Outcomes prediction in pre-operative radiotherapy locally advanced rectal cancer: leucocyte assessment as immune biomarker
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Alexis Vallard1, Max-Adrien Garcia2, Peng Diao3, Sophie Espenel1, Guy de Laroche1, Jean-Baptiste Guy1, Majed Ben Mrad1, Chloé Rancoule1, David Kaczmarek4, Thierry Muron5, Gregoire Pigné1, Jack Porcheron6, Michel Peoc'h7, Jean-Marc Phelip8, Julien Langrand-Escure1 and Nicolas Magné1
1Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
2Public Health Department, Hygée Institute, Saint Priest en Jarez, France
3Department of Radiation Oncology, Sichuan Cancer Hospital, Chengdu, Sichuan Province, China
4Department of Thoracic and Digestive Surgery, Private Loire Hospital (HPL), Saint Etienne, France
5Department of Medical Oncology, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
6Department of Digestive and Oncologic Surgery, North University Hospital, Saint Priest en Jarez, France
7Department of Pathology, North University Hospital, Saint Priest en Jarez, France
8Department of Hepatology and Gastroenterology, North University Hospital, Saint Priest en Jarez, France
Nicolas Magné, email: firstname.lastname@example.org
Keywords: rectal cancer; chemoradiation; neutrophil; lymphocyte; ratio
Received: September 01, 2017 Accepted: March 19, 2018 Published: April 27, 2018
Objective: Leukocytes are hypothesized to reflect the inflammatory tumor microenvironment. We aimed to validate their prognostic significance in a large cohort of patients treated with pre-operative radiation for locally advanced rectal cancer (RC).
Results: From 2004 to 2015, 257 RC patients with available biological data underwent a pre-operative radiotherapy, with a median age of 66 years. The median rectal EQD2 was 49.2Gy. Most of patients experienced concurrent chemotherapy (n = 245, 95.4%), mainly with 5-FU (83.3%). Clear surgical margins (i.e. complete resection) were achieved in 234 patients (91.1%). A complete (Mandard TRG1: n = 35, 13.6%) or almost complete pathological response (Mandard TRG2: n = 56, 21.8%) were achieved in 91 patients (35.4%). With a median follow-up of 46.1 months, 8 patients (3.1%) experienced local relapse, 38 (14.8%) experienced metastases and 45 (17.5%) died. Elevated pre-radiation neutrophil to lymphocyte ratio (NLR > 2.8) was identified as an independent predictive factor of increased local relapse, of decreased progression-free survival and overall survival in multivariate analysis. Elevated NLR was marginally associated with incomplete pathological response in multivariate analysis, suggesting a possible value as a biomarker of radio-sensitivity.
Conclusions: Pre-radiation NLR is a simple and robust biomarker for risk stratification in locally advanced RC patients undergoing pre-operative radiotherapy, and might select the subpopulation eligible to treatment intensification or to neoadjuvant chemotherapy.
Material and Methods: Clinical records from consecutive patients treated in a single institution between 2004 and 2015 with curative-intent radiotherapy were retrospectively analyzed. Classical prognosis factors of RC and peripheral immune markers based on lymphocytes and neutrophil counts were studied.
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