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Inflammation plays a key role in tumor progression, with the neutrophil-to-lymphocyte ratio (NLR) emerging as a potential prognostic marker. While preoperative NLR is a well-established predictor of survival, its prognostic value 1\u00a0year postoperatively remains underexplored. This study aims to evaluate the prognostic significance of NLR 1\u00a0year after curative CRC surgery, identify factors associated with its elevation, and assess its impact on survival and recurrence. A retrospective analysis was conducted on 788 patients who underwent curative-intent CRC surgery between 2015 and 2022. NLR was assessed preoperatively and 1\u00a0year postoperatively, using a cutoff of 3.3. Patients were categorized into four subgroups:\u00a0\u201cLow-Low\u201d:\u00a0NLR\u2009\u2264\u20093.3 pre- and postoperatively;\u00a0\u201cLow\u2013High\u201d:\u00a0NLR\u2009\u2264\u20093.3 preoperatively but\u2009&gt;\u20093.3 postoperatively;\u00a0\u201cHigh-Low\u201d:\u00a0NLR\u2009&gt;\u20093.3 preoperatively but\u2009\u2264\u20093.3 postoperatively, and\u00a0\u201cHigh-High\u201d:\u00a0NLR\u2009&gt;\u20093.3 at both time points. Survival analysis was performed using Cox regression. Postoperative NLR values were significantly lower than preoperative levels (median: 2.8 vs. 4.1, p\u2009&lt;\u20090.001). An elevated post-NLR (&gt;\u20093.3) correlated with poorer survival and higher recurrence rates. The \u201cLow\u2013High\u201d group exhibited the worst prognosis, with a 5-year survival rate of 42.6% compared to 79.8% in the \u201cLow-Low\u201d group. Multivariate analysis confirmed post-NLR\u2009&gt;\u20093.3 as an independent predictor of worse survival (HR: 3.49; 95%CI 2.41\u20135.04). Persistently elevated NLR 1\u00a0year after CRC surgery is associated with worse survival and higher recurrence. Routine postoperative NLR monitoring may help identify high-risk patients for closer follow-up and early intervention.<\/jats:p>","DOI":"10.1007\/s13304-025-02286-y","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T07:59:55Z","timestamp":1750838395000},"page":"2331-2342","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Prognostic impact of persistent postoperative neutrophil-to-lymphocyte ratio elevation 1\u00a0year after colorectal cancer surgery"],"prefix":"10.1007","volume":"77","author":[{"given":"David","family":"Ort\u00edz-L\u00f3pez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7362-1110","authenticated-orcid":false,"given":"Joaqu\u00edn","family":"Marchena-G\u00f3mez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yurena","family":"Sosa-Quesada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Artiles-Armas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz","family":"Arencibia-P\u00e9rez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Gil-Garc\u00eda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Nogu\u00e9s-Ram\u00eda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Roque-Castellano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,6,25]]},"reference":[{"key":"2286_CR1","doi-asserted-by":"publisher","first-page":"233","DOI":"10.3322\/caac.21772","volume":"73","author":"RL Siegel","year":"2023","unstructured":"Siegel RL, Wagle NS, Cercek A et al (2023) Colorectal cancer statistics, 2023. 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