NEUTROPHIL-LYMPHOCYTE RATIO AND NUTRITION STATUS ARE CLINICALLY USEFUL IN PREDICTING PROGNOSIS IN PATIENTS WITH COLORECTAL CANCER

Background:Colorectal cancer (CRC) is the third most malignant neoplasm and the fourth leading cause of cancer death in Brazil. Changes caused by cancer lead to modification in protein-energy metabolism, exacerbated pro-inflammatory state, immune depression and, moreover, affect the ability to ingest or absorb nutrients properly. Despite the substantial improvement in early diagnosis and treatment, the prognosis of patients with CRC remains unsatisfactory. neutrophil-lymphocyte ratio (NLR) and nutritional status may provide an independent prognostic value in CRC. Thus, aim of our study was to investigate the influence of nutritional status classification and NLR on the long-term survival of patients diagnosed with CRC. Methods: A retrospective analysis was conducted in patients with CRC in a Brazilian reference cancer institute. The population of the study was composed of patients in CRC pre-treatment, from 20 years of age, of both sexes. The independent variables related to nutritional status evaluated were body mass index (BMI) and weight loss (WL) classification. It was considered overall survival (OS) in 5 years old. KaplanMeier curves were conducted for survival analyses. Cox multivariate model also was used to measure the adjusted effects. The results were considered statistically significant when p < 0.05. Results: A total of 148 patients were included in the study. The most prevalent nutritional status was overweight/obesity (43.2%) and severe WL had an important frequency (27.0%). Sixty-seven subjects (45.3%) had NLR ≥3. Analysis of the survival curve showed that the NLR above the cutoff point was significantly associated with the lower OS (p < 0.001). Regarding nutritional status, there was a higher survival rate for overweight/obese patients (p = 0.002) and a lower survival rate among subjects with severe WL (p = 0.009). Multivariate Cox regression demonstrated that NLR ≥3 (HR: 3.639, p = 0.001; 95% CI, 1.7087.771) was identified as independent poor prognostic factors for OS. On the other hand, patients without WL (HR: 0.367, p = 0.040; 95% CI, 0.1410.954) and overweight/obesity (HR: 0.260 p = 0.003; 95% CI, 0.1060.639) presented better prognostic. Conclusion: NLR, WL, BMI assessments can be promising prognostic indicators in CRC patients. These tools are easy to measure, inexpensive and may be useful in improving decisions about therapeutic protocols and the survival perspectives in patients with CRC.