A good preoperative immune prognostic index is predictive of better prognosis for locally advanced rectal cancer patients with ypTNM stage II who underwent radical resection after neoadjuvant chemoradiotherapy

Abstract

Background: No studies have investigated the role of IPI in assessing the prognosis for LARC patients undergoing nCRT. Objective: We attempted to combine neutrophil-to-lymphocyte ratio (NLR) and serum lactate dehydrogenase (sLDH) to generate a new rectal immune prognostic index (RIPI) to explore whether RIPI is associated with the prognosis of LARC. And try to find out whether there is a population that might benefit from RIPI in LARC. Methods: Locally advanced rectal cancer (LARC) patients who underwent radical surgery after Neoadjuvant chemoradiotherapy (nCRT) from February 2012 to May 2017 were enrolled. Based on the best cut-off points of NLR and sLDH, we developed rectal immune prognostic index (RIPI). Patients were grouped as follows: 1) good, RIPI = 0, good, 0 factors; 2) poor, RIPI = 1, 1 or 2 factors. Results: A total of 642 patients were enrolled. In yp TNM stage II patients, there was a statistically significant difference in 5-year disease-free survival (DFS) (p=0.03) between RIPI=1 and RIPI=0 groups. In ypCR, stage I, stage II, and stage III, there was no significant difference in 5-year DFS between IPI=0 and IPI=1 groups. In multivariate analysis, the significant factor predicting DFS was RIPI score (p=0.035) Conclusion: RIPI was closely related to the prognosis of LARC patients undergoing nCRT. In particular, RIPI is of great significance in evaluating the prognosis of LARC patients with ypTNM stage II who underwent radical resection after nCRT.