Prognosis of locally advanced rectal cancer can be predicted more accurately using pre- and post-chemoradiotherapy neutrophil-lymphocyte ratios in patients who received preoperative chemoradiotherapy

Abstract

PurposeThe neutrophil-lymphocyte ratio (NLR) has been suggested as an inflammation-related factor, but also as an indicator of systemic anti-tumor immunity. We aimed to evaluate the prognostic value of the NLR and to propose a proper cut-off value in patients with locally advanced rectal cancer who received preoperative chemoradiation (CRT) followed by curative total mesorectal excision (TME).MethodsA total of 110 rectal cancer patients with clinical T3-4 or node-positive disease were retrospectively analyzed. The NLR value before preoperative CRT (pre-CRT NLR) and the NLR value between preoperative CRT and surgery (post-CRT NLR) were obtained. Using a maximally selected log-rank test, cut-off values were determined as 1.75 for the pre-CRT NLR and 5.14 for the post-CRT NLR.ResultsPatients were grouped as follows: group A, pre-CRT NLR ≤ 1.75 and post-CRT NLR ≤ 5.14 (n = 29); group B, pre-CRT NLR > 1.75 and post-CRT NLR ≤ 5.14, or pre-CRT NLR ≤ 1.75 and post-CRT NLR > 5.14 (n = 61); group C, pre-CRT NLR > 1.75 and post-CRT NLR > 5.14 (n = 20). The median follow-up time was 31.1 months. The 3-year disease-free survival (DFS) and overall survival (OS) rates showed significant differences between the NLR groups (3-year DFS rate: 92.7% vs. 73.0% vs. 47.3%, for group A, B, and C, respectively, p = 0.018; 3-year OS rate: 96.0% vs. 85.5% vs. 59.8%, p = 0.034). Multivariate analysis revealed that the NLR was an independent prognostic factor for DFS (p = 0.028).ConclusionBoth the pre-CRT NLR and the post-CRT NLR have a predictive value for the prognosis of patients with locally advanced rectal cancer treated with preoperative CRT followed by curative TME and adjuvant chemotherapy. A persistently elevated post-CRT NLR may be an indicator of an increased risk of distant metastasis.

The Role of Neutrophil-to-lymphocyte Ratio on the Effect of CRT for Patients With Rectal Cancer

“…NLR was dichotomized as greater or less than the median value of the data set, namely 2.45 for the pre-CRT NLR and 3.85 for the post-CRT NLR. To date there has been no consensus about the NLR cut-off value that varies between reports from 1.75 to 5.14 (31)(32)(33). Further prospective, multicenter studies are needed to validate the results of this study and to determine the appropriate cut-off value.…”

Leukocytosis and neutrophilia as independent prognostic immunological biomarkers for clinical outcome in the CAO/ARO/AIO‐04 randomized phase 3 rectal cancer trial

“…Also, a combined leukocyte‐CEA score revealed that classified patients into three risk groups showed strong correlation with clinical outcome. Our data are in line to previous reports indicating an unfavorable role of peripheral blood leukocytosis and neutrophilia in the context of inflammation in different malignancies, including rectal cancer . With regard to NLR, a pooled analysis of retrospective studies indicated a negative predictive impact in rectal cancer .…”

“…Our data are in line to previous reports indicating an unfavorable role of peripheral blood leukocytosis and neutrophilia in the context of inflammation in different malignancies, [12][13][14][15][16][17][18]21 including rectal cancer. 22,23 With regard to NLR, a pooled analysis of retrospective studies indicated a negative predictive impact in rectal cancer. 24 However, the above-mentioned studies in rectal and other malignancies consisted of retrospective series with small patient number that lacked robust multivariable analyses.…”

Prognostic value of neutrophil-to-lymphocyte ratio in locally advanced non-small cell lung cancer treated with concurrent chemoradiotherapy

“…Recent studies have shown that inflammation-related biomarkers were correlated with prognosis in many solid cancers such as colorectal cancer, hepatocellular carcinoma, and NSCLC [3,[6][7][8][9][10][11][12][13]. Among inflammation-related biomarkers, NLR and PLR are affordable and easily available markers using…”

“…The prognostic and predictive factors of NSCLC are known as disease stage, performance status, sex, age, histology, tumor size, and mediastinal infiltration [2]. Recently, routinely assessed biological variables, such as neutrophil-tolymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and leukocytosis have been suggested as the prognostic factors [3,[6][7][8][9][10][11][12][13]. Templeton et al conducted a meta-analysis of 100 studies with a total of 40,599 patients and they demonstrated that a high NLR is associated with poor overall survival (OS) in many solid tumors [6].…”