Sir,
We read with great interest the article ‘A derived neutrophil to lymphocyte (N/L) ratio predicts clinical outcome in stage II and III colon cancer patients' by Absenger et al (2013). They aimed to investigate the effect of the preoperative N/L ratio on time to recurrence and overall survival in patients with stage II and III colon cancer. They concluded that the N/L ratio is an independent prognostic marker in our study cohort including patients with stage II and III colon cancer. The ready availability of this parameter at no additional cost may encourage its wider use in clinical practice in the future. Thank to the authors for their contribution.
White blood cell (WBC) count is one of the useful inflammatory biomarkers in clinical practice. Although WBC is in normal range, subtypes of WBC like N/L ratio may predict cardiovascular mortality. N/L ratio is a readily measurable laboratory marker used to evaluate systemic inflammation (Balta et al, 2013c). Because hypertension, diabetes mellitus, metabolic syndrome (Balta et al, 2013a), left ventricular dysfunction, acute coronary syndromes, valvular heart disease, abnormal thyroid function tests, renal or hepatic dysfunction, known malignancy (Stotz et al, 2013; Szkandera et al, 2013), local or systemic infection, previous history of infection (<3 months), inflammatory diseases, and any medication that related to inflammatory condition of patients, the measurement of N/L ratio can be potentially affected in all of above conditions. For these reasons, it would be better, if the authors had mentioned these factors.
In conclusion, we strongly believe that these findings will elucidate further studies about N/L ratio as a surrogate marker of predicting mortality in colon cancer patients. Not only N/L ratio but also mean platelet volume, red cell distribution width (Demirkol et al, 2013), platelet distribution width, CRP, uric acid (Cakar et al, 2013) and gamma-glutamyl transferase (Cakar et al, 2012) are easy markers to evaluate the prognosis of colon cancer patients (Demirkol et al, 2012). However, one should keep in mind that N/L ratio itself alone without other inflammatory markers may not give exact information to clinicians about the prognosis of colon cancer patients. So, from that point of view we think that it should be evaluated accompanied with other serum inflammatory markers (Balta et al, 2013b).
The authors declare no conflict of interest.
References
- Absenger G, Szkandera J, Pichler M, Stotz M, Arminger F, Weissmueller M, Schaberl-Moser R, Samonigg H, Stojakovic T, Gerger A. A derived neutrophil to lymphocyte ratio predicts clinical outcome in stage II and III colon cancer patients. Br J Cancer. 2013;109:395–400. doi: 10.1038/bjc.2013.346. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Balta S, Cakar M, Demirkol S, Arslan Z, Akhan M. Higher neutrophil to lymhocyte ratio in patients with metabolic syndrome. Clin Appl Thromb Hemost. 2013;19 (5:579. doi: 10.1177/1076029612475023. [DOI] [PubMed] [Google Scholar]
- Balta S, Demirkol S, Cakar M, Arslan Z, Unlu M, Celik T.2013Other Inflammatory Markers should not be forgetten when assessing the neutrophil-to-lymphocyte ratio Clin Appl Thromb Hemoste-pub ahead of print 23 April 2013doi: 10.1177/1076029613486019 [DOI] [PubMed]
- Balta S, Demirkol S, Celik T, Kucuk U, Unlu M, Arslan Z, Balta I, Iyisoy A, Kocak N, Haqmal H, Yokusoglu M.2013Association between coronary artery ectasia and neutrophil-lymphocyte ratio Angiologye-pub ahead of print 17 March 2013doi: 10.1177/0003319713480424 [DOI] [PubMed]
- Cakar M, Balta S, Demirkol S, Altun B, Demirbas S. Serum gamma-glutamyltransferase (GGT) should be evaluated together with other ınflammatory markers in clinical practice. Angiology. 2012;124:60. doi: 10.1177/0003319712469876. [DOI] [PubMed] [Google Scholar]
- Cakar M, Sarlak H, Balta S, Unlu M, Demirbas S, Demirkol S. Serum uric Acid still carries controversies about its role in endothelial dysfunction. J Clin Hypertens (Greenwich) 2013;15:296. doi: 10.1111/jch.12066. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Demirkol S, Balta S, Celik T, Arslan Z, Unlu M, Cakar M, Kucuk U, Demirbas S, Iyisoy A, Yokusoglu M. Assessment of the relationship between red cell distribution width and cardiac syndrome X. Kardiol Pol. 2013;71:480–484. doi: 10.5603/KP.2013.0094. [DOI] [PubMed] [Google Scholar]
- Demirkol S, Balta S, Unlu M, Yuksel UC, Celik T, Arslan Z, Kucuk U, Yokusoglu M. Evaluation of the mean platelet volume in patients with cardiac syndrome X. Clinics (São Paulo, Brazil) 2012;67:1019–1022. doi: 10.6061/clinics/2012(09)06. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Stotz M, Gerger A, Eisner F, Szkandera J, Loibner H, L Ress A, Kornprat P, A Zoughbi W, Seggewies FS, Lackner C, Stojakovic T, Samonigg H, Hoefler G, Pichler M. Increased neutrophil-lymphocyte ratio is a poor prognostic factor in patients with primary operable and inoperable pancreatic cancer. Br J Cancer. 2013;109:416–421. doi: 10.1038/bjc.2013.332. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Szkandera J, Absenger G, Liegl-Atzwanger B, Pichler M, Stotz M, Samonigg H, Glehr M, Zacherl M, Stojakovic T, Gerger A, Leithner A. Elevated preoperative neutrophil/lymphocyte ratio is associated with poor prognosis in soft-tissue sarcoma patients. Br J Cancer. 2013;108:1677–1683. doi: 10.1038/bjc.2013.135. [DOI] [PMC free article] [PubMed] [Google Scholar]