ABSTRACT
AIM: The aim of the study was to investigate the role of the neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker of rectal cancers. METHODS: We undertook a retrospective review of patients with rectal cancer. Pre-treatment NLR was assessed for association and predictive values against clinicopathological staging and post-treatment outcomes. RESULTS: A total of 140/180 cases were included in the final analysis [male:female 2:1; mean age 68 years (interquartile range 58-75)]. The pre-operative mean NLR was 5.4 ± 6.8. There was a strong positive correlation between NLR and C-reactive protein (Spearman's rho 64.3%, p < 0.001). A high NLR was associated with a positive nodal status on MRI (5.2 vs. 3.8, p = 0.03) and histopathological (4.8 vs. 3.8, p = 0.02) assessment. The NLR showed an average value for predicting MRI and pathological nodal status on receiver operating characteristic analysis [area under the curve = 0.72 (95% CI = 0.54-0.91), p = 0.031 and area under the curve = 0.64 (95% CI = 0.52-0.077), p = 0.021, respectively]. On multivariate analysis, the total lymph node retrieved at operation was the best predictor of pathological nodal involvement; NLR did not show any predictive value. Patients with an NLR >4 showed reduced recurrence-free (60 vs. 86 months, p = 0.52) and overall survival (57 vs. 84 months, p = 0.40) without statistical significance. CONCLUSION: Raised pre-treatment NLR may indicate nodal involvement in patients with rectal cancer.
Subject(s)
Lymph Node Excision , Lymph Nodes/pathology , Lymphocytes , Neutrophils , Rectal Neoplasms/blood , Rectal Neoplasms/pathology , Aged , Area Under Curve , Biomarkers, Tumor/blood , C-Reactive Protein/metabolism , Disease-Free Survival , Female , Humans , Lymph Nodes/diagnostic imaging , Lymph Nodes/surgery , Lymphatic Metastasis , Lymphocyte Count , Magnetic Resonance Imaging , Male , Middle Aged , Predictive Value of Tests , ROC Curve , Rectal Neoplasms/surgery , Retrospective Studies , Survival RateABSTRACT
BACKGROUND: Old age is considered a risk factor; however, its effect on the prognosis of injured elderly patients remains uncertain. AIM: To find the effect of old age on final outcome of elderly patients withmultiple trauma and to determine whether a different therapeutic approach is needed. METHODS: All patients with at least two injured body regions, as defined by the ISS, of grade 4 in AIS, were included. RESULTS: We studied 165 patients up to 64 years (Y) of age and 56 patients older than 65 years (E) in a 10-year period. On presentation 21.2% of Y and 25% of E, were hypovolemic (p = NS). No significant difference in number of injuries/patient was noted between Y and E patients, hemodynamically stable (HS) and unstable (HU) - (3.0 vs. 2.9 and 3.9 vs. 3.6). An increased relative frequency of chest and abdomen injuries was noted in Y and E, who died or were HU on presentation. A higher relative frequency of long bone and pelvis fractures was noted in the E. The ISS was not different among HS and HU, Y and E. Hospitalization in ICU was more common in E than in Y (69.6 vs. 47.3%), but there was no difference in the final outcome: overall mortality was 10.3% in Y versus 16.1% in E (p = NS), mortality in HU was 42.9% in Y versus 50% in E (p = NS). ISS was not associated with mortality in either group. CONCLUSIONS: Old age has no influence on final outcome of E multi trauma patients; hence, the therapeutic approach of these patients should be the same in Y.
