Neutrophil-lymphocyte ratio and platelet-lymphocyte ratios correlate with staging in patients with colorectal carcinoma

Rohit Krishna A., Anil Kumar A. V.


Background: Systemic inflammation status is revealed to be associated with prognosis of solid tumours. Inflammatory markers including C-reactive protein, Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio have been claimed to provide insight into resectability of carcinoma and in predicting prognosis. The objective of this study was to study neutrophil lymphocyte ratio and platelet lymphocyte ratio profiles in patients with colo-rectal cancers.

Methods: This study was done as a hospital based descriptive on 80 patients diagnosed with colonic and rectal cancers. The study was carried out from May 2017 to May 2018 at General Surgery and Radiotherapy departments at Government Medical College, Trivandrum. Neutrophil lymphocyte ratio and platelet lymphocyte ratio was calculated and correlated with the pre-operative staging, post-operative staging and the histopathological grade.

Results: Both neutrophil lymphocyte ratio and platelet lymphocyte ratio were found to be higher in patients with colo-rectal cancers as compared to values in normal healthy population. Neutrophil lymphocyte ratio was well correlated with tumour status, nodal status and overall stage in pathological staging. Platelet lymphocyte ratio was well correlated with tumour status and overall stage in CT staging and with tumour status, nodal status and overall stage in pathological staging.

Conclusions: Neutrophil lymphocyte ratio and platelet lymphocyte ratio are correlated with colo-rectal carcinomas and may provide valuable information in staging the patients. They are cost-effective, easily measurable but affected by race, sex, age, co-morbidities and many other potential factors. Routine estimation of these ratios can serve as adjunct to staging as well as help to prognosticate the patients.


Colonic cancer, Neutrophil-lymphocyte ratio, Platelet-lymphocyte ratio, Rectal cancer

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Nakajima K, Ochiai T, Suzuki T, Shimada H, Hayashi H, Yasumoto A, et al. Impact of Preoperative Serum Carcinoembryonic Antigen, CA 19-9 and Alpha Fetoprotein Levels in Gastric Cancer Patients. Tumor Biol. 1998;19:464-9.

Chua W, Charles KA, Baracos VE, Clarke SJ. Neutrophil/lymphocyte ratio predicts chemotherapy outcomes in patients with advanced colorectal cancer. Brit J Canc. 2011;104(8):1288-95.

Ferradini L, Miescher S, Stoeck M, Busson P, Barras C, Cerf‐Bensussan N, et al. Cytotoxic potential despite impaired activation pathways in T lymphocytes infiltrating nasopharyngeal carcinoma. Int J Canc. 1991;47(3):362-70.

Gwak MS, Choi SJ, Kim J, Ko JS, Kim TH, Lee SM, et al. Effects of gender on white blood cell populations and neutrophil-lymphocyte ratio following gastrectomy in patients with stomach cancer. J Kor Medic Sci. 2007;22(S1):4-8.

Ietomi K. A study on the role of granulocytes in carcinoma-bearing hosts--G/L ratio as a new host indicator. Nihon Gan Chiryo Gakkai Shi. 1990;25(3):662-71.

Satomi A, Murakami S, Ishida K, Mastuki M, Hashimoto T, Sonoda M. Significance of increased neutrophils in patients with advanced colorectal cancer. Acta Oncol. 1995;34(1):69-73.

Gomez D, Farid S, Malik HZ, Young AL, Toogood GJ, Lodge JP, et al. Preoperative neutrophil-to-lymphocyte ratio as a prognostic predictor after curative resection for hepatocellular carcinoma. World J Surg. 2008;32(8):1757-62.

Kwon HC, Kim SH, Oh SY, Lee S, Lee JH, Choi HJ, et al. Clinical significance of preoperative neutrophil-lymphocyte versus platelet-lymphocyte ratio in patients with operable colorectal cancer. Biomarkers. 2012;17(3):216-22.

Mallappa S, Sinha A, Gupta S, Chadwick SJ. Preoperative neutrophil to lymphocyte ratio >5 is a prognostic factor for recurrent colorectal cancer. Colorectal Dis. 2013;15(3):323-8.

1Sarraf KM, Belcher E, Raevsky E, Nicholson AG, Goldstraw P, Lim E. Neutrophil/lymphocyte ratio and its association with survival after complete resection in non-small cell lung cancer. J Thorac Cardiovasc Surg. 2009;137(2):425-8.

Donskov F, von der Maase H. Impact of immune parameters on long-term survival in metastatic renal cell carcinoma. J Clin Oncol. 2006;24(13):1997-2005.

Donskov F, Hokland M, Marcussen N, Madsen HT, von der Maase H. Monocytes and neutrophils as ‘bad guys’ for the outcome of interleukin-2 with and without histamine in metastatic renal cell carcinoma – results from a randomised phase II trial. Br J Cancer. 2006;94:218-26.

Schmidt H, Suciu S, Punt CJ, Gore M, Kruit W, Patel P, et al. American Joint Committee on Cancer Stage IV Melanoma; EORTC 18951. Pretreatment levels of peripheral neutrophils and leukocytes as independent predictors of overall survival in patients with American Joint Committee on Cancer Stage IV Melanoma: results of the EORTC 18951 Biochemotherapy Trial. J Clin Oncol. 2007;25(12):1562-9.

An X, Mao HP, Wei X, Chen JH, Yang X, Li ZB, et al. Elevated neutrophil to lymphocyte ratio predicts overall and cardiovascular mortality in maintenance peritoneal dialysis patients. Int Urol Nephrol. 2012;44(5):1521-8.

Shiny A, Bibin YS, Shanthirani CS, Regin BS, Anjana RM, Balasubramanyam M, et al. Association of neutrophil-lymphocyte ratio with glucose intolerance: an indicator of systemic inflammation in patients with type 2 diabetes. Diabetes Technol Ther. 2014;16(8):524-30.

Halazun KJ, Hardy MA, Rana AA, Woodland DC, Luyten EJ, Mahadev S, et al. Negative impact of neutrophil-lymphocyte ratio on outcome after liver transplantation for hepatocellular carcinoma. Ann Surg. 2009;250(1):141-51.

Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell. 2011;144(5):646-74.

Alexander NI. Reference Values of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Mean Platelet Volume in Healthy Adults in North Central Nigeria. J Blood Lymph. 2016;6:143.

Kweon OJ, Lee MK, Kim HJ, Chung JW, Choi SH, Kim HR. Neutropenia and neutrophil-to-lymphocyte ratio in a healthy Korean population: race and sex should be considered. Int J Lab Hematol. 2016;38(3):308-18.

Azab B, Camacho-Rivera M, Taioli E. Average values and racial differences of neutrophil lymphocyte ratio among a nationally representative sample of United States subjects. PLoS One. 2014;9(11):e112361.

Lin BD, Hottenga JJ, Abdellaoui A, Dolan CV, de Geus EJ, Kluft C, et al. Causes of variation in the neutrophil–lymphocyte and platelet–lymphocyte ratios: a twin-family study. Biomark Medic. 2016;10(10):1061-72.