Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Predict Poor Survival in Rectal Cancer Patients Receiving Neoadjuvant Concurrent Chemoradiotherapy

Abstract

was calculated for all the patients from the two groups. The patient acute hematologic toxicity (e.g. patient with symptoms of leukopenia, neutropenia, anemia, or thrombocytopenia) was recorded according to RTOG scoring scale. Independent sample t test were applied for the dose-volume parameters, and card square analysis for clinical parameters. Results: In terms of the OAR dose-volume parameters, the V 5 wV 35 and D mean for the pelvic bone, left femoral head and the right femoral head significantly (p<0.05) decreased for the PBMS-IMRT Group compared with the IMRT group. There was no significant difference in any dosevolume parameters for the bladder. As for PTV dose distribution, there was a significant (pZ0.001) improvement of the target conformity in the PBMS-IMRT group. In addition, the dose homogeneity was also improved by 14.5% for this group, although not significantly (PZ0.108). For the following acute hematologic toxicity observation, the numbers of the patients with grade 0, 1, 2, 3, 4 were 12, 6, 14, 10, and 0 respectively for the IMRT group. Meanwhile the corresponding numbers were 10, 19, 12, 1, and 0 for PBMS-IMRT group. The incidence of grade 2 or upper acute hematologic toxicity in the PBMS-IMRT group was significantly reduced (31%, 13/42 vs. 57.1%, 24/42, pZ0.027). There was no incidence of grade 2 or upper acute cystitis in both of the two groups. Conclusion: The marrow-sparing of the pelvic bone significantly reduces its dosage as well as the left and right femoral head. Patients with pelvic bone marrow-sparing had lower incidence of the grade 2 or upper acute hematologic toxicity compared with those without marrow-paring. Pelvic bone marrow-sparing can benefit patients with rectal cancer undergoing chemo-radiotherapy.

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?

“…In terms of survival rate, many studies have investigated whether pretreatment serologic markers, such as PLR and NLR, are associated with long-term oncologic survival as well as pCR in rectal cancer patients who underwent neoadjuvant CRT. A retrospective study by Ke et al [9] revealed that a pre-CRT elevated PLR ( > 188) was an independent prognostic factor for poor DFS, but not for OS, and that a pre-CRT elevated NLR ( > 3.5) was an independent prognostic factor for both poor DFS and OS. Zhang et al [28] reported that a high NLR ( ≥ 2.3) was associated with unfavorable OS and DFS, and they also reported that NLR was the most effective prognostic marker according to time-dependent ROC analysis.…”

“…Platelet-to-lymphocyte (PLR) and neutrophil-to-lymphocyte (NLR) ratios have been widely used as prognostic tools in various malignancies, based on the theory that platelets and neutrophils are pro-tumorigenic factors and lymphocytes are protective factors against tumors [7,8]. Some studies have reported that elevated PLR and NLR can reflect poor oncologic outcomes as well as response to neoadjuvant CRT in rectal cancer patients [9,10]. However, there are still debates about the prognostic effect of PLR and NLR for locally advanced rectal cancer cases because of existing contradictory results [9,11].…”

“…Some studies have reported that elevated PLR and NLR can reflect poor oncologic outcomes as well as response to neoadjuvant CRT in rectal cancer patients [9,10]. However, there are still debates about the prognostic effect of PLR and NLR for locally advanced rectal cancer cases because of existing contradictory results [9,11].…”

High Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Low Lymphocyte Levels Are Correlated With Worse Pathological Complete Response Rates

“…Colorectal cancer is the third most common malignancy and ranks second among cancer deaths [ 1 ]. Rectal cancer accounts for nearly one-third of all colorectal cancers, and almost half of them are diagnosed with locally advanced stage [ 2 ].…”

Prognostic Significance of Lymphocyte-to-Monocyte and Platelet-to-Lymphocyte Ratio in Rectal Cancer: A Systematic Review, Meta-analysis, and Meta-regression

“…[7][8][9][10][11] These tests are inexpensive and can be readily performed in daily oncologic practice. However, although some studies showed significant correlation between low LMR and high PLR and poor survival outcomes of rectal cancer, [12][13][14][15][16][17] others failed to replicate these results. [18][19][20][21][22][23] These discrepancies may relate, in part, to differences in treatment modalities and tumor characteristics.…”