The genetic and morphological evaluation (GAME) score is a prognostic tool that defines three risk groups (low, moderate and high risk) of patients with in metastatic colorectal cancer (mCRC). Neutrophil-lymphocyte ratio (NLR) has been identified as a factor of poor prognosis. We aimed to compare these markers as prognostic factors in Tunisian metastatic colorectal cancer.


A retrospective study was conducted at the medical oncology department in Sfax, including patients treated for mCRC with unresectable metastases, between 2014 and 2018. The GAME score was calculated allocating points for KRAS mutation, CEA levels, lymph node metastasis, Tumour Burden score (TBS) and extrahepatic disease. The risk group is defined as low (LR) if score 0-1, moderate (MR) if score 2-3 and high (HR) if score is at least 4. NLR was assessed and correlated with survival. The NLR was defined as high if ≥3 and low if < 3.


55 patients with mCRC were included. The mean age was 60.39 years. Liver metastases were isolated in 19 cases (43.18%) and associated with other metastases in the other cases. The RAS status was mutated in 34% of cases. The pre-treatment NLR was ≥3 in 33 patients, (56.4%). NLR ≥3 was associated with poorer OS (3-year OS of 9.7% vs 25.3%, p=0.04). The 3-year overall survival (OS) rate was 58%, 33% and 18% for LR, MR and HR groups respectively (p=0.004). NLR≥3 was associated with poorer prognosis compared with HR GAME score (p=0.02).


Our study concluded that NLR ≥3 was associated with a poorer prognosis compared with the genetic and morphological evaluation high score in metastatic CRC.