Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as predictive and prognostic markers in patients with locally advanced rectal cancer treated with neoadjuvant chemoradiation.

Abstract

758 Background: A standard therapy for locally advanced rectal cancer (LARC) includes fluoropyrimidine (FP)-based neoadjuvant chemoradiation (nCRT). Previous studies have inconsistently demonstrated that baseline neutrophil- and platelet-to-lymphocyte ratios (NLR and PLR) are predictive of response to nCRT or prognostic of outcomes in LARC. Methods: We performed a review of patients with LARC undergoing nCRT followed by surgery with curative intent from 2005-2013 in 3 academic cancer centers from 2 Canadian provinces. Data regarding demographics, staging, baseline hematologic variables (<4 weeks prior/up to 2 weeks after initiating nCRT) and treatment details were collected. Outcome measures of interest were pathological complete response (pCR), disease-free survival (DFS) and overall survival (OS). Logistic regression and Cox proportional hazard models were used to assess for an association between baseline hematologic variables and outcomes. Results: Of 1081 identified patients, 845 were included in the DFS/OS analysis. Median age was 61 (range 23-87), 70% male, 85% performance status (PS) 0-1. 31% and 67% had clinical stage II and III disease, respectively. 25% had elevated NLR (≥ 4), and 64% had elevated PLR (≥ 150). 98% of patients received FP-based nCRT, with 96% receiving ≥ 44 Gy (median 50 Gy [range 20-74]). 80% completed neoadjuvant chemotherapy and 94% completed neoadjuvant radiotherapy, with a pCR rate of 23%. After a median follow up time of 64 months, 6% developed local recurrence, 20% developed distant recurrence and 19% have died. 5-year OS and DFS were 78% (95% CI 74-81%) and 76% (95% CI 73-79%), respectively. In multivariate analyses, elevated baseline NLR and PLR were not prognostic for OS or DFS. Elevated NLR was a negative predictor of pCR (OR 0.61, p=0.037, 95% CI 0.38-0.97); there was no association with elevated PLR. Conclusions: Elevated NLR was a negative predictor of pCR, but not prognostic for DFS and OS. PLR was neither predictive nor prognostic.

The prognostic utility of pre‐treatment neutrophil‐to‐lymphocyte‐ratio (NLR) in colorectal cancer: A systematic review and meta‐analysis

“…Reasonable attempts were made to request unreported HR or 95% CI data from the authors. As a result, one additional study 34 was included in the analysis with this information provided.…”

Can pretreatment platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios predict long-term oncologic outcomes after preoperative chemoradiation followed by surgery for locally advanced rectal cancer?

“…Andras et al [23] reported that NLR is a simple and cost-effective marker for predicting neoadjuvant treatment response in LARC, with a cut-off value of 4.5. In contrast, Dudani et al [25] analyzed 1,237 rectal cancer patients who underwent neoadjuvant CRT, and showed that neither pretreatment PLR nor NLR predicted pCR. However, some studies have focused on changes in serologic markers before and after neoadjuvant CRT.…”

“…In contrast, there have been several studies showing that pretreatment serologic markers are not related to the survival rate of rectal cancer patients who underwent neoadjuvant CRT followed by curative resection. Dudani et al [25] conducted a study by setting the cut-off values of PLR and NLR to 150 and 4, respectively, and reported that PLR and NLR were not independent prognostic factors of DFS or OS. Portale et al [11] found neither PLR nor NLR to be associated with survival in rectal cancer patients.…”

Systemic inflammatory indices predict tumor response to neoadjuvant chemoradiotherapy for locally advanced rectal cancer

“…Previous studies have focused on the predictive value of baseline systemic inflammatory responses. Dudani et al ( 31 ) reviewed 1,527 patients with rectal cancer receiving nCRT and surgery, and revealed that NLR and PLR were not predictors for disease-free survival or overall survival, and could not predict pCR. Additionally, Shen et al ( 29 ) reported that there was no significant association between tumor response and NLR to nCRT.…”