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Xu YJ, Tao D, Qin SB, Xu XY, Yang KW, Xing ZX, Zhou JY, Jiao Y, Wang LL. Prediction of pathological complete response and prognosis in locally advanced rectal cancer. World J Gastrointest Oncol 2024; 16:2508-2518. [DOI: 10.4251/wjgo.v16.i6.2508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/18/2024] [Accepted: 04/24/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Colorectal cancer is currently the third most common malignant tumor and the second leading cause of cancer-related death worldwide. Neoadjuvant chemoradiotherapy (nCRT) is standard for locally advanced rectal cancer (LARC). Except for pathological examination after resection, it is not known exactly whether LARC patients have achieved pathological complete response (pCR) before surgery. To date, there are no clear clinical indicators that can predict the efficacy of nCRT and patient outcomes.
AIM To investigate the indicators that can predict pCR and long-term outcomes following nCRT in patients with LARC.
METHODS Clinical data of 128 LARC patients admitted to our hospital between September 2013 and November 2022 were retrospectively analyzed. Patients were categorized into pCR and non-pCR groups. Univariate analysis (using the χ2 test or Fisher’s exact test) and logistic multivariate regression analysis were used to study clinical predictors affecting pCR. The 5-year disease-free survival (DFS) and overall survival (OS) rates were calculated using Kaplan-Meier analysis, and differences in survival curves were assessed with the log-rank test.
RESULTS Univariate analysis showed that pretreatment carcinoembryonic antigen (CEA) level, lymphocyte-monocyte ratio (LMR), time interval between neoadjuvant therapy completion and total mesorectal excision, and tumor size were correlated with pCR. Multivariate results showed that CEA ≤ 5 ng/mL (P = 0.039), LMR > 2.73 (P = 0.023), and time interval > 10 wk (P = 0.039) were independent predictors for pCR. Survival analysis demonstrated that patients in the pCR group had significantly higher 5-year DFS rates (94.7% vs 59.7%, P = 0.002) and 5-year OS rates (95.8% vs 80.1%, P = 0.019) compared to the non-pCR group. Tumor deposits (TDs) were significantly correlated with shorter DFS (P = 0.002) and OS (P < 0.001).
CONCLUSION Pretreatment CEA, LMR, and time interval contribute to predicting nCRT efficacy in LARC patients. Achieving pCR demonstrates longer DFS and OS. TDs correlate with poor prognosis.
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Affiliation(s)
- Yi-Jun Xu
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Dan Tao
- Department of Radiation Oncology, The Fourth Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Song-Bing Qin
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Xiao-Yan Xu
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Kai-Wen Yang
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Zhong-Xu Xing
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Ju-Ying Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Yang Jiao
- School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou 215123, Jiangsu Province, China
| | - Li-Li Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
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Xu YJ, Tao D, Qin SB, Xu XY, Yang KW, Xing ZX, Zhou JY, Jiao Y, Wang LL. Prediction of pathological complete response and prognosis in locally advanced rectal cancer. World J Gastrointest Oncol 2024; 16:2520-2530. [PMID: 38994151 PMCID: PMC11236239 DOI: 10.4251/wjgo.v16.i6.2520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/18/2024] [Accepted: 04/24/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Colorectal cancer is currently the third most common malignant tumor and the second leading cause of cancer-related death worldwide. Neoadjuvant chemoradiotherapy (nCRT) is standard for locally advanced rectal cancer (LARC). Except for pathological examination after resection, it is not known exactly whether LARC patients have achieved pathological complete response (pCR) before surgery. To date, there are no clear clinical indicators that can predict the efficacy of nCRT and patient outcomes. AIM To investigate the indicators that can predict pCR and long-term outcomes following nCRT in patients with LARC. METHODS Clinical data of 128 LARC patients admitted to our hospital between September 2013 and November 2022 were retrospectively analyzed. Patients were categorized into pCR and non-pCR groups. Univariate analysis (using the χ 2 test or Fisher's exact test) and logistic multivariate regression analysis were used to study clinical predictors affecting pCR. The 5-year disease-free survival (DFS) and overall survival (OS) rates were calculated using Kaplan-Meier analysis, and differences in survival curves were assessed with the log-rank test. RESULTS Univariate analysis showed that pretreatment carcinoembryonic antigen (CEA) level, lymphocyte-monocyte ratio (LMR), time interval between neoadjuvant therapy completion and total mesorectal excision, and tumor size were correlated with pCR. Multivariate results showed that CEA ≤ 5 ng/mL (P = 0.039), LMR > 2.73 (P = 0.023), and time interval > 10 wk (P = 0.039) were independent predictors for pCR. Survival analysis demonstrated that patients in the pCR group had significantly higher 5-year DFS rates (94.7% vs 59.7%, P = 0.002) and 5-year OS rates (95.8% vs 80.1%, P = 0.019) compared to the non-pCR group. Tumor deposits (TDs) were significantly correlated with shorter DFS (P = 0.002) and OS (P < 0.001). CONCLUSION Pretreatment CEA, LMR, and time interval contribute to predicting nCRT efficacy in LARC patients. Achieving pCR demonstrates longer DFS and OS. TDs correlate with poor prognosis.
