Circulating lymphocyte number has a positive association with tumor response in neoadjuvant chemoradiotherapy for advanced rectal cancer

Joji Kitayama,Hirokazu Nagawa,Eiji Sunami,Kazushige Kawai,Koji Yasuda

doi:10.1186/1748-717x-5-47

Joji Kitayama, Hirokazu Nagawa + Show 3 more

Open Access

https://doi.org/10.1186/1748-717x-5-47

Copy DOI

Journal: Radiation Oncology	Publication Date: Jun 3, 2010
Citations: 144	License type: CC BY 2.0

Affiliation: The University of Tokyo

Abstract

Although neoadjuvant chemoradiotherapy (CRT) is the standard treatment for advanced rectal cancer (RC), markers to predict the treatment response have not been fully established. In 73 patients with advanced RC who underwent CRT in a neoadjuvant setting, we retrospectively examined the associations between the clinical effects of CRT and blood cell counts before and after CRT. Clinical or pathological complete response (CR) was observed in 10 (14%) cases. The CR rate correlated significantly with the size and the circumferential extent of the tumor. Hemoglobin level, white blood cell (WBC) count and platelet count before CRT did not show a significant difference between CR and non-CR cases. Interestingly, however, lymphocyte ratio in WBC was significantly higher (p = 0.020), while neutrophil ratio tended to be lower (p = 0.099), in CR cases, which was shown to be an independent association by multivariate analysis. When all the blood data obtained in the entire treatment period were evaluated, circulating lymphocyte count was most markedly decreased in the CRT period and gradually recovered by the time of surgery, while the numbers of neutrophils and monocytes were comparatively stable. Moreover, the lymphocyte percentage in samples obtained from CR patients was maintained at a relatively higher level than that from non-CR patients. Since tumor shrinkage is known to be dependent not only on the characteristics of tumor cells but also on various host conditions, our data raise the possibility that a lymphocyte-mediated immune reaction may have a positive role in achieving complete eradication of tumor cells. Maintenance of circulating lymphocyte number may improve the response to CRT in rectal cancer.

Highlights

Neoadjuvant chemoradiotherapy (CRT) is the standard treatment for advanced rectal cancer (RC), markers to predict the treatment response have not been fully established
Preoperative chemoradiotherapy (CRT) is currently used worldwide as the initial treatment for advanced RC, since it can produce down-staging in approximately half of patients with locally advanced rectal cancer RC, resulting in a lower rate of postoperative local recurrence and a higher rate of sphincter-preserving surgery as well as longer survival [1,2,3]
We retrospectively examined circulating blood cells before and after CRT and assessed the possible relationship between these laboratory values and tumor response to CRT, with the approval of the Ethics Committee of the University of Tokyo

Summary

Introduction

Neoadjuvant chemoradiotherapy (CRT) is the standard treatment for advanced rectal cancer (RC), markers to predict the treatment response have not been fully established. We retrospectively examined circulating blood cells before and after CRT and assessed the possible relationship between these laboratory values and tumor response to CRT, with the approval of the Ethics Committee of the University of Tokyo. In the 73 patients, blood data on hemoglobin (Hb), white blood cells (WBC) with their subpopulations, and platelets were examined at various time points before CRT and during and after CRT until surgery.

Results

Conclusion