Hematologic indices predict oncologic outcomes in colon cancer

Background : Systemic inflammation is associated with adverse oncological outcomes in colorectal cancer (CRC). Therefore markers of systemic inflammation such as the neutrophil lymphocyte ratio may be associated with long-term oncological outcomes. This study aimed to characterize the relationship between several ratios derived from hematologic indices using a classification and regression tree analysis. Methods : Hematologic white cell ratios were established for all patients undergoing colonic cancer resection (N = 436) with curative intent in a regional cancer center. The optimal ratios associated with overall survival were established in a training set (n = 386) using a classification and regression tree technique (CRT). The association between ratios and overall survival was assessed in a separate test set (n = 50). Within the test set, two groups were generated based on each ratio (above and below the cut-off point identified in the training set). The association between ratios and overall survival was assessed using a stepwise cox proportional hazards regression model. Results : CRT analysis identified the following optimal hematological ratios associated with adverse overall survival (OS): neutrophil lymphocyte ratio (NLR) greater than 3.40 and white cell count lymphocyte ratio (WLR) greater than 5.28. NLR [ 3.40 was an independent predictor of adverse OS on multivariate analysis (HR 3.4, 95 % CI 2.64 5.13, p \ 0.001). WLR [ 5.28 (HR 4.10, 95 % CI 3.13 7.42, p = 0.03) was also an independent prognostic factor. Conclusions: Multiple ratios derived from standard hematological indices are independent predictors of overall survival.