Neutrophil count is the most important prognostic component of the differential white cell count in patients undergoing elective surgery for colorectal cancer

• We examined 508 patients undergoing elective resection for colorectal cancer.
• Only the neutrophil count was independently associated with cancer-specific survival.
• A raised neutrophil count is associated with poorer cancer-specific survival.
• These results may suggest that neutrophils drive tumor progression and dissemination.
• The neutrophil count forms the basis of the prognostic value of the NLR and other prognostic scores that are based on the components of the differential white cell count.

BackgroundSystemic inflammatory scoring systems such as the NLR have been reported to have prognostic value in many solid organ cancers. The aim of this study was to examine the relationships between the components of the white cell count (WCC) and survival in patients undergoing elective surgery for colorectal cancer.MethodsPatients undergoing elective resection at a single center (1997 to 2008) were identified from a prospective database (n = 508). Patient demographics and preoperative laboratory measurements including the differential WCC and their association with cancer-specific survival (CSS) and overall survival were examined.ResultsThere were 172 cancer deaths and 120 noncancer deaths. On Kaplan–Meier analysis of the whole cohort, age, Tumor, Nodal, and Metastasis stage, venous invasion, margin involvement, peritoneal involvement and tumor perforation, and white cell and neutrophil count (all P < .05) were associated with CSS. In those with node-negative colon cancer (n = 226), on multivariate analysis, age, venous invasion, modified Glasgow Prognostic Score, and neutrophil count (all P < .05) were independently associated with CSS.ConclusionOf the components of a differential WCC, only the neutrophil count was independently associated with survival, particularly in node-negative colon cancer.