Research Article

Hubungan antara Neutrophil-Lymphocyte Ratio (NLR) dengan Tumor-Infiltrating Lymphocyte (TIL), staging, dan grading histopatologi pasien kanker kolorektal di RSUP Sanglah, Bali, Indonesia

Gede Dian Astika Putera , I Made Mulyawan, I Ketut Sudartana

Gede Dian Astika Putera
Residen Ilmu Bedah, Fakultas Kedokteran, Universitas Udayana, RSUP Sanglah, Bali, Indonesia. Email: opongpongo@gmail.com

I Made Mulyawan
Spesialis Bedah Konsultan Digestif, Fakultas Kedokteran, Universitas Udayana, RSUP Sanglah, Bali, Indonesia

I Ketut Sudartana
Spesialis Bedah Konsultan Digestif, Fakultas Kedokteran, Universitas Udayana, RSUP Sanglah, Bali, Indonesia
Online First: December 01, 2020 | Cite this Article
Putera, G., Mulyawan, I., Sudartana, I. 2020. Hubungan antara Neutrophil-Lymphocyte Ratio (NLR) dengan Tumor-Infiltrating Lymphocyte (TIL), staging, dan grading histopatologi pasien kanker kolorektal di RSUP Sanglah, Bali, Indonesia. Intisari Sains Medis 11(3): 1354-1358. DOI:10.15562/ism.v11i3.780


Background: Colorectal Cancer (CRC) is a significant public health problem in Indonesia. Inflammation is said to have an essential role in the pathogenesis and progressiveness of the CRC. The ratio of neutrophils and lymphocytes (NLR) is a marker that is easily measured. It is hoped that this ratio can be a useful, inexpensive, and fast marker that is routinely carried out, especially for CRC patients.

Methods: This study was an analytic cross-sectional design study to determine the relationship between NLR and TIL, histopathology, and TNM stage in patients with TRC. The variables assessed in this study included age, gender, NLR, TIL, grading, stage, and Receiver Operating Curve (ROC) analysis of the relationship between NLR and colorectal cancer stage. Data were analyzed using SPSS version 17 for Windows.

Results: There was no significant correlation (p=0.301) between NLR and TIL. The correlation of NLR with histopathological grading was also not significant (p=0.250). There was a significant correlation between NLR with the CRC staging (p<0.001). NLR's cut-off point for staging was determined to be 4.0 with a sensitivity of 98% and a specificity of 95%. This correlation has an Odd-Ratio (OR) of 465.500 and p<0.001 so that the correlation is significant. Obtained correlation coefficient (r) NLR with CRC patient stage of 0.898, where this value has a strong correlation (r> 0.75).

Conclusion: High NLR is associated with advanced stage in CRC with an NLR cut-off point of 4.

 

 

Latar Belakang: Kanker kolorektal (KKR) merupakan masalah kesehatan masyarakat di Indonesia.  Inflamasi dikatakan memiliki peran penting dalam patogenesis dan progesifitas KKR. Rasio neutrofil dan limfosit (NLR) merupakan suatu marker yang mudah diukur. Diharapkan rasio ini dapat menjadi salah satu marker yang bermanfaat, murah dan cepat serta rutin dilakukan khususnya pada pasien KKR

Metode: Penelitian ini merupakan suatu penelitian rancangan potong lintang analitik untuk mengetahui hubungan antara NLR dengan TIL, histopatologi, dan stadium TNM pada pasien dengan KKR. Variabel yang dinilai pada penelitian ini meliputi Usia, jenis kelamin, NLR, TIL, grading, stadium, maupun analisis Receiver Operating Curve (ROC) hubungan NLR dengan stadium kanker kolorektal. Data dianalisis dengan SPSS versi 17 untuk Windows.

Hasil: Tidak didapatkan hubungan yang bermakna (p=0,301) antara NLR dengan TIL. Hubungan NLR dengan grading histopatologi juga tidak bermakna (p=0,250). Terdapat hubungan yang bermakna antara NLR dengan stadium KKR (p<0.001). Cut-off point NLR terhadap stadium ditentukan sebesar 4.0 dengan sensitivitas 98% dan spesifisitas 95%.  Hubungan ini memiliki Odd-Ratio sebesar 465.500 dan p < 0.001 sehingga hubungannya bermakna. Didapatkan koefisien korelasi (r) NLR dengan stadium pasien KKR sebesar 0.898 dimana nilai ini memiliki korelasi yang kuat (r > 0.75).

Kesimpulan: NLR tinggi berhubungan dengan stadium yang tinggi pada kasus KKR dengan nilai cut off point NLR adalah 4. 

References

Siegel R, Desantis C, Jemal A. Colorectal cancer statistics, 2014. CA Cancer J Clin. 2014;64(2):104-117.

Abdullah M, Sudoyo AW, Utomo AR, Fauzi A, Rani AA. Molecular profile of colorectal cancer in Indonesia: is there another pathway?. Gastroenterol Hepatol Bed Bench. 2012;5(2):71-78.

Li MX, Liu XM, Zhang XF, Zhang JF, Wang WL, Zhu Y, et al. Prognostic role of neutrophil-to-lymphocyte ratio in colorectal cancer: a systematic review and meta-analysis. Int J Cancer. 2014;134(10):2403-2413.

Faria SS, Fernandes PC Jr, Silva MJ, et al. The neutrophil-to-lymphocyte ratio: a narrative review. Ecancermedicalscience. 2016;10:702.

Suppan C, Bjelic-Radisic V, La Garde M, Groselj-Strele A, Eberhard K, Samonigg H, et al. Neutrophil/Lymphocyte ratio has no predictive or prognostic value in breast cancer patients undergoing preoperative systemic therapy. BMC Cancer. 2015;15:1027.

Elyasinia F, Keramati MR, Ahmadi F, Rezaei S, Ashouri M, Parsaei R, et al. Neutrophil-Lymphocyte Ratio in Different Stages of Breast Cancer. Acta Med Iran. 2017;55(4):228-232.

Dell'Aquila E, Cremolini C, Zeppola T, Lonardi S, Bergamo F, Masi G, et al. Prognostic and predictive role of neutrophil/lymphocytes ratio in metastatic colorectal cancer: a retrospective analysis of the TRIBE study by GONO. Ann Oncol. 2018;29(4):924-930.

Song Y, Yang Y, Gao P, Chen X, Yu D, Xu Y, et al. The preoperative neutrophil to lymphocyte ratio is a superior indicator of prognosis compared with other inflammatory biomarkers in resectable colorectal cancer. BMC Cancer. 2017;17(1):744.

Noh H, Eomm M, Han A. Usefulness of pretreatment neutrophil to lymphocyte ratio in predicting disease-specific survival in breast cancer patients. J Breast Cancer. 2013;16(1):55-59.

Templeton AJ, McNamara MG, Šeruga B, Vera Badillo FE, Aneja P, Ocana A, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014;106(6):dju124.

Shibutani M, Maeda K, Nagahara H, Noda E, Ohtani H, Nishiguchi Y, Hirakawa K, et al. A high preoperative neutrophil-to-lymphocyte ratio is associated with poor survival in patients with colorectal cancer. Anticancer Res. 2013;33(8):3291-3294.

Prabawa IPY, Bhargah A, Liwang F, Tandio DA, Tandio AL, Lestari AAW, et al. Pretreatment Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) as a Predictive Value of Hematological Markers in Cervical Cancer. Asian Pac J Cancer Prev. 2019;20(3):863-868.


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