The impact of chemotherapy-associated neutrophil/ lymphocyte counts on prognosis of adjuvant chemotherapy in colorectal cancer

Abstract

BackgroundLeukocytes play an important role in cancer development. However, the impact of chemotherapy-associated neutropenia/lymphopenia on the prognosis of adjuvant chemotherapy is unknown. Here, we aimed to explore the impact of chemotherapy-associated neutrophil/lymphocyte counts on prognosis of adjuvant chemotherapy in colorectal cancer (CRC) and the risk factors for developing neutropenia/lymphopenia which showed impact on the prognosis of CRC receiving adjuvant chemotherapy.MethodsFrom February 2003 to January 2011, 243 stage II and III CRC patients receiving adjuvant chemotherapy were enrolled in this retrospective study. The associations between neutrophil/ lymphocyte counts and disease free survival (DFS)/overall survival (OS) of CRC, and the risk factors for neutropenia/lymphopenia were investigated.ResultsNo association of chemotherapy-associated neutrophil counts and CRC recurrence (AUC = 0.474, P = 0.534), death (AUC = 0.449, P = 0.249) was found by ROC analysis. However, the chemotherapy-associated lymphocyte counts could significantly affect CRC recurrence (AUC = 0.634, P = 0.001), or death(AUC = 0.607, P = 0.015), with a optimized cut-off of 0.66 × 109/L for recurrence, and 0.91 × 109/L for death, respectively. Kaplan–Meier method showed chemotherapy-associated lymphopenia <0.66 × 109/L was associated with shorter DFS (P < 0.0001), and chemotherapy-associated lymphopenia <0.91 × 109/L was associated with shorter OS (P = 0.003). Cox regression model showed chemotherapy-associated lymphopenia <0.66 × 109/L was the independent prognostic factor for DFS (HR, 3.521; 95%CI = 1.703-7.282), and chemotherapy-associated lymphopenia <0.91 × 109/L was the independent prognostic factor for OS (HR, 2.083; 95% CI = 1.103-3.936). Multivariate logistic regression showed the risk of developing chemotherapy-associated lymphopenia <0.66 × 109/L was found in those with pretreatment CEA ≥10 ng ml-1 (OR, 3.338; 95% CI = 1.523-7.315), and the risk of developing chemotherapy-associated lymphopenia <0.91 × 109/L was found in those with age >60 years (OR, 2.872; 95% CI = 1.344-6.136).ConclusionsChemotherapy-associated lymphopenia <0.66 × 109/L /0.91 × 109/L has a significant impact on the prognosis of CRC receiving adjuvant chemotherapy. Pretreatment CEA ≥10 ng ml-1 is the independent risk factor for developing lymphopenia <0.66 × 109/L, and age >60 years is the independent risk factor for developing lymphopenia <0.91 × 109/L during adjuvant chemotherapy of CRC.

FOLFOX chemotherapy can safely be given to neutropenic patients with early-stage colorectal cancer for higher dose intensity and fewer visits

“…Chu-Yuan et al found the mean ANC at cycle 1 to be 4.27 × 10 9 /L (95 % CI, 4.1-4.5 × 10 9 /L) [8]. This compares to 5.0 × 10 9/ L (95 % CI, 4.6-5.4 × 10 9 /L) for the current study.…”

“…However, the completion rate in the current study was 82 %, which compares to 91 % [8] and 75 % [9] in other studies.…”

“…Myeloid growth factors are used to prevent dose modification which would adversely effect RDI [6]. There are conflicting data regarding the association of RDI and improved survival in the treatment of colorectal cancer as it has never been directly tested [7][8][9].…”

Reduced-Intensity Haploidentical Bone Marrow Transplantation with Post-Transplant Cyclophosphamide for Solid Tumors in Pediatric and Young Adult Patients

“…In other tumor types lymphopenia has correlated with lower disease-free survival, particularly with the use of chemotherapy [68–70]. Reconstituting the immune system is thus an important goal of our BMT platform.…”

Prognostic significance of pretreatment albumin/globulin ratio in patients with hepatocellular carcinoma

“…Of note, mounting evidence suggests that the presence of the systemic inflammatory response, reflected in routine hematology, has a decidedly protumor capacity leading to poor prognosis in a host of malignant neoplasms 6–9. Albumin and globulin, the major constituents of serum proteins, have a vital effect on the systemic inflammatory response.…”