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ARTICLE

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

Yen-Cheng Chen1,2,3, Tsung-Kun Chang1,2,4, Wei-Chih Su1,2,4, Yung-Sung Yeh4,5,6,7, Po-Jung Chen1,2, Tzu-Chieh Yin2,4,8, Ching-Chun Li2,9, Ching-Wen Huang2,3, Hsiang-Lin Tsai2,3, Jaw-Yuan Wang1,2,3,10,11,12,*
1 Graduate Institute of Clinical Medicine, College of Medicine; Kaohsiung Medical University, Kaohsiung, 80708, Taiwan
2 Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan
3 Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan
4 Department of Surgery, Faculty of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan
5 Division of Trauma and Surgical Critical Care, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan
6 Department of Emergency Medicine, Faculty of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan
7 Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, 11031, Taiwan
8 Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Gangshan Hospital, Kaohsiung, 820, Taiwan
9 Department of Surgery, Division of Colorectal Surgery, Kaohsiung Municipal Hsiaokang Hospital, Kaohsiung, 812, Taiwan
10 Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan
11 Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan
12 Center for Disease Multi-omincs Research, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan
* Corresponding Author: Jaw-Yuan Wang. Email: email
(This article belongs to the Special Issue: Advances and Innovations in Colorectal Cancer Research and Treatment)

Oncology Research https://doi.org/10.32604/or.2025.069397

Received 22 June 2025; Accepted 31 October 2025; Published online 19 January 2026

Abstract

Background: 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. Methods: 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). Results: 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). Conclusion: 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.

Keywords

Locally advanced rectal cancer; neoadjuvant concurrent chemoradiotherapy; robotic-assisted surgery; neutrophil-to-lymphocyte ratio; carcinoembryonic antigen

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