Korean J Fam Pract 2019; 9(3): 284-289  https://doi.org/10.21215/kjfp.2019.9.3.284
The Association between Neutrophil to Lymphocyte Ratio and Development of Early Adenomatous Colon Polyps among Middle-Aged and Elderly Individuals in Korea
Jung-Hwan Kim, A-Ra Cho, Byoung-Jin Park*
Department of Family Medicine, Yonsei University College of Medicine, Seoul, Korea
Byoung-Jin Park
Tel: +82-31-331-8710, Fax: +82-31-331-5551
E-mail: bjpark96@yuhs.ac
Received: August 13, 2018; Revised: November 2, 2018; Accepted: November 29, 2018; Published online: June 20, 2019.
© The Korean Academy of Family Medicine. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Coloncancer is one of the main causes of mortality. Early adenomatous colon polyp is a precursor of colon cancer through the ‘adenoma-carcinoma sequence.’ Epidemiological studies suggest that the neutrophil to lymphocyte ratio can be one of useful inflammatory markers in clinical settings. This study aimed to evaluate the association between neutrophil to lymphocyte ratio and development of early adenomatous colon polyps.
Methods: This cross-sectional study retrospectively examined 960 middle-aged and elderly individuals aged ≥45 years who underwent colonoscopy in a health examination program. Multivariate logistic regression was used to analyze the association between neutrophil to lymphocyte ratio and development of early adenomatous colon polyps.
Results: Among the 960 subjects, the prevalence of early adenomatous polyps was 20.7% (n=199). The mean age, body mass index, number of current smokers, white blood cell count, triglyceride level, and number of subjects receiving hypolipidemic drugs were higher in the group with early adenomatous polyps than in the multivariate analysis, the odds ratio (95% confidence interval) for the development of early adenomatous polyps was 1.23 (1.01−1.50) with neutrophil to lymphocyte ratio increment after adjusting the confounding variables (P=0.037).
Conclusion: We found that the neutrophil to lymphocyte ratio was associated with the development of early adenomatous colon polyps among middle-aged and elderly individuals. Accordingly, this result suggests that regular monitoring of early adenomatous colon polyps may be useful among individuals with a higher neutrophil to lymphocyte ratio.
Keywords: Neutrophils; Lymphocytes; Colonic Polyps; Middle Aged
References
  1. American Cancer Society. Cancer facts & figures 2015. 3rd ed. Atlanta:American Cancer Society; 2015. p. 14-6.
  2. National Cancer Center, Ministry of Health and Welfare (Korea). Quality guidelines of colorectal cancer screening. Goyang: National Cancer Center; 2014. p. 21-34.
  3. Fearnhead NS, Wilding JL, Bodmer WF. Genetics of colorectal cancer: hereditary aspects and overview of colorectal tumorigenesis. Br Med Bull 2002; 64: 27-43.
    Pubmed CrossRef
  4. Lee SH, Lee KS, Lee JY, Ji JH, Park JK, Park YS, et al. Clinical usefulness of fecal occult blood test as a screening method for asymptomatic patients with colon polyps. Korean J Gastroenterol 2006; 48: 388-94.
    Pubmed
  5. Del Prete A, Allavena P, Santoro G, Fumarulo R, Corsi MM, Mantovani A. Molecular pathways in cancer-related inflammation. Biochem Med (Zagreb) 2011; 21: 264-75.
    Pubmed CrossRef
  6. Li Z, Zhao R, Cui Y, Zhou Y, Wu X. The dynamic change of neutrophil to lymphocyte ratio can predict clinical outcome in stage I-III colon cancer. Sci Rep 2018; 8: 9453.
    Pubmed KoreaMed CrossRef
  7. Kobayashi M, Kubo T, Komatsu K, Fujisaki A, Terauchi F, Natsui S, et al. Changes in peripheral blood immune cells: their prognostic significance in metastatic renal cell carcinoma patients treated with molecular targeted therapy. Med Oncol 2013; 30: 556.
    Pubmed CrossRef
  8. Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature 2008; 454: 436-44.
    Pubmed CrossRef
  9. Han F, Shang X, Wan F, Liu Z, Tian W, Wang D, et al. Clinical value of the preoperative neutrophil-to-lymphocyte ratio and red blood cell distribution width in patients with colorectal carcinoma. Oncol Lett 2018; 15: 3339-49.
    Pubmed KoreaMed CrossRef
