Neutrophils in Rectal Cancer—A Review: Stage III Rectal Cancer Patients and 5-Fluorouracil Therapy. Introducing New Inclusion Criteria and Scoring System (Presenting the “Sarandria Score”)

Abstract

This review is intended to shed new light on the role of neutrophils in colorectal cancer and in the meanwhile emphasize the differences between rectal and colon cancer, strengthen and highlight the possibility of a clinical prognostic and predictive scoring (Sarandria Score). A novel scoring system described in this review can be used as inclusion criteria and as a predictive and prognostic scoring for stage III rectal cancer patients. Background: Colorectal Cancer (CRC) is a major public health problem, representing the third most commonly diagnosed cancer in males and the second in females. Various studies have reported relevant differences related to CRC primary location site (right-sided colon, left-sided colon, rectum) including response to adjuvant chemotherapy and prognosis. In stage III CRC patients, previous findings showed that higher density of tumor-associated neutrophils (TANs) was associated with better response to 5-FU-based chemotherapy. Main topics: In this review, the current knowledge status on the role of neutrophils in colorectal cancer is assessed, including novel finding discovered by Dr. Nicola Sarandria on the role of neutrophils in rectal cancer. It includes different factors which point to an anti-tumoral role of neutrophils in rectal cancer when in presence of chemotherapeutic agents (such as 5-fluorouracil). The clinical significance of TANs was assessed and whether it can be different depended on the location of the primary CRC (right-sided colon, left-sided colon, rectum). Conclusions: This review officially highlights the possibility of a new clinical prognostic and predictive scoring (Sarandria Score) involving intratumoral neutrophilic infiltration in rectal cancer and the possibility of a new inclusion criterion based on this infiltrate for Stage III rectal cancer patients treated with 5-FU therapy. This review includes knowledge from data published on my medical degree thesis showing that higher levels of TANs densities were associated with better disease-free survival (DFS) in 5-FU treated patients affected by rectal cancer (while it was inversely related in patients without 5-FU therapy). This is also further evidence in support of a possible conceptual division of what is now known as colorectal cancer into two separate entities: colon and rectal cancer.