Prognostic clinical factors in pretreated colorectal cancer patients receiving regorafenib: Implications for clinical management.

Prete, Michela Del; Loupakis, Fotios; Prochilo, Tiziana; Salvatore, Lisa; Faloppi, Luca; Bianconi, Maristella; Bittoni, Alessandro; Aprile, Giuseppe; Zaniboni, Alberto; Falcone, Alfredo; Scartozzi, Mario; Cascinu, Stefano

doi:10.1200/jco.2015.33.3_suppl.591

Cited by 8 publications

(11 citation statements)

References 25 publications

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“…An elevated NLR is considered to be associated with elevated circulating concentrations of these cytokines, which offers an insight into mechanisms underlying an elevated NLR (30,31). Nevertheless, the cutoff points of NLR proposed in previous studies differ, including NLR thresholds of 2.3, 4.02 or 5 in gastric cancer (14,32,33), 0.38, 2.4 or 3 in colorectal cancer (15,34,35), 2.3 or 2.5 in NSCLC (10,36), and consensus has not been established. The heterogeneity of those studies may contribute to the different results.…”

Section: Discussionmentioning

confidence: 93%

Prognostic value of preoperative neutrophil-lymphocyte ratio is superior to platelet-lymphocyte ratio for survival in patients who underwent complete resection of thymic carcinoma

Yuan¹,

Gao²,

Mu³

et al. 2016

J. Thorac. Dis.

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Background: Preoperative neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) have prognostic value in patients with various operable tumors. The aim of our study was to determine whether NLR and PLR are predictive of survival in thymic carcinoma patients after complete resection. Results: Univariate analysis found that a high level of NLR was associated with lower disease-free survival (DFS) (HR: 3.385, 95% CI: 1.073-10.678, P=0.037) and lower overall survival (OS) (HR: 12.836, 95% CI:1.615-101.990, P=0.016). The optimal NLR threshold of 4.1 could stratify the patients with high risk of recurrence or metastasis (P=0.026) and death (P=0.006). Meanwhile, the NLR value of >4.1 in those patients was associated with bigger tumor size (P=0.035) and more advanced Masaoka stages (P=0.040) compared with NLR ≤4.1. However, the PLR and other variables were not significantly associated with survival in thymic carcinoma patients. Conclusions:The preoperative NLR of >4.1 was significantly associated with larger tumor size, more advanced Masaoka stages and reduced DFS and OS, but was not an independent predictor of survival in thymic carcinoma patients after complete resection.

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Section: Discussionmentioning

confidence: 93%

Prognostic value of preoperative neutrophil-lymphocyte ratio is superior to platelet-lymphocyte ratio for survival in patients who underwent complete resection of thymic carcinoma

Yuan¹,

Gao²,

Mu³

et al. 2016

J. Thorac. Dis.

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“…A previously well-conducted study comprising 208 regorafenib-treated patients demonstrated an association between high neutrophil, high platelet, low lymphocyte count and/or high neutrophil–lymphocyte ratio with prognosis. 26 Due to the stringent inclusion criteria of our study, our data distribution did not allow to use the same cut-off used in the study by Del Prete and colleagues and median values were used instead. Notwithstanding small numbers and patient selection based on trial inclusion/exclusion criteria, no significant correlation with efficacy was found with any of the above-mentioned factors (see online appendix tables A8 and A9).…”

Section: Resultsmentioning

confidence: 99%

Functional imaging and circulating biomarkers of response to regorafenib in treatment-refractory metastatic colorectal cancer patients in a prospective phase II study