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Affiliation(s)
- Yi-Jun Xu
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Dan Tao
- Department of Radiation Oncology, The Fourth Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Song-Bing Qin
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Xiao-Yan Xu
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Kai-Wen Yang
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Zhong-Xu Xing
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Ju-Ying Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Yang Jiao
- School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou 215123, Jiangsu Province, China
| | - Li-Li Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
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Orafaie A, Shahabi F, Mehri A, Ansari M, Kasraeifar S, Ghiyasi M, Saberi‐Karimian M, Abdollahi A, Tabatabaei SM. The association of preoperative hematologic parameters with short-term clinical outcomes in rectal cancer: A feature importance analysis. Cancer Med 2024; 13:e7225. [PMID: 38778698 PMCID: PMC11112298 DOI: 10.1002/cam4.7225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 03/14/2024] [Accepted: 04/18/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Various hematologic parameters have been proposed as prognostic factors in rectal cancer management, but data are conflicting and unclear. This study is designed to investigate the prognostic factor capability of preoperative hematologic parameters with postoperative morbidities and mortality in rectal cancer patients undergoing curative resection. METHODS All 200 consecutive rectal cancer patients diagnosed at Ghaem University Hospital from 2017 to 2022 were retrospectively evaluated. The receiver operating characteristic (ROC) curves and machine learning (ML) algorithms of Random Forest, Recursive Feature Elimination, simulated annealing, Support Vector Machine, Decision Tree, and eXtreme Gradient Boosting were administered to investigate the role of preoperative hematologic parameters accompanied by baseline characteristics on three clinical outcomes including surgical infectious complications, recurrence, and death. RESULTS The frequency of infectious complications was correlated with the surgical procedure, while tumor recurrence was significantly influenced by T stage and N stage. In terms of mortality, alongside T and N stage, the status of resection margin involvement was significantly correlated. Based on the ROC analysis, the NLR >2.69, MPV ≤9 fL, and PDW ≤10.5 fL were more classified patients to mortality status. Likewise, the PLT >220 109/L, MPV ≤9 fL, PDW ≤10.4 fL, and PLR >13.6 were correlated with recurrence. However, all factors examined in this study were not significant classifiers for the outcome of surgical infectious complications. The results of ML algorithms were also in line with ROC analysis. CONCLUSION According to the results of both ROC analysis and ML models, preoperative hematologic parameters are considerable prognostic factors of postoperative outcomes in rectal cancer patients, and are recommended to be monitored by clinicians to prevent unfavorable outcomes.
