death in all cancer patients in the world. Early detection of the lesions can decrease the morbidity and mortality. In the last few decades,

pretreatment platelet and leukocyte count (including neutrophils and lymphocytes) has become the focus of the study in relation to the prognosis of

various types of cancer.

Objective: To assess the role of pretreatment Platelet Lymphocyte Ratio (PLR) and Neutrophil Lymphocyte Ratio (NLR) as a prognostic factor in

stage III and IV rectal cancer patients.

Methods: This was an observational analytic study with cross sectional and retrospective cohort design. The research sample was taken by

consecutive sampling method based on registration data of rectal adenocarcinoma patients at H. Adam Malik Medan General Hospital from

January 2011 until December 2013. Statistical analysis was did by SPSS Program Version 22.

Results: From a total of 55 patients, the mean age of the study subjects is 53.91 ± 1.72 years. The samples are 34 (61.8%) males and 21 (38.2%)

females. Most cancer‘s lesions are found in 1/3 distal of the rectum (41.8%). Based on result of laboratory examination, mean of platelet count is

252,45 ± 77,83, mean of lymphocyte count is 6,91 ± 21,21, and mean of neutrophil count is 6,39 ± 3,44. We determined a cut–off value of 2.2 for

NLR and 130 for PLR in the whole group. From the Kaplan Meier test, overall survival in patients with low NLR is better than patients with high

NLR (p value <0.001) and overall survival in patients with low PLR is also better than patients with high PLR (p value <0.001). While 5 years of

disease free survival in patients with low NLR is better than patients with high NLR (p value = 0.018). Similarly, 5 years of disease free survival in

patients with low PLR were compared with high PLR (p value = 0.035).

Conclusions: Our study found that high PLR and high NLR are the useful prognostic factors for predicting poor long–term outcomes in stage III

and IV rectal cancer patients.