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High platelet-to-lymphocyte ratio predicts improved survival outcome for perioperative NSAID use in patients with rectal cancer



Nonsteroidal anti-inflammatory drugs (NSAIDs) have been shown to block tumor-associated inflammation in rectal cancer. However, the perioperative use of NSAIDs remains controversial. This study was designed to investigate whether the perioperative use of NSAIDs influences outcomes and to provide a predictive marker to identify patients who would benefit from NSAIDs.


We enrolled 515 patients with stage I to III rectal cancer in this retrospective study. Patients were classified into the NSAID and non-NSAID groups according to their perioperative use of NSAIDs. The whole cohort was stratified by platelet-to-lymphocyte ratio (PLR). The primary endpoints were disease-free survival (DFS) and overall survival (OS).


The NSAID group had a 12.6% lower risk of recurrence than the non-NSAID group (P = 0.015), while the association with survival was nonsignificant. In the high-PLR subset, the NSAID group had a 17.3% lower risk of recurrence (P = 0.003) and a better DFS (P = 0.033) outcome than the non-NSAID group. Multivariate analysis confirmed this independent significant association with DFS (P = 0.023). In the low-PLR subset, the association of NSAID use with survival was nonsignificant.


Perioperative use of NSAIDs was associated with improved survival outcomes in rectal cancer patients with high PLR.

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This study was funded by the National Basic Research Program of China (973 Program, 2015CB554001), the National Natural Science Foundation of China (81972245 and 81902877), the Natural Science Fund for Distinguished Young Scholars of Guangdong Province (2016A030306002), the Tip-top Scientific and Technical Innovative Youth Talents of Guangdong Special Support Program (2015TQ01R454), the Project 5010 of Clinical Medical Research of Sun Yat-sen University-5010 Cultivation Foundation (2018026), the Natural Science Foundation of Guangdong Province (2016A030310222 and 2018A0303130303), the Program of Introducing Talents of Discipline to Universities, and the National Key Clinical Discipline (2012).

Author information

Conceptualization, Huichuan Yu, Yanxin Luo, and Meijin Huang; methodology, Zenghong Huang and Huichuan Yu; software, Zenghong Huang and Xiaolin Wang; validation, Xiaolin Wang, Qi Zou, Zhuokai Zhuang, and Yumo Xie; formal analysis, Zenghong Huang and Huichuan Yu; investigation, Xiaolin Wang; resources, Yanxin Luo; data curation, Huichuan Yu; writing—original draft preparation, Zenghong Huang and Huichuan Yu; writing—review and editing, Yanxin Luo; visualization, Du Cai, Liangliang Bai, and Guannan Tang; funding acquisition, Huichuan Yu and Yanxin Luo; supervision, Huichuan Yu

Correspondence to Huichuan Yu.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional Medicine Ethics Committee of The Sixth Affiliated Hospital, Sun Yat-sen University, and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Huang, Z., Wang, X., Zou, Q. et al. High platelet-to-lymphocyte ratio predicts improved survival outcome for perioperative NSAID use in patients with rectal cancer. Int J Colorectal Dis (2020).

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  • Nonsteroidal anti-inflammatory drugs
  • Rectal cancer
  • Systemic inflammatory marker
  • Disease-free survival
  • Platelet-to-lymphocyte ratio