# Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Locally Advanced Rectal Cancer Treated with Neoadjuvant Concurrent Chemoradiotherapy and Robotic-Assisted Resection

## TL;DR

This study shows that a high neutrophil-to-lymphocyte ratio before treatment predicts worse survival in locally advanced rectal cancer patients undergoing robotic surgery.

## Contribution

The study demonstrates that pretreatment NLR ≥3.2 is an independent predictor of poor survival outcomes in LARC patients treated with robotic-assisted surgery.

## Key findings

- Patients with NLR ≥3.2 had significantly worse overall and disease-free survival compared to those with NLR <3.2.
- Multivariate analysis confirmed NLR ≥3.2 as an independent predictor of poor overall and disease-free survival.
- Combining NLR with CEA levels may improve prognostic accuracy for LARC patients undergoing robotic-assisted surgery.

## Abstract

The long-term outcomes of robotic-assisted surgery and the prognostic significance of the pretreatment neutrophil-to-lymphocyte ratio (NLR) in locally advanced rectal cancer (LARC) remain uncertain. This study aimed to assess the long-term outcomes of patients with LARC undergoing robotic-assisted surgery and to determine the prognostic value of pretreatment NLR.

We retrospectively reviewed 252 patients with LARC who were treated at a single medical center in Taiwan between January 2012 and January 2023. All patients underwent neoadjuvant concurrent chemoradiotherapy (CRT) followed by robotic-assisted surgery with total mesorectal excision (TME). Patients were stratified into four groups on the basis of pretreatment NLRs and carcinoembryonic antigen (CEA) levels. Univariate and multivariate analyses were conducted to identify prognostic indicators for overall survival (OS) and disease-free survival (DFS).

Patients with a pretreatment NLR of ≥3.2 exhibited significantly worse OS and DFS compared with those with an NLR of <3.2 (OS: 94.4 vs. 116.5 months, p = 0.001; DFS: 78.8 vs. 101.7 months, p = 0.003). Group A exhibited the poorest prognosis, whereas Group D had the most favorable outcomes. Multivariate analysis revealed NLR ≥ 3.2 as an independent predictor of poor OS (hazard ratio [HR] = 2.306, 95% CI: 1.149–3.747; p = 0.001) and DFS (HR = 2.055, 95% CI: 1.341–3.148; p = 0.001).

Neoadjuvant concurrent CRT followed by robotic-assisted TME is an effective treatment strategy for LARC. A higher pretreatment NLR (≥3.2) independently predicted worse OS and DFS. Stratification using the NLR in combination with CEA levels may enhance prognostic accuracy for patients undergoing robotic-assisted surgery for LARC.