  10. Papa A, Emdin M, Passino C, Michelassi C, Battaglia D, Cocci F. Predictive value of elevated neutrophil-lymphocyte ratio on cardiac mortality in patients with stable coronary artery disease. Clin Chim Acta 2008; 395: 27-31.
    Pubmed CrossRef
  11. Templeton AJ, Knox JJ, Lin X, Simantov R, Xie W, Lawrence N, et al. Change in neutrophil-to-lymphocyte ratio in response to targeted therapy for metastatic renal cell carcinoma as a prognosticator and biomarker of efficacy. Eur Urol 2016; 70: 358-64.
    Pubmed CrossRef
  12. Saroha S, Uzzo RG, Plimack ER, Ruth K, Al-Saleem T. Lymphopenia is an independent predictor of inferior outcome in clear cell renal carcinoma. J Urol 2013; 189: 454-61.
    Pubmed KoreaMed CrossRef
  13. An X, Ding PR, Li YH, Wang FH, Shi YX, Wang ZQ, et al. Elevated neutrophil to lymphocyte ratio predicts survival in advanced pancreatic cancer. Biomarkers 2010; 15: 516-22.
    Pubmed CrossRef
  14. Uçmak F, Tuncel ET. Relationship between lesions in adenomatous polypdysplasia-colorectal cancer sequence and neutrophil-to-lymphocyte ratio. Med Sci Monit 2016; 22: 4536-41.
    Pubmed KoreaMed CrossRef
  15. Chang CK, Ulrich CM. Hyperinsulinaemia and hyperglycaemia: possible risk factors of colorectal cancer among diabetic patients. Diabetologia 2003;46: 595-607.
    Pubmed CrossRef
  16. Keku TO, Lund PK, Galanko J, Simmons JG, Woosley JT, Sandler RS. Insulin resistance, apoptosis, and colorectal adenoma risk. Cancer Epidemiol Biomarkers Prev 2005; 14: 2076-81.
    Pubmed CrossRef
  17. Kadowaki T, Yamauchi T. Adiponectin and adiponectin receptors. Endocr Rev 2005; 26: 439-51.
    Pubmed CrossRef
  18. Park HY, Kim JR, Seo JY, Shin KS, Yoo BW, Cho YJ, et al. The association between colon polyp and the metabolic syndrome in asymptomatic Korean adults. Korean J Health Promot 2013; 13: 87-92.
  19. Zahm SH, Cocco P, Blair A. Tobacco smoking as a risk factor for colon polyps. Am J Public Health 1991; 81: 846-9.
    Pubmed KoreaMed CrossRef
  20. Kim DH, Ahn YO, Lee BH, Tsuji E, Kiyohara C, Kono S. Methylenetetrahydrofolate reductase polymorphism, alcohol intake, and risks of colon and rectal cancers in Korea. Cancer Lett 2004; 216: 199-205.
    Pubmed CrossRef
  21. Nilsen TI, Vatten LJ. Prospective study of colorectal cancer risk and physical activity, diabetes, blood glucose and BMI: exploring the hyperinsulinaemia hypothesis. Br J Cancer 2001; 84: 417-22.
    Pubmed KoreaMed CrossRef
  22. Ackroyd FW, Hedberg SE. Colonic polyps. Annu Rev Med 1985; 36: 619-25.
    Pubmed CrossRef
  23. Kefeli A, Basyigit S, Yeniova AO, Nazligul Y, Kucukazman M, Aktas B. General properties of colon polyps in Central Anatolia. Euroasian J Hepatogastroenterol 2014; 4: 7-10.
    Pubmed KoreaMed CrossRef
  24. Johnson DA, Gurney MS, Volpe RJ, Jones DM, VanNess MM, Chobanian SJ, et al. A prospective study of the prevalence of colonic neoplasms in asymptomatic patients with an age-related risk. Am J Gastroenterol 1990; 85: 969-74.
    Pubmed
  25. Larsson SC, Orsini N, Wolk A. Diabetes mellitus and risk of colorectal cancer:a meta-analysis. J Natl Cancer Inst 2005; 97: 1679-87.
    Pubmed CrossRef
  26. Trevisan M, Liu J, Muti P, Misciagna G, Menotti A, Fucci F; Risk Factors and Life Expectancy Research Group. Markers of insulin resistance and colorectal cancer mortality. Cancer Epidemiol Biomarkers Prev 2001; 10: 937-41.
    Pubmed
  27. Bowker SL, Majumdar SR, Veugelers P, Johnson JA. Increased cancer-related mortality for patients with type 2 diabetes who use sulfonylureas or insulin. Diabetes Care 2006; 29: 254-8.
    Pubmed CrossRef
  28. Ioannou GN, Boyko EJ. Metformin and colorectal cancer risk in diabetic patients. Diabetes Care 2011; 34: 2336-7.
    Pubmed KoreaMed CrossRef
  29. Munkholm P. Review article: the incidence and prevalence of colorectal cancer in inflammatory bowel disease. Aliment Pharmacol Ther 2003; 18 Suppl 2: 1-5.
    Pubmed CrossRef
  30. Boolbol SK, Dannenberg AJ, Chadburn A, Martucci C, Guo XJ, Ramonetti JT, et al. Cyclooxygenase-2 overexpression and tumor formation are blocked by sulindac in a murine model of familial adenomatous polyposis. Cancer Res 1996; 56: 2556-60.
    Pubmed

This Article


Author ORCID Information

Services
Social Network Service

e-submission

Archives