patients

Stage III colorectal cancer (CRC) is typically treated with surgery; however, it has a high recurrence rate and inconsistent benefits from postoperative chemotherapy. Inflammatory markers like the neutrophil-to-lymphocyte ratio (NLR) have shown prognostic value in various cancers. However, the prognostic significance of NLR measured before and after CRC surgery is not clear. This study aims to clarify the prognostic value of the combination of pre- and post-surgery NLR in stage III CRC patients.

Patients with stage III CRC treated between 2001 and 2022 were retrospectively analyzed using data from the Chang Gung Medical Research Database. Patients were categorized into 4 groups based on their pre- and post-operative NLR levels. Kaplan–Meier survival analysis and Cox proportional hazard models were used to assess the associations between NLR levels and overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS).

Data from 2,742 patients, median age of 62 years and 54% male, were analyzed. After adjustment, patients in Group IV, with high NLR values both before and after surgery, had greater risks of worse DFS (adjusted hazard ratio [aHR] = 1.30, 95% confidence interval [CI]: 1.13–1.50), OS (aHR = 1.36, 95% CI: 1.14–1.63), and CSS (aHR = 1.27, 95% CI: 1.04–1.55) compared to Group I.

High NLR levels before and after surgery is a strong predictor of poor outcomes in stage III CRC patients. The findings suggest that monitoring NLR at both time points can be a valuable prognostic tool, guiding postoperative care and treatment strategies to improve patient outcomes.