The impact of neoadjuvant therapy on the prognostic value of preoperative neutrophil-to-lymphocyte ratio for colorectal liver metastases: a multi-center cohort study.

Background: Neutrophil-to-lymphocyte ratio (NLR) is a promising prognostic marker for patients undergoing hepatectomy for colorectal liver metastases (CRLM). However, its prognostic value in patients receiving neoadjuvant therapy (NAT) has not been sufficiently addressed. Methods: From 2013 to 2023, a cohort of 692 patients with CRLM receiving hepatectomy were enrolled in five centers. Clinicopathological characteristics were obtained from a prospectively maintained multi-center database. The effect of NLR (> 2 versus ≤ 2) on overall survival (OS) and recurrence-free survival was estimated by Kaplan–Meier analysis. Univariable and multivariable Cox regression analysis was applied to investigate the influence of individual clinicopathological parameters on OS. Results: In the entire cohort, the median NLR level was 2.11 (0.30–16.33). There were 307 (44.4%) patients receiving NAT followed by hepatectomy, while 385 (55.6%) patients undergoing upfront surgery. Notably, patients in the NAT group showed significantly lower NLR level than those in the upfront surgery group (1.83 versus 2.32, P < 0.001). In the upfront surgery group, high NLR was significantly associated with worse OS, independent of other factors (HR = 1.49, 95% CI 1.08–2.05, P = 0.02). In the NAT group, there was no significant difference in OS between the high NLR and low NLR group. Conclusion: The prognostic value of NLR in surgically resected CRLM is potentially influenced by NAT in the modern era. [ABSTRACT FROM AUTHOR]