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Affiliation(s)
- Ala Orafaie
- Endoscopic and Minimally Invasive Surgery Research CenterMashhad University of Medical SciencesMashhadIran
| | - Fatemeh Shahabi
- Endoscopic and Minimally Invasive Surgery Research CenterMashhad University of Medical SciencesMashhadIran
| | - Ali Mehri
- Endoscopic and Minimally Invasive Surgery Research CenterMashhad University of Medical SciencesMashhadIran
| | - Majid Ansari
- Endoscopic and Minimally Invasive Surgery Research CenterMashhad University of Medical SciencesMashhadIran
| | - Sajjad Kasraeifar
- Endoscopic and Minimally Invasive Surgery Research CenterMashhad University of Medical SciencesMashhadIran
| | - Mahdie Ghiyasi
- Endoscopic and Minimally Invasive Surgery Research CenterMashhad University of Medical SciencesMashhadIran
| | - Maryam Saberi‐Karimian
- Endoscopic and Minimally Invasive Surgery Research CenterMashhad University of Medical SciencesMashhadIran
- Lung Diseases Research CenterMashhad University of Medical SciencesMashhadIran
| | - Abbas Abdollahi
- Endoscopic and Minimally Invasive Surgery Research CenterMashhad University of Medical SciencesMashhadIran
| | - Seyyed Mohammad Tabatabaei
- Department of Medical Informatics, School of MedicineMashhad University of Medical SciencesMashhadIran
- Clinical Research Unit, Imam Reza Hospital, School of MedicineMashhad University of Medical SciencesMashhadIran
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Ding Y, Liu Z, Li J, Niu W, Li C, Yu B. Predictive effect of the systemic inflammation response index (SIRI) on the efficacy and prognosis of neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer. BMC Surg 2024; 24:89. [PMID: 38481180 PMCID: PMC10935841 DOI: 10.1186/s12893-024-02384-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 03/06/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Inflammation is a part of tumours, and inflammatory cells can affect the proliferation, invasion, and development of tumour cells. An increasing number of peripheral blood inflammatory markers have been found to play very important roles in the treatment and prognosis of cancer patients. The systemic inflammatory response index (SIRI) is a newer inflammatory marker, and its role in colorectal cancer, especially in locally advanced rectal cancer, is still unclear. METHODS From 2015 to 2020, 198 patients with locally advanced rectal cancer (LARC) who underwent surgery following neoadjuvant chemoradiotherapy (Neo-CRT) were analysed. Patients were categorized into good- and poor- response groups according to their pathological results, and clinical characteristics and baseline parameters were compared between the two groups. The optimal cutoff values for inflammatory indicators were determined using receiver operating characteristic (ROC) analysis. Univariate and multivariate analyses were performed using the Cox proportional hazard model. Survival analysis was performed via the Kaplan‒Meier method. RESULTS After patients were grouped into good and poor response groups, indicator differences were found in CEA, neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and SIRI. According to the ROC analysis, the NLR (P = 0.015), SII (P = 0.001), and SIRI (P = 0.029) were significant prognostic factors. After univariate and multivariate analyses of the Cox proportional hazards regression model, only the SIRI was found to be an independent prognostic factor for overall survival (OS) and disease-free survival (DFS). Finally, Kaplan‒Meier survival curves also confirmed the ability of the SIRI to predict survival. CONCLUSION The preoperative SIRI can be used to predict the response to Neo-CRT in LARC patients and is an independent predictor of OS and DFS in postoperative patients. A high SIRI was associated with poor radiotherapy response and predicted poor OS and DFS.
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Affiliation(s)
- Yuanyi Ding
- The Second General Surgery, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumour Hospital, Hebei, 050011, China
| | - Zining Liu
- The Second General Surgery, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumour Hospital, Hebei, 050011, China
| | - Jing Li
- The Second General Surgery, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumour Hospital, Hebei, 050011, China
| | - Wenbo Niu
- The Second General Surgery, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumour Hospital, Hebei, 050011, China
| | - Chenhui Li
- The Second General Surgery, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumour Hospital, Hebei, 050011, China
| | - Bin Yu
- The Second General Surgery, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumour Hospital, Hebei, 050011, China.
