Abstract
BackgroundColorectal cancer is the fourth most common cancer globally and neoadjuvant concurrent chemoradiotherapy (nCRT) and surgery are the standard treatments for locally advanced colorectal carcinoma. This study investigated the association between dynamic changes in absolute lymphocyte counts (ALCs) and disease-free survival (DFS) in rectal cancer patients receiving nCRT and identified factors associated with these changes.MethodsWe retrospectively examined 34 patients with locally advanced rectal cancer who received nCRT followed by surgery and adjuvant chemotherapy. The association between ALCs and DFS and that between ALCs and downstaging were analyzed and potential clinical- and treatment-related factors related to dynamic changes in ALCs were subsequently evaluated. The patient eligibility criteria were as follows: pathologically confirmed rectal adenocarcinoma, clinical stages II–III, ≥ 18 years of age, and so on. Pre-RTL was defined as ALCs obtained before the initiation of nCRT and pre-SL was defined as ALCs obtained before surgery. We measured pre-SL to pre-RTL ratio (pre-SLR), DFS, and ALCs.ResultsThe median ALC declined significantly during nCRT. A lower pre-SLR was associated with poorer DFS with statistical significance in Kaplan–Meier (p = 0.007), univariate regression (hazard ratio [HR] = 6.287, 95% confidence interval [CI] 1.374–28.781, p = 0.018), and multivariable regression (HR = 7.347, 95% CI 1.595–33.850, p = 0.011) analyses. Neither patient characteristics nor treatment-related factors were related to downstaging. The pelvic bone marrow (PBM) volume receiving at least 30 Gy (V30) was significantly associated with pre-SLR in the univariate (HR = 5.760, 95% CI 1.317–25.187, p = 0.020) and multivariable (HR = 5.760, 95% CI 1.317–25.187, p = 0.020) regression analyses.LimitationsOur study had several limitations. The sample size was small and the study was performed in a selected population, which may limit the generalization of the findings.ConclusionsRadiotherapy had a profound impact on the change in ALCs. A lower pre-SLR was significantly associated with poorer DFS in rectal cancer patients receiving nCRT. The V30 of PBM was a predictor of pre-SLR.
Highlights
Colorectal cancer is the fourth most common cancer globally and neoadjuvant concurrent chemoradiotherapy and surgery are the standard treatments for locally advanced colorectal carcinoma
The present study aimed to explore whether diseasefree survival (DFS) is associated with circulating absolute lymphocyte counts (ALCs) before chemoradiotherapy, during neoadjuvant concurrent chemoradiotherapy (nCRT), and before surgery in patients with locally advanced rectal cancer and to explore the potential clinical and treatment-related factors associated with lymphocyte counts
The patient eligibility criteria were as follows: pathologically confirmed rectal adenocarcinoma, clinical stages II–III, ≥ 18 years of age, Eastern Cooperative Oncology Group (ECOG) performance status of 0–1, baseline complete blood counts and carcino-embryonic antigen (CEA) data available, received nCRT followed by surgery-at our institution, total mesorectal excision (TME) performed with R0 resection, no history of previous radiotherapy or chemotherapy, no history of previous or coexisting cancer, and at least three weekly complete blood counts documented during nCRT
Summary
Colorectal cancer is the fourth most common cancer globally and neoadjuvant concurrent chemoradiotherapy (nCRT) and surgery are the standard treatments for locally advanced colorectal carcinoma. This study investigated the association between dynamic changes in absolute lymphocyte counts (ALCs) and diseasefree survival (DFS) in rectal cancer patients receiving nCRT and identified factors associated with these changes. NCRT and surgery are, the standard treatments for locally advanced colorectal carcinoma. A series of studies has shown that the host immune system is significantly associated with the prognosis of patients with colorectal cancer. A high ratio of lymphocytes in white blood cells before treatment is associated with higher pathologic complete remission and better disease-free survival (DFS) and overall survival (OS) in rectal cancer [7]. Lymphopenia is associated with prognosis in patients with advanced colorectal cancer receiving chemotherapy [9]
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