Predictive value of leukocyte- and platelet-derived ratios in rectal adenocarcinoma

William H. Ward, Neha Goel, Karen J. Ruth, Andrew C. Esposito, Fernando Lambreton, Elin R. Sigurdson, Joshua E. Meyer, Jeffrey M. Farma

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background: Advances in treatment of rectal cancer have improved survival, but there is variability in response to therapy. Recent data suggest the utility of the lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) in predicting survival. Our aim was to examine these ratios in rectal cancer patients and determine whether any association exists with overall survival (OS). Methods: Using prospectively maintained institutional data, a query was completed for clinical stage II-III rectal adenocarcinoma patients treated from 2002 to 2016. We included patients who had a complete blood count collected before neoadjuvant chemoradiation (pre-CRT) and again before surgery (post-CRT). The LMR, NLR, and PLR were calculated for the pre-CRT and post-CRT time points. Potential cutpoints associated with OS differences were determined using maximally selected rank statistics. Survival curves were compared using log-rank tests and were adjusted for age and stage using Cox regression. Results: A total of 146 patients were included. Cutpoints were significantly associated with OS for pre-CRT ratios but not for post-CRT ratios. Within the pretreatment group, a “low” (<2.86) LMR was associated with decreased OS (log-rank P = 0.004). In the same group, a “high” (>4.47) NLR and “high” PLR (>203.6) were associated with decreased OS (log-rank P < 0.001). With covariate adjustment for age, and separately for final pathologic stage, the associations between OS and LMR, NLR, and PLR each retained statistical significance. Conclusions: If obtained before the start of neoadjuvant chemoradiation, LMR, NLR, and PLR values are accurate predictors of 5-y OS in patients with locally advanced rectal adenocarcinoma.

Original languageEnglish (US)
Pages (from-to)275-282
Number of pages8
JournalJournal of Surgical Research
StatePublished - Dec 2018
Externally publishedYes


  • Lymphocyte-to-monocyte ratio
  • Neutrophil-to-lymphocyte ratio
  • Overall survival
  • Platelet-to-lymphocyte ratio
  • Rectal adenocarcinoma

ASJC Scopus subject areas

  • Surgery


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