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Wang K, Li M, Yan J. Construction and Evaluation of Nomogram for Hematological Indicators to Predict Pathological Response after Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer. J Gastrointest Cancer 2023; 54:791-801. [PMID: 36103002 PMCID: PMC10613134 DOI: 10.1007/s12029-022-00861-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE A retrospective study was conducted by developing prediction models to evaluate the association between hematological indexes, their changes during neoadjuvant chemoradiotherapy (NCRT), and tumor pathological response in patients with locally advanced rectal cancer. METHODS The clinical data of 202 patients who received NCRT and radical surgery in Sichuan Cancer Hospital were retrospectively analyzed. Univariate and logistic multivariate regression analyses were used to identify hematological indexes with predictive significance. The independent risk factors were imported into the R software, and a nomogram prediction model was developed. The bootstrap method and ROC curve were used to evaluate the discriminative degree of the model. RESULTS Univariate analysis demonstrated age, tumor diameter, preoperative T, distance from tumor to the anal verge, CEA before NCRT, preoperative CEA, lymphocyte changes, platelet changes, and pathology of rectal cancer after NCRT were associated. Multivariate analysis demonstrated that age, tumor distance from the anus, preoperative CEA, lymphocyte changes, and platelet changes were independent risk factors. The independent risk factors were imported into the R software to construct a nomogram model. The area under the ROC was 0.76, and the slope of the calibration curve of the nomogram was close to 1. CONCLUSION A low preoperative CEA level, a young age, a high tumor from the anal verge, the maintenance of circulating lymphocyte level, and a decreased platelet level after NCRT are important factors for favorable outcomes after NCRT. Developing a nomogram prediction model with good discrimination and consistency can provide some guidance for predicting pathological responses after NCRT.
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Affiliation(s)
- Keli Wang
- Department of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Meijiao Li
- Department of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Jin Yan
- Department of Clinical Medicine, Southwest Medical University, Luzhou, China.
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital & Institute, Cancer Hospital Affiliated to School of Medicine, University of Electronic Science and Technology, Chengdu, China.
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Kimura C, Crowder SE, Kin C. Is It Really Gone? Assessing Response to Neoadjuvant Therapy in Rectal Cancer. J Gastrointest Cancer 2023; 54:703-711. [PMID: 36417142 DOI: 10.1007/s12029-022-00889-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Non-operative management of rectal cancer is a feasible and appealing treatment option for patients who develop a complete response after neoadjuvant therapy. However, identifying patients who are complete responders is often a challenge. This review aims to present and discuss current evidence and recommendations regarding the assessment of treatment response in rectal cancer. METHODS A review of the current literature on rectal cancer restaging was performed. Studies included in this review explored the optimal interval between the end of neoadjuvant therapy and restaging, as well as modalities of assessment and their diagnostic performance. RESULTS The current standard for restaging rectal cancer is a multimodal assessment with the digital rectal examination, endoscopy, and T2-weighted MRI with diffusion-weighted imaging. Other diagnostic procedures under investigation are PET/MRI, radiomics, confocal laser endomicroscopy, artificial intelligence-assisted endoscopy, cell-free DNA, and prediction models incorporating one or more of the above-mentioned exams. CONCLUSION Non-operative management of rectal cancer requires a multidisciplinary approach. Understanding of the robustness and limitations of each exam is critical to inform patient selection for that treatment strategy.
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Affiliation(s)
- Cintia Kimura
- Department of Surgery, Division of General Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, H3680K94305, USA
| | - Sarah Elizabeth Crowder
- Department of Surgery, Division of General Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, H3680K94305, USA
- Brigham Young University, Provo, UT, USA
| | - Cindy Kin
- Department of Surgery, Division of General Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, H3680K94305, USA.
