The impact of neoadjuvant therapy on the prognostic value of preoperative neutrophil-to-lymphocyte ratio for colorectal liver metastases: a multi-center cohort study.
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Abstract
Background: Neutrophil-to-lymphocyte ratio (NLR) is a promising prognostic marker for patients undergoing hepatectomy for colorectal liver metastases (CRLM). However, its prognostic value in patients receiving neoadjuvant therapy (NAT) has not been sufficiently addressed.
Methods: From 2013 to 2023, a cohort of 692 patients with CRLM receiving hepatectomy were enrolled in five centers. Clinicopathological characteristics were obtained from a prospectively maintained multi-center database. The effect of NLR (> 2 versus ≤ 2) on overall survival (OS) and recurrence-free survival was estimated by Kaplan-Meier analysis. Univariable and multivariable Cox regression analysis was applied to investigate the influence of individual clinicopathological parameters on OS.
Results: In the entire cohort, the median NLR level was 2.11 (0.30-16.33). There were 307 (44.4%) patients receiving NAT followed by hepatectomy, while 385 (55.6%) patients undergoing upfront surgery. Notably, patients in the NAT group showed significantly lower NLR level than those in the upfront surgery group (1.83 versus 2.32, P < 0.001). In the upfront surgery group, high NLR was significantly associated with worse OS, independent of other factors (HR = 1.49, 95% CI 1.08-2.05, P = 0.02). In the NAT group, there was no significant difference in OS between the high NLR and low NLR group.
Conclusion: The prognostic value of NLR in surgically resected CRLM is potentially influenced by NAT in the modern era.
期刊介绍：
The International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and Surgery aims to publish novel and state-of-the-art papers which deal with the physiology and pathophysiology of diseases involving the entire gastrointestinal tract. In addition to original research articles, the following categories will be included: reviews (usually commissioned but may also be submitted), case reports, letters to the editor, and protocols on clinical studies.
The journal offers its readers an interdisciplinary forum for clinical science and molecular research related to gastrointestinal disease.
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