Abstract
BackgroundTo evaluate the value of pretreatment inflammatory-nutritional biomarkers in predicting responses to neoadjuvant chemoradiotherapy (nCRT) and survival in patients with locally advanced rectal cancer (LARC).MethodsPatients with LARC who underwent nCRT and subsequent surgery between October 2012 and December 2019 were considered for inclusion. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), and prognostic nutritional index (PNI) were calculated from according to routine laboratory data within 1 week prior to nCRT. The correlations between baseline inflammatory-nutritional biomarkers and responses were analyzed using Chi-square test or Fisher’s exact test, and multivariate logistic regression analysis was performed to identify the independent predictors of pathological responses to nCRT. Univariate and multivariate Cox proportional hazard models were used to assess the correlations of predictors with disease-free survival (DFS) and overall survival (OS).ResultsA total of 273 patients with LARC were enrolled in this study. Higher LMR and PNI were observed in the good-response group, meanwhile higher NLR and PLR were observed in the poor-response group. Multivariate logistic regression analysis results revealed that PLR and PNI independently predicted responses to nCRT. Multivariable Cox regression analysis determined that PNI was an independent predictor of DFS and OS in patients with LARC. The value of pretreatment PNI in predicting responses and survival was continuously superior to those of NLR, PLR, and LMR. The optimal cutoff value of the PNI was approximate 45. Subgroup analyses indicated that the pathological responses and survival in the high PNI group (≥ 45) were significantly better than those in the low PNI group (< 45), especially in patients with clinical stage III rectal cancer.ConclusionThe pretreatment PNI can serve as a promising predictor of response to nCRT and survival in patients with LACR, which is superior to NLR, PLR, and LMR, and the patients with clinical stage III rectal cancer who have a higher PNI are more likely to benefit from nCRT.
Highlights
Standard treatment for patients with clinical locally advanced rectal cancer (LARC) includes neoadjuvant chemoradiation therapy followed by total mesorectal excision (TME) and adjuvant chemotherapy [1]
Patients treated only with neoadjuvant CRT and “watchand-wait” strategy (n = 14), those who did not complete the course of chemoradiotherapy (n = 4), those who received concurrent oxaliplatin (n = 21) during CRT, those who did not complete the full-dose adjuvant chemotherapy postoperatively (n = 20), those with macroscopically (R2, n = 1) or microscopically (R1, n = 4) positive pathological resection margin, those with incomplete baseline laboratory results (n = 4), those who had no available postoperative histopathology samples (n = 3) and those who were lost to follow-up (n=12) were excluded from this study
Higher lymphocyte to monocyte ratio (LMR) and prognostic nutritional index (PNI) were observed in the good-response group, higher neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were observed in the poor-response group
Summary
Standard treatment for patients with clinical locally advanced rectal cancer (LARC) includes neoadjuvant chemoradiation therapy (nCRT) followed by total mesorectal excision (TME) and adjuvant chemotherapy [1]. This intensive tri-modal therapy is associated with increased local control and sphincter preservation rates and reducing toxicity compared with the postoperative therapy [2]. Most primary tumors respond well to nCRT, and about 20% of patients even show a pathological complete response (pCR), which may indicate a favorable prognosis [3]. To evaluate the value of pretreatment inflammatory-nutritional biomarkers in predicting responses to neoadjuvant chemoradiotherapy (nCRT) and survival in patients with locally advanced rectal cancer (LARC)
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