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Manoochehry S, Rasouli HR, Ahmadpour F, Keramati A. Evaluation of the role of inflammatory blood markers in predicting the pathological response after neoadjuvant chemoradiation in patients with locally advanced rectal cancer. Radiat Oncol J 2023; 41:81-88. [PMID: 37403350 DOI: 10.3857/roj.2023.00115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/09/2023] [Indexed: 07/06/2023] Open
Abstract
PURPOSE This study aimed to evaluate the role of inflammatory blood markers in predicting the pathological response rate after neoadjuvant chemoradiation (neo-CRT) in patients with locally advanced rectal cancer (LARC). MATERIALS AND METHODS In this prospective cohort study, we analyzed the data of patients with LARC who underwent neo-CRT and surgical removal of the rectal mass between 2020 and 2022 in a tertiary medical center. Patients were examined weekly during chemoradiation and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and systemic immune inflammation index (SII) were calculated from weekly laboratory data. Wilcoxon signed-ranks and logistic regression analysis were utilized to determine whether any laboratory parameters during different time point assessments or their relative changes could predict the tumor response based on a permanent pathology review. RESULTS Thirty-four patients were recruited for the study. Eighteen patients (53%) achieved good pathologic response. Statistical analysis by Wilcoxon signed-ranks method indicated significant rises in NLR, PLR, MLR, and SII on weekly assessments during chemoradiation. Having an NLR over 3.21 during chemoradiation was correlated with the response on a Pearson chi-squared test (p = 0.04). Also, a significant correlation was found between the PLR ratio over 1.8 and the response (p = 0.02). NLR ratio over 1.82 marginally missed a significant correlation with the response (p = 0.13). On multivariate analysis, a PLR ratio over 1.8 showed a trend for response (odds ratio = 10.4; 95% confidence interval, 0.9-123; p = 0.06). CONCLUSION In this study, PLR ratio as an inflammatory marker showed a trend in the prediction of response in permanent pathology to neo-CRT.
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Affiliation(s)
- Shahram Manoochehry
- Trauma Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Rasouli
- Trauma Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Fathollah Ahmadpour
- Trauma Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Alireza Keramati
- Trauma Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Zhou C, Wang K, Zhang X, Xiao Y, Yang C, Wang J, Qu F, Wang X, Liu M, Gao C, Xiao L, Wu F. Assessing the predictive value of clinical factors to pathological complete response for locally advanced rectal cancer: An analysis of 124 patients. Front Oncol 2023; 13:1125470. [PMID: 37064150 PMCID: PMC10102576 DOI: 10.3389/fonc.2023.1125470] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
PurposeTo investigate the clinical factors affecting pathological complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer (LARC).MethodsClinical data of 124 LARC patients treated with nCRT and surgery in the fourth Hospital of Hebei Medical University from 2014 to 2019 were retrospectively analyzed. In this study, univariate analysis and logistic dichotomous multivariate regression analysis were used to study the clinical factors affecting pCR, and the receiver operator characteristic curve (ROC) analysis was used to further verify the accuracy of partial indexes in predicting pCR.ResultsOf the 124 enrolled patients, 19 patients (15.32%) achieved pCR. Univariate analysis showed that the number of cycles of consolidation chemotherapy, serum carcino-embryonic antigen (CEA) level before treatment, MRI longitudinal length of tumor, and extramural vascular invasion (EMVI) were statistically correlated with pCR. ROC analysis of the longitudinal length of tumor measured by MRI showed that the area under the curve (AUC) value, sensitivity and specificity were 0.735, 89.47% and 48.57% respectively, and the optimal cut-off value was 5.5cm. The ROC analysis showed that the AUC value, sensitivity and specificity of pCR prediction using CEA were 0.741, 63.16% and 90.48%, respectively, and the optimal cut-off value was 3.1ng/ml. Multivariate results showed that the number of cycles of consolidation chemotherapy, serum CEA level before treatment, and EMVI were independent predictors of pCR.ConclusionThe number of cycles of consolidation chemotherapy, serum CEA level before treatment, and EMVI may be important determinants of LARC patients to reach pCR after nCRT.
