Severe lymphopenia as a prognostic factor in rectal cancer patients receiving adjuvant chemoradiotherapy: a retrospective study

Abstract Objectives The relationship between total lymphocyte counts (TLCs) and survival is not well documented in rectal cancer. This study aimed to investigate the association between TLCs and disease-free survival (DFS) and identify factors associated with lymphopenia in locally advanced rectal cancer patients receiving chemoradiotherapy. Methods Thirty-six patients with locally advanced rectal cancer were retrospectively analyzed. TLCs were evaluated before surgery (pre-S), before radiotherapy (pre-RT), and during concurrent chemoradiotherapy (CCRT). The relationship between TLCs and DFS was analyzed by univariate and multivariate analysis. Potential clinical factors associated with lymphopenia were also evaluated. Results Median TLC declined significantly during radiotherapy. Severe lymphopenia during CCRT was significantly associated with poorer DFS on Kaplan-Meier analysis (p=0.01), univariate regression analysis (p=0.036), and multivariate regression analysis (p=0.038). Pre-S TLCs (p=0.009) and pre-RT TLCs (p=0.042) were significantly associated with severe lymphopenia on univariate regression analysis; however, only pre-S TLCs (p=0.026) were significantly associated with severe lymphopenia on multivariate regression analysis. Conclusions Severe lymphopenia was a predictor of poorer DFS in patients with locally advanced rectal cancer receiving adjuvant chemoradiotherapy. Pre-S TLCs were predictors of severe lymphopenia. Further study is warranted to reduce the rate of severe lymphopenia.

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Factors predictive of receiving neoadjuvant versus adjuvant chemoradiotherapy in locally advanced rectal cancer and the impact on overall survival.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.686 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 686-686

Author(s):

Alex Richard Coffman ◽

Dustin Boothe ◽

Jonathan Evans Frandsen ◽

Molly Gross ◽

Thomas Bartley Pickron ◽

...

Keyword(s):

Rectal Cancer ◽

Overall Survival ◽

Multivariate Analysis ◽

Clinical Stage ◽

Locally Advanced ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Adjuvant Chemoradiotherapy ◽

Factors Associated ◽

The Impact

686 Background: Neoadjuvant chemoradiotherapy (NCRT) is generally accepted as the optimal treatment strategy compared to adjuvant chemoradiotherapy (ACRT) for locally advanced rectal cancer due to improvement in local control and reduced toxicity. However, NCRT has not been shown to improve overall survival (OS). We investigated the effect of NCRT versus ACRT on OS as well as the impact of demographic factors and clinical stage for the selection of each treatment approach utilizing the National Cancer Data Base. Methods: Adult patients with stage II and stage III adenocarcinoma of the rectum diagnosed from 2004-2013 were included. Chi-square analysis was used to compare demographic variables and clinical stage between the NCRT and ACRT treatment groups. Univariate and multivariate logistic regression modeling was used to identify factors predictive of each treatment strategy. Kaplan Meier and log-rank analysis along with propensity score matching was performed to determine the effect on OS. Results: A total of 20,262 patients were identified: 17,737 (87.5%) received NCRT and 2,525 (12.5%) received ACRT. Utilization of NCRT increased over the study period (p < 0.01). Factors associated with receipt of NCRT on multivariate analysis include: treatment at an academic institution (OR 0.76, 95% CI 0.68-0.85), income greater than $46,000 (OR 0.79, 95% CI 0.67-0.92), and living greater than 50 miles from a treatment facility. Factors associated with receipt of ACRT on multivariate analysis include: female sex (OR 1.12, 95% CI 1.01-1.24), Charlson comorbidity index of 1 (OR 1.18, 95% CI 1.04-1.34), and radiotherapy dose greater than 5040 centigray (OR 1.76, 95% CI 1.56-1.98). Compared to ACRT, NCRT was associated with a decreased risk of death on multivariate analysis (HR 0.91, 95% CI 0.84-1.00), which persisted after propensity score analysis. Conclusions: The use of NCRT for locally advanced rectal cancer is increasing and is associated with an OS benefit compared to ACRT.

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Logistic Regression Analysis Of Factors Related To Preoperative Concurrent Chemoradiotherapy Resistance In Locally Advanced Rectal Cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2020.07.1971 ◽

2020 ◽

Vol 108 (3) ◽

pp. e658

Author(s):

F.P. Wu ◽

J. Wang

Keyword(s):

Rectal Cancer ◽

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Concurrent Chemoradiotherapy ◽

Locally Advanced ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer

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EP-1293: Intensified neo-adjuvant chemoradiotherapy in locally advanced rectal cancer: long-term follow-up

Radiotherapy and Oncology ◽

10.1016/s0167-8140(16)32543-9 ◽

2016 ◽

Vol 119 ◽

pp. S607-S608

Author(s):

F. De Felice ◽

D. Musio ◽

A.L. Magnante ◽

N. Bulzonetti ◽

I. Benevento ◽

...

Keyword(s):

Rectal Cancer ◽

Locally Advanced ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Adjuvant Chemoradiotherapy ◽

Long Term Follow Up

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Sequential PET/CT with [18F]-FDG Predicts Pathological Tumor Response to Preoperative Short Course Radiotherapy with Delayed Surgery in Patients with Locally Advanced Rectal Cancer Using Logistic Regression Analysis

PLoS ONE ◽

10.1371/journal.pone.0169462 ◽

2017 ◽

Vol 12 (1) ◽

pp. e0169462 ◽

Cited By ~ 8

Author(s):

Biagio Pecori ◽

Secondo Lastoria ◽

Corradina Caracò ◽

Marco Celentani ◽

Fabiana Tatangelo ◽

...

Keyword(s):

Rectal Cancer ◽

Regression Analysis ◽

Tumor Response ◽

Locally Advanced ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Short Course ◽

Pet Ct ◽

18F Fdg ◽

Short Course Radiotherapy

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Pretreatment Inflammatory-Nutritional Biomarkers Predict Responses to Neoadjuvant Chemoradiotherapy and Survival in Locally Advanced Rectal Cancer

Frontiers in Oncology ◽

10.3389/fonc.2021.639909 ◽

2021 ◽

Vol 11 ◽

Author(s):

Yijun Wang ◽

Lejun Chen ◽

Biyun Zhang ◽

Wei Song ◽

Guowei Zhou ◽

...

Keyword(s):

Rectal Cancer ◽

Regression Analysis ◽

Clinical Stage ◽

Locally Advanced ◽

Neoadjuvant Chemoradiotherapy ◽

Multivariate Logistic Regression Analysis ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Multivariate Logistic Regression ◽

Response Group

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.

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