The role of haematological parameters in predicting the response to radical chemoradiotherapy in patients with anal squamous cell cancer

Abstract

Background Historically, the treatment of choice for anal cancer had been abdominoperineal resection (APR). Radical radiotherapy with concurrent 5-fluorouracil plus mitomycin C chemotherapy was later established as standard therapy, although with a failure rate of 20–30%. The aim of this study was to evaluate the outcomes after radical chemoradiotherapy (CRT), prognostic and predictive factors and patterns of failure. Patients and methods This study included 47 patients treated with radical CRT for patohistologicaly confirmed anal squamous cell carcinoma. Analysed haematological parameters included: neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and haemoglobin level. The final logistic regression model included treatment break period. Tumour response was assessed at 24 weeks from CRT completion. Follow-up was performed every 3 months during the first two years, and every 6 months thereafter. Results A complete clinical response (CR) was detected in 30 patients (63.8%). Patients who did not achieve a 6-months CR and those who had a CR after 6 months but then relapsed were referred to surgical treatment. With combined CRT and surgical salvage treatment the CR rate was 80.9%. Patients with CR after 6 months had significantly longer disease-free survival (DFS), progression-free survival (PFS), and overall survival (OS). A significant effect on the 6-month response was confirmed for PLR (p = 0.03). Conclusions Important prognostic factors associated with CR were baseline haemoglobin level and period of treatment interruptions. Potential haematological prognostic factors could be PLR and NLR, which can be routinely determined by low-cost and minimally invasive methods.

Exploring novel genetic and hematological predictors of response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer

“…The NMR has been investigated in low-risk differentiated thyroid carcinoma as a prognostic factor, and it was found that lower initial level is related to a worse prognosis, which is in relation to our findings ( Offi et al, 2021 ). Our group has previously shown that hematological parameters easily derived and routinely determined by low-cost and minimally invasive methods might be useful in predicting the response to chemoradiotherapy in patients with anal cancer ( Stojanovic-Rundic et al, 2021 ). Also, we successfully evaluated the role of hematological parameters in predicting the survival and toxicity to specific treatment in the lung cancer setting ( Jokic et al, 2021 ).…”

Exploring novel inflammation-related genetic and hematological predictors of response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer

“…Our group has previously shown that hematological parameters easily derived and routinely determined by low-cost and minimally invasive methods might be useful in predicting the response to chemoradiotherapy in patients with anal cancer 7 . Also, we successfully evaluated the role of hematological parameters in predicting the survival and toxicity to specific treatment in the lung cancer setting 55 .…”

“…In the majority of cases, it is diagnosed in advanced stages, when treatment options are limited. In this regard, in the past we have profiled the diagnostic, prognostic and predictive factors for cancers of the digestive system, leading to improved research strategies for patient management and care [2][3][4][5][6][7] . However, there is a need for better primary prevention, more effective screening program, diagnosis at an earlier stage of the disease and improvement of existing treatment modalities in our country and on a global level.…”

“…6 LMR -Lymphocyte-monocyte ratio;7 PLR -Platelet-lymphocyte ratio;8 NMR -Neutrophil-tomonocyte ratio;9 Tumor location -distance from anal verge; 10 cCR -Patients without operative treatment due to complete clinical response;11 TRG -Tumor regression grade; 12 Rresponders;13 NonR -non-responders Correlation of clinical evaluation and pathological examination as a gold standard in a group of patients where operative treatment was conducted is presented in Table4. Using disease prevalence of 79.4% the sensitivity, specificity, positive predictive value, negative predictive value and predictive accuracy were calculated (Table5).…”

Methylenetetrahydrofolate reductase polymorphic variants in rectal cancer: significance for cancer risk and response to chemoradiotherapy

“…In Serbia in the majority of cases, CRC is diagnosed in advanced stages where limited treatment options are available and survival is poor. Our group and others have invested efforts into profiling the diagnostic, prognostic and predictive factors for CRC and anal cancer, in an effort to provide better research strategies for treatment and overall management (Jakovljevic et al, 2012a; Brotto et al, 2013; Cavic et al, 2016; Nikolic et al, 2021; Stojanovic-Rundic et al, 2021; Vuletić et al, 2021; Marinkovic et al, 2023; Stanojevic et al, 2023).…”