589P - Is baseline neutrophil to lymphocyte ratio (NLR) an independent prognostic biomarker for progression free survival (PFS) and overall survival (OS)...

Date 08 October 2016
Event ESMO 2016 Congress
Session Poster Display
Topics Colon and Rectal Cancer
Presenter Connie Diakos
Citation Annals of Oncology (2016) 27 (6): 149-206. 10.1093/annonc/mdw370
Authors C.I. Diakos1, K. Wilson2, R. Asher2, V. Gebski2, S. Yip2, G. van Hazel3, B. Robinson4, A. Broad5, T.J. Price6, J. Simes7, N. Tebbutt8, S. Clarke9
  • 1Kolling Institute Of Medical Research, Royal North Shore Hospital, 2065 - St Leonards/AU
  • 2Nhmrc Clinical Trials Centre, NHMRC Clinical Trials Centre University of Sydney, 2050 - Camperdown/AU
  • 3School Of Medicine And Pharmacology, University of Western Australia, Perth/AU
  • 4Oncology Service, Christchurch Hospital, Christchurch/NZ
  • 5Medical Oncology, Andrew Love Cancer Centre, 3220 - Geelong/AU
  • 6Haematology And Oncology, The Queen Elizabeth Hospital and University of Adelaide, 5011 - Adelaide/AU
  • 7Oncology, NHMRC Clinical Trials Centre, Sydney/AU
  • 8Medical Oncology, Austin Hospital, 3084 - Heidelberg/AU
  • 9Medical Oncology, Royal North Shore Hospital, 2065 - St Leonards/AU



NLR (ratio of absolute neutrophil and lymphocyte counts) has shown prognostic utility for OS in a number of cancer types. The AGITG MAX study examined capecitabine (C) with C + bevacizumab (B) and C + B + mitomycin C (M) in first-line treatment of mCRC. CB demonstrated superiority over C for PFS and was comparable to CBM. We examine NLR in the MAX study to assess its utility for prediction of treatment effect, PFS and OS.


PFS and OS estimates were obtained using the method of Kaplan-Meier and hazard ratios obtained using proportional hazards models. Analysis included adjusting for baseline (BL) disease and patient (pt) characteristics and investigating potential interaction effects between NLR status and significant BL predictors of outcome.


MAX study recruited 471 pts; relevant BL haematological data was available for 403 pts (86%). At BL, 24% of pts had high NLR (≥5). High NLR correlated with rectal primary (p = 0.007), higher ECOG status (p 


NLR provides independent prognostic information for patients with mCRC receiving first-line treatment in the MAX study, for both PFS and OS. This should become a standard stratification indication for future randomised controlled trials.

Clinical trial identification

ANZ Clinical Trial Registry ACTRN12605000025639

Legal entity responsible for the study

Australian Gastro-Intestinal Trials Group


Lead sponsor: Australian Gastro-Intestinal Trials Group. Funder: Roche.


C.I. Diakos: Ipsen Advisory Board, November 2015 & April 2016. V. Gebski: Honoraria: Sirtex. Consultancy: Sirtex. Travel support: Sirtex. A. Broad: Roche Advisory Board. T.J. Price: Merck Advisory Board. N. Tebbutt: Advisory Board Roche, Merck Serono. S. Clarke: Advisory Board Roche, Merck. All other authors have declared no conflicts of interest.