Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2025; 17(6): 106813
Published online Jun 27, 2025. doi: 10.4240/wjgs.v17.i6.106813
Role of neutrophil-to-lymphocyte, platelet-to-lymphocyte, and monocyte-to-lymphocyte ratios in rectal cancer prognosis
Li-Li Shao, Xiang Li, Li-Fen Wang
Li-Li Shao, Xiang Li, Li-Fen Wang, Clinical Laboratory, Changzhi People’s Hospital of Shanxi Province, Changzhi 046000, Shanxi Province, China
Author contributions: Shao LL designed the study; Shao LL, Li X, and Wang LF contributed to the analysis of the manuscript, the data collection, and the writing of this article; All authors read and approved the final manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of the Changzhi People’s Hospital of Shanxi Province (No. 2024K057).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Li Shao, Associate Chief Physician, Clinical Laboratory, Changzhi People’s Hospital of Shanxi Province, No. 502 Changxing Middle Road, Changzhi 046000, Shanxi Province, China. shaolili001@126.com
Received: March 7, 2025
Revised: March 31, 2025
Accepted: May 6, 2025
Published online: June 27, 2025
Processing time: 84 Days and 3.5 Hours
Abstract
BACKGROUND

An efficient index holds the potential to predict rectal cancer prognosis.

AIM

To investigate the impact of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) on rectal cancer prognosis.

METHODS

This retrospective study involved 180 patients with rectal cancer from the Changzhi People’s Hospital of Shanxi Province. A 2-mL blood sample was collected at 24 h preoperatively and 72 h postoperatively to measure neutrophils, lymphocytes, platelets, and monocytes using an automatic blood analyzer. Preoperative and postoperative NLR, PLR, and MLR were compared. Patients were followed up for 12 months and categorized into good and poor prognosis groups. A receiver operating characteristic curve was constructed to analyze their predictive values.

RESULTS

The NLR, PLR, and MLR values were significantly lower post-surgery (P < 0.05). A total of 152 and 28 patients were categorized in the good and poor prognosis groups, respectively. Patients with poor prognoses exhibited slightly higher postoperative NLR, PLR, and MLR values than those with good prognoses (P < 0.05). Receiver operating characteristic analysis showed that the area under the curve for NLR, PLR, and MLR was 0.828 with a sensitivity and specificity of 89.29% and 90.79%, respectively. These values were higher than individual NLR (area under the curve: 0.660, sensitivity: 67.86%, specificity: 54.61%), PLR (0.668, 75.00%, 55.30%), and MLR (0.635, 60.71%, 48.03%), all showing statistically significant differences (P < 0.05), effectively predicting patient outcomes.

CONCLUSION

The findings of this study indicated that NLR, PLR, and MLR values of patients with rectal cancer can be used to effectively predict the outcome of patients.

Keywords: Rectal cancer; Neutrophil-to-lymphocyte ratio; Platelet-to-lymphocyte ratio; Monocyte-to-lymphocyte ratio; Prognosis

Core Tip: This retrospective study of 180 patients with rectal cancer revealed that combined assessment of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio provided superior prognostic value compared with individual ratios. Post-surgery neutrophil-to-lymphocyte/platelet-to-lymphocyte/monocyte-to-lymphocyte ratio levels showed significant discriminative power (area under the curve = 0.828) with 89.29% sensitivity and 90.79% specificity for predicting poor outcomes. The dynamic reduction of inflammatory ratios in responders highlighted their clinical utility for postoperative monitoring and risk stratification.