The Pre-treatment Systemic Inflammatory Response Biomarkers are Important Determinant of Prognosis for Patients Undergoing Neoadjuvant Therapy for Rectal Cancer

Abstract

Purpose: To evaluate the prognostic potential of inflammatory response biomarkers neutrophil to lymphocyte ratio (NLR), derived neutrophil to lymphocyte ratio (dNLR), platelet to lymphocyte ratio (PLR) and lymphocyte to monocyte ratio (LMR) in predicting the outcome of rectal cancer patients undergoing neoadjuvant chemoradiation prior to surgery. Methods: Retrospective review of T3/T4, or N+ rectal cancer treated with neoadjuvant chemoradiation 50.4 Gy concurrently with either 5 FU (1 g/m2/d) or Capecitabine 825 mg/m2 twice daily. Four additional cycles of 5-FU chemotherapy (500 mg/m2/d, i.v. bolus) or capecitabine (2500 mg/m2 days 1-14, repeated day 22), were applied post-operatively. Pre-treatment NLR, dNLR, PLR and LMR calculated from peripheral blood cell were compared with clinicopathological parameters. The prognostic value of baseline NLR, dNLR, PLR and LMR for disease free survival (DFS) and overall survival (OS) were assessed using Log rank and Cox regression. Results: The final analysis included 80 patients, the receiver operating curve (ROC) calculated cut off values of baseline NLR, dNLR, LMR and PLR in predicting outcome were 3, 2.1, 4.9 and 169 respectively. Elevated NLR, dNLR, PLR, LMR, age of patients (≥50 years), depth of invasion ≥T3, lymph node N1-N2, stage III, grade 3 tumors, and partial response to preoperative chemoradiation were significantly associated with decreased OS, and DFS. Multivariate analysis revealed that elevated NLR and dNLR were independent Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation factors for worse OS and DFS hazard ratio (HR) 2.34 (95% CI=3.41-7.24), 4.53 (95% CI, 2.61-8.32) and DSF with (HR) 1.84 (95% CI=2.27-5.36), 4.23 (95% CI=3.49-9.52) respectively. Conclusion: The baseline NLR, dNLR, LMR and PLR showed a significant association with different clinicopathological prognostic factors in rectal cancer patients receiving preoperative chemoradiation. Additionally, NLR, dNLR may be considered as potential independent prognostic indicators of clinical outcomes.