Khan¹,

Rata

Cunningham

et al. 2017

Gut

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ObjectiveRegorafenib demonstrated efficacy in patients with metastatic colorectal cancer (mCRC). Lack of predictive biomarkers, potential toxicities and cost-effectiveness concerns highlight the unmet need for better patient selection.DesignPatients with RAS mutant mCRC with biopsiable metastases were enrolled in this phase II trial. Dynamic contrast-enhanced (DCE) MRI was acquired pretreatment and at day 15 post-treatment. Median values of volume transfer constant (Ktrans), enhancing fraction (EF) and their product KEF (summarised median values of Ktrans× EF) were generated. Circulating tumour (ct) DNA was collected monthly until progressive disease and tested for clonal RAS mutations by digital-droplet PCR. Tumour vasculature (CD-31) was scored by immunohistochemistry on 70 sequential tissue biopsies.ResultsTwenty-seven patients with paired DCE-MRI scans were analysed. Median KEF decrease was 58.2%. Of the 23 patients with outcome data, >70% drop in KEF (6/23) was associated with higher disease control rate (p=0.048) measured by RECIST V. 1.1 at 2 months, improved progression-free survival (PFS) (HR 0.16 (95% CI 0.04 to 0.72), p=0.02), 4-month PFS (66.7% vs 23.5%) and overall survival (OS) (HR 0.08 (95% CI 0.01 to 0.63), p=0.02). KEF drop correlated with CD-31 reduction in sequential tissue biopsies (p=0.04). RAS mutant clones decay in ctDNA after 8 weeks of treatment was associated with better PFS (HR 0.21 (95% CI 0.06 to 0.71), p=0.01) and OS (HR 0.28 (95% CI 0.07–1.04), p=0.06).ConclusionsCombining DCE-MRI and ctDNA predicts duration of anti-angiogenic response to regorafenib and may improve patient management with potential health/economic implications.

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“…Lymphocytes usually function as pivotal tumour suppressors by inducing cytotoxic cell death and producing cytokines that inhibit cancer cell proliferation and metastatic activity [34,35]. Elevated NLR, caused by lymphocytopenia and/or a high neutrophil count, may lead to a poor immune response to malignancy and an increased potential for tumour recurrence [33,[36][37][38][39][40]. Thus, NLR is recognized as an efficient inflammationbased prognostic parameter in solid tumours [29].…”

Section: Discussionmentioning

confidence: 99%

Significance of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio and prognostic nutritional index for predicting clinical outcomes in T1–2 rectal cancer

et al. 2020

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Background: Inflammation-related parameters have been revealed to have prognostic value in multiple caners. However, the significance of some inflammation-related parameters, including the peripheral blood neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR) and prognostic nutritional index (PNI), remains controversial in T1-2 rectal cancer (RC). Methods: Clinical data of 154 T1-2 RC patients were retrospectively reviewed. The cutoff values for NLR, PLR, LMR, and PNI were determined by receiver operating characteristic curves. The relationships of these parameters with postoperative morbidities and prognosis were statistically analysed. Results: The optimal cutoff values for preoperative NLR, PLR, LMR and PNI were 2.8, 140.0, 3.9, and 47.1, respectively. Significant but heterogeneous associations were found between NLR, PLR, LMR and PNI and clinicopathological factors. In addition, high NLR, high PLR, and low PNI were correlated with an increased postoperative morbidity rate. Patients with high NLR/PLR or low LMR/PNI had lower OS and DFS rates. On multivariate analysis, only high NLR was identified as an independent risk factor for poor DFS. Conclusions: NLR, PLR, and PNI are valuable factors for predicting postoperative complications in T1-2 RC patients. A preoperative NLR of more than 2.8 is an independent prognostic factor for poor DFS in T1-2 RC patients.

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Prognostic clinical factors in pretreated colorectal cancer patients receiving regorafenib: Implications for clinical management.

Abstract: Background:We assessed the impact on survival of angiogenesis and inflammation-related factors, particularly LDH serum levels, platelet, neutrophil and lymphocyte counts, and neutrophil-to-lymphocyte ratio (NLR), in metastatic colorectal cancer patients receiving regorafenib monotherapy.

Cited by 8 publications

References 25 publications

Prognostic value of preoperative neutrophil-lymphocyte ratio is superior to platelet-lymphocyte ratio for survival in patients who underwent complete resection of thymic carcinoma

Prognostic value of preoperative neutrophil-lymphocyte ratio is superior to platelet-lymphocyte ratio for survival in patients who underwent complete resection of thymic carcinoma

Functional imaging and circulating biomarkers of response to regorafenib in treatment-refractory metastatic colorectal cancer patients in a prospective phase II study

Significance of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio and prognostic nutritional index for predicting clinical outcomes in T1–2 rectal cancer

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