Preoperative neutrophil to lymphocyte ratio as a survival predictor in nonmetastatic colon cancer in a Latin America-based population.

Authors

Horacio N López-Basave, Germán Calderillo-Ruíz, Flavia Morales-Vásquez, Gerardo Miranda-Dévora, David Tlelo-Amastal, Luis M Alavez-Ortega, Wendy R Muñoz-Montaño

Published in

Annals of coloproctology. Volume 42. Issue 4. Pages 396-406. Epub Aug 12, 2026.

Abstract

Colon cancer represents a major global health challenge, with a steadily increasing incidence. Therefore, the identification of novel and easily accessible biomarkers in colon cancer is essential. Although the neutrophil to lymphocyte ratio (NLR) has emerged as a potential prognostic indicator in various malignancies, its applicability in colon cancer within Latin America remains unexplored. This study evaluated the association between preoperative NLR and overall survival (OS) and disease-free survival (DFS).
We conducted a retrospective cohort study at the gastroenterology department of Mexico's National Cancer Institute between 2008 and 2022. All patients with nonmetastatic colon cancer who underwent upfront surgery were screened for inclusion. The optimal NLR cutoff value was determined using X-tile software and receiver operating characteristic curve analysis. Prognostic factors were assessed using Cox proportional hazards regression models.
A total of 522 patients were included in the analysis and categorized into high NLR (>3.0, n=230) and low NLR (≤3.0, n=292). High NLR was associated with worse 3- and 5-year OS compared with low NLR (89.9% vs. 97.5% and 84.8% vs. 94.8%, respectively) in both univariate (P<0.001) and multivariate analyses (hazard ratio [HR], 3.020; 95% confidence interval [CI], 1.638-5.570; P<0.001). High NLR was also associated with worse 3- and 5-year DFS compared with low NLR (74.2% vs. 86.5% and 72.4% vs. 82.9%, respectively) in univariate (P=0.002) and multivariate analyses (HR, 1.627; 95% CI, 1.106-2.392; P=0.013).
This exploratory study highlights the prognostic relevance of NLR in nonmetastatic colon cancer and supports its utility for predicting OS and DFS in a Latin American population. As a readily available biomarker, NLR may be particularly useful in low-income settings. Further prospective studies are required to validate its clinical applicability.

PMID:
42687594
Bibliographic data and abstract were imported from PubMed on 03 Sep 2026.

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