Is the presence of acellular mucin in rectal cancer patients with a pathologic complete response to preoperative chemoradiation of prognostic significance?

170 Background: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) predict for survival in cancer patients. In patients receiving multi-modality therapy, the effect of each specific therapy on the NLR and PLR is not well understood. We therefore evaluated changes in NLR and PLR among locally advanced esophageal cancer patients who received trimodality therapy. Methods: We performed a retrospective analysis of non-metastatic patients with esophageal cancer who received neoadjuvant chemoradiation (CRT) followed by esophagectomy at our institution between March 2000 and April 2012. NLR and PLR values were obtained the following time points (TP): 1) at diagnosis before CRT, 2) after CRT prior to surgery, and 3) after surgery. We also evaluated change in NLR and PLR using the difference and ratio between TPs. Overall survival (OS) was evaluated by Kaplan-Meier analysis. Univariate and multivariate Cox regression models were applied to evaluate the independent prognostic significance of NLR and PLR. Results: 83 patients with stage II-IV esophageal cancer and median age 60 years were included. Median follow up was 29.3 months. Median dose of 50.4 Gy (50.4-59.4) in 28 fractions (28-33) was used. Median NLR and PLR at the each TP: 1) 3.3 and 157.2, 2) 12 and 645, and 11.5 and 391.7, respectively. On multivariate analysis, inferior OS was associated with PLR ≥250 at TP 3 (p=.03), PLR decrease ≥609.2 from TP 2-3 (p=.02), and PLR ratio (TP 1/TP3) ≥1.08 (p=.03). Inferior progression free survival (PFS) was associated with NLR at TP 2 ≥36 (p=.0008), NLR increase ≥28.3 from TP 1-2 (p=.0005), PLR increase from TP 1-3 ≥19 (p=.01), and PLR ratio (TP 2/TP 3) ≥0.34 (p=0.1). Pathologic complete response (pCR) was less likely for adenocarcinoma histology (p=.03), NLR at TP 2 ≥10.6 (p=.04), and NLR increase from TP 1 to TP 2 ≥4.6 (p=.03). Conclusions: This is the first study to demonstrate that changes in NLR and PLR throughout trimodality therapy for esophageal cancer correlate with OS, PFS, and pCR. Further evaluation is warranted to better define which of the identified cut-off values are most clinically significant.

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Clinical significance of neutrophil-lymphocyte ratio to the patients with locally advanced rectal cancer who received preoperative chemoradiation therapy.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.138 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 138-138

Author(s):

Joo Hwan Lee ◽

Jong Hoon Lee ◽

Sung Hwan Kim ◽

Hyo Chun Lee

Keyword(s):

Rectal Cancer ◽

Locally Advanced ◽

Pathologic Complete Response ◽

Complete Response ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Preoperative Chemoradiation ◽

Chemoradiation Therapy ◽

Preoperative Chemoradiation Therapy ◽

National University

138 Background: Preoperative chemoradiation therapy (CRT) and total mesorectal excision have been the standard care of the patients with locally advanced rectal cancer. Response to the preop CRT varied from patient to patient, approximately 10-15% of the patients achieved complete response, on the contrary, nearly 40% of the patients still showed ypT4 disease. The aim of this study is to assess the prognostic value of NLR and suggest the optimal cut-off value to predict tumor response to the preoperative chemoradiation therapy in the patients with locally advanced rectal cancer. Methods: We analyzed the medical records of 1134 patients who diagnosed with locally advanced rectal cancer and treated with preop CRT followed by radical surgery at St. Vincent hospital, Seoul St. Mary’s hospital, Chonnam National University Hwasun Hospital, Gyeongsang National University Hospital and Dongsan Medical Center from 1998 to 2015. All patients had histologically confirmed rectal adenocarcinoma within 10 cm from anal verge. All patients received preoperative CRT to the pelvis followed by TME. Complete blood count was performed at initial workup before treatment and NLR was calculated with differential count. Results: An optimal cut-off value of the NLR was revealed as 1.98. The NLR showed average value for predicting death (AUC 0.516, p < 0.001). According to the cut-off value, patients were divided into two groups; high NLR (NLR≥2.0, n = 530) and low NLR (NLR < 2.0, n = 604). The patients with low NLR achieved pathologic complete response more frequently. 105 patients of total 604 patients (17.4%) with low NLR showed no remnant tumor cells, compared to 63 patients of the 530 patients (11.9%) with high NLR did (p = 0.012). The proportion of the patients who were downstaged to T1-2N0 was evaluated. In the low NLR group, 258 patients (42.7%) were downstaged, while 199 patients (37.5%) in the high NLR group were, which showed a tendency but did not reach statistical significance (p = 0.087). Conclusions: In this large-scale multi-center analysis, NLR was once again identified as a predictor of treatment response of preop CRT in patients with locally advanced rectal cancer.

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