Clin Oncol | Volume 6, Issue 1 | Research Article | Open Access

Neutrophil-to-Lymphocyte Ratio Combined with Skeletal Muscle Mass Loss Predicts Survival in Patients with Metastatic Colorectal Cancer Receiving Palliative Chemotherapy

Daisuke Takayanagi*, Noriyuki Isohata, Tetsutaro Nemoto, Daiki Nemoto, Masato Aizawa, Kenichi Utano, Kazutomo Togashi and Shungo Endo

Department of Coloproctology, Fukushima Medical University, Japan

*Correspondance to: [email protected] 

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Aim: Increasing evidence indicates that a high Neutrophil-to-Lymphocyte Ratio (NLR) and Skeletal Muscle Mass (SMM) loss are associated with poor survival in patients with unresectable advanced/metastatic Colorectal Cancer (uCRC). We assessed the clinical outcomes in uCRC patients receiving chemotherapy in relation to the NLR and SMM loss.
Methods: In this study, we retrospectively enrolled 78 patients with uCRC who underwent systemic chemotherapy between December 2012 and June 2019. The bilateral psoas muscle crosssectional area at the superior border of the fourth lumbar vertebra was measured using Computed Tomography (CT), and the Psoas Muscle Index (PMI) was determined. SMM loss was defined as a decrease in PMI of ≥ 5% when comparing pre-chemotherapy PMI values with values obtained 3 months after chemotherapy initiation. The NLR was calculated as the absolute neutrophil count divided by the absolute lymphocyte count measured before chemotherapy. The NLR cutoff value was set as 3.0. Patients were divided into four groups according to NLR status and SMM loss: High NLR/SMM loss, high NLR/non-SMM loss, low NLR/SMM loss, and low NLR/non-SMM loss.
Results: Thirty-two patients had a high NLR; they exhibited significantly shorter Overall Survival (OS) than those with a low NLR (median 16.0 vs. 30.3 months; log-rank, p=0.001). The OS in patients with high NLR/SMM loss was significantly lower than that in all other groups (median 11.8 vs. 21.5 vs. 21.5 vs. 34.2 months; log-rank, p<0.001). In multivariate analysis, high NLR/SMM loss
was an independent prognostic factor for shorter OS (hazard ratio: 3.44, 95% confidence interval: 1.45 to 8.12, p=0.0048).
Conclusion: There was a significant correlation between NLR status and SMM loss and prognosis in patients with uCRC who were receiving chemotherapy. Intensive supportive care, including exercise and nutrition, is needed for uCRC patients with a high NLR.


Metastatic colorectal cancer; Chemotherapy; Skeletal muscle loss; Neutrophil-tolymphocyte ratio


Takayanagi D, NIsohata D, Nemoto T, Nemoto D, Aizawa M, Utano K, et al. Neutrophil-to-Lymphocyte Ratio Combined with Skeletal Muscle Mass Loss Predicts Survival in Patients with Metastatic Colorectal Cancer Receiving Palliative Chemotherapy. Clin Oncol. 2021;6:1779..

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