Pre-, postchemoradiation NLR predict prognosis in rectal cancer after curative TME
Both pre- and postchemoradiation (CRT) neutrophil-lymphocyte ratio (NLR) have a prognostic value in patients with locally advanced rectal cancer who have received preoperative CRT and curative total mesorectal excision (TME), a new study shows.
The study included 110 patients with rectal cancer or rectal adenocarcinoma who received curative TME after preoperative CRT. Those with fevers, upper respiratory infections, urinary tract infections, rheumatoid diseases, metabolic syndrome or coronary artery disease were excluded.
Three-dimensional radiotherapy was performed simultaneously with chemotherapy with either intravenous 5-fluorouracil or oral capecitabine. NLR before preoperative CRT, during the weekly CRTs and 4 weeks after CRT was calculated.
Participants were grouped into three, according to pre- and post-CRT NLR values: ≤1.75 and ≤5.14, respectively (group A); >1.75 and ≤5.14, or ≤1.75 and >5.14, respectively (group B); and >1.75 and >5.14, respectively (group C). The respective median pre-CRT NLR in these groups were 1.22, 2.24 and 2.86 and median post-CRT NLR were 2.59, 3.13 and 5.86.
The overall 3-year disease-free survival rate was 73.1 percent; for groups A, B and C, these rates were 92.7, 73.0 and 47.3 percent, respectively (p=0.018). The 3-year locoregional recurrence-free survival (LRFS) for group A (96.2 percent) was significantly better compared to groups B (80.7 percent) and C (66.5 percent; p=0.017).
The 3-year distant metastasis-free survival for group C (51.7 percent) was significantly lower compared to groups A (92.7 percent) and B (76.4 percent; p=0.04). For the three groups, overall survival rates were 96.0, 85.5 and 59.8 percent, respectively (p=0.034).
Univariate analysis showed that pre-CRT NLR (p=0.040), post-CRT NLR (p=0.029), NLR group (p=0.027), perineural invasion (p=0.046), pathologic N stage (p=0.038) and pre-CRT carcinoembryonic antigen (CEA; p=0.021) were significantly associated with disease-free survival.
Multivariable analysis, on the other hand, showed that NLR group (p=0.028) and pre-CRT CEA (p=0.035) were the significant prognostic factors for disease-free survival.