Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as a prognostic factor of colorectal cancer patients

Abstract

Objective : This study aimed to assess the prognostic significance of the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in colorectal cancer patients prior to therapeutic initiation.

Methods : A retrospective analytical study was conducted in patients with colorectal cancer who had undergone preoperative complete blood count (CBC) evaluation at Mahasarakham Hospital between 2023 and 2025and hospital staff of Mahasarakham Hospital who underwent the annual health check-up in 2025 were included as the normal control group. The collected data were analyzed using GraphPad Prismand IBM-SPSS software.

Result : Among 157 patients enrolled in the study, histopathological diagnosis classified 56 patients as having benign conditions and 101 as having colorectal adenocarcinoma. In patients with colorectal adenocarcinoma, the optimal cut-off value of the neutrophil-to-lymphocyte ratio (NLR) was 2.55 with a sensitivity of 64.4% and a specificity of 94.4% (AUC = 0.827, p<0.001). The optimal cut-off value of the platelet-to-lymphocyte ratio (PLR) was 212.0, with a sensitivity of 65.3% and a specificity of 90.5% (AUC = 0.794, p<0.001). In the benign group, the optimal NLR cut-off was 3.15, with a sensitivity of 83.9% and a specificity of 97.5% (AUC = 0.951, p<0.001), while the PLR cut-off was 212.0, with a sensitivity of 83.9% and a specificity of 90.5% (AUC = 0.904, p<0.001). Furthermore, NLR and PLR values in stage I colorectal cancer patients were significantly different from those in patients with stage IV disease (p<0.001).

Conclusion : A cut-off value of 2.55 for NLR and 212.0 for PLR may serve as useful indices for prognostic assessment in patients with colorectal adenocarcinoma prior to treatment. Additionally, both NLR and PLR were found to be associated with the metastatic spread of cancer cells.