Association of neutrophil-to-lymphocyte and lymphocyte-to-monocyte ratios with treatment response and quality of life in colorectal and pancreatic cancer: A prospective analysis

Background Systemic inflammation and hypercoagulability are key drivers of cancer progression. This study aimed to evaluate the predictive value of inflammatory and coagulation-related ratios—specifically neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and ferritin-to-D-dimer ratio (FDR)—in patients with colorectal and pancreatic cancer. Methods We prospectively enrolled 73 patients with confirmed colorectal (n=57) or pancreatic cancer (n=16). Patients were classified as responders (n=39) or non-responders (n=34) based on radiological evaluation 6 months post-therapy. Baseline complete blood counts, ferritin, and D-dimer levels were compared. Predictive accuracy was assessed using Receiver Operating Characteristic (ROC) curve analysis. Results Non-responders exhibited significantly higher baseline leukocyte and neutrophil counts ( p <0.002). Ferritin levels were 2.5-fold higher in non-responders ( p <0.05). ROC analysis identified NLR as a strong predictor of treatment failure (AUC=0.895; Optimal Cut-off >2.68), while LMR was a significant predictor of favorable response (AUC=0.864). Unlike previous reports, FDR was significantly elevated in non-responders ( p =0.002). High NLR was moderately correlated with poor functional status (ECOG r=0.44) exclusively in the non-responder group. Conclusions Baseline NLR and LMR are robust predictors of therapeutic outcome in colorectal and pancreatic cancer.