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Affiliation(s)
- Chaoxi Zhou
- Department of General Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Kanghua Wang
- Department of Medical Oncology, Affiliated Hospital Of Hebei University, Baoding, China
- Department of Radiotherapy, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaoxiao Zhang
- Department of Radiation Oncology, Hebei Cancer Hospital Chinese Academy of Medical Sciences, Langfang, China
| | - Yuting Xiao
- Department of Radiotherapy, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Congrong Yang
- Department of Radiotherapy, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jun Wang
- Department of Radiotherapy, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Fuyin Qu
- Department of Radiotherapy, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xuan Wang
- Department of Radiotherapy, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ming Liu
- Department of Radiotherapy, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chao Gao
- Department of Radiotherapy, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Linlin Xiao
- Department of Radiotherapy, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Fengpeng Wu
- Department of Radiotherapy, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Fengpeng Wu,
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Liu J, Wang Z, Liu G, Liu Z, Lu H, Ji S. Assessment of Naples prognostic score in predicting survival for small cell lung cancer patients treated with chemoradiotherapy. Ann Med 2023; 55:2242254. [PMID: 37552770 PMCID: PMC10411310 DOI: 10.1080/07853890.2023.2242254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/08/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUNDS The Naples prognosis score (NPS) is a novel prognostic biomarker-based immune and nutritional status and that can be used to evaluate prognosis. Our study aimed to investigate the prognostic role of NPS in SCLC patients. METHODS Patients treated with chemoradiotherapy were retrospectively analyzed between June 2012 and August 2017. We divided patients into three groups depending on the NPS: group 0, n = 31; group 1, n = 100; and group 2, n = 48, and associations between clinical characteristics and NPS group were analyzed. The univariable and multivariable Cox analyses were used to evaluate the prognostic value of clinicopathological characteristics and laboratory indicators for overall survival (OS) and progression-free survival (PFS). RESULTS Data from 179 patients were analyzed. Treatment modality (p < 0.001) and serum CEA (p = 0.03) were significantly different among the NPS groups. The age, sex, smoking status, KPS, Karnofsky performance score (KPS), disease extent, and number of metastatic sites were not correlated with NPS (all p > 0.05). KPS, disease extent, prophylactic cranial irradiation, treatment response and NPS Group were associated with OS. In addition, KPS, disease extent, prophylactic cranial irradiation, treatment response and NPS Group were associated with PFS. Multivariate analysis results showed that NPS was identified as an independent prognostic factor for OS (Group 1: hazard ratio [HR] = 2.704, 95% confidence interval [CI] = 1.403-5.210; p = 0.003; Group 2: HR = 5.154, 95% CI = 2.614-10.166; p < 0.001) and PFS (Group 1: HR = 2.018, 95% CI = 1.014-4.014; p = 0.045; Group 2: HR = 3.339, 95% CI = 1.650-6.756; p = 0.001). CONCLUSIONS NPS is related to clinical outcomes in patients with SCLC.
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Affiliation(s)
- Jiafeng Liu
- Department of Radiotherapy & Oncology, Rizhao Central Hospital, Rizhao, China
| | - Zuosheng Wang
- Department of Radiotherapy & Oncology, Rizhao Central Hospital, Rizhao, China
| | - Guibao Liu
- Department of Radiotherapy & Oncology, Rizhao Central Hospital, Rizhao, China
| | - Zhengcao Liu
- Department of Radiotherapy & Oncology, The affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, Suzhou, China
| | - Huiling Lu
- Department of Radiotherapy & Oncology, The affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, Suzhou, China
| | - Shengjun Ji
- Department of Radiotherapy & Oncology, The affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, Suzhou, China
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Shi X, Zhao M, Shi B, Chen G, Yao H, Chen J, Wan D, Gu W, He S. Pretreatment blood biomarkers combined with magnetic resonance imaging predict responses to neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Front Oncol 2022; 12:916840. [PMID: 36016621 PMCID: PMC9396285 DOI: 10.3389/fonc.2022.916840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 07/19/2022] [Indexed: 12/30/2022] Open
Abstract
Aim To investigate the value of pretreatment blood biomarkers combined with magnetic resonance imaging (MRI) in predicting the efficacy of neoadjuvant chemoradiotherapy (NCRT) in patients with locally advanced rectal cancer (LARC). Methods This study involved patients with LARC who received NCRT and subsequently underwent total mesenteric excision from June 2015 to June 2021 at the First Affiliated Hospital of Soochow University. Patients with incomplete courses of neoadjuvant therapy, comorbidities with other malignancies or diseases that affect the study outcome, and those who underwent unplanned surgery were ultimately excluded. Laboratory data such as albumin, CEA, various blood cell levels, and MRI related data such as tumor regression grade assessed by magnetic resonance imaging (mrTRG) were collected from the included patients one week prior to NCRT. MrTRG is a common clinical imaging metric used to assess the degree of tumor regression in rectal cancer, primarily based on morphological assessment of residual tumor. Furthermore, pretreatment blood biomarkers such as neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), albumin to fibrinogen ratio (AFR), and prealbumin to fibrinogen ratio (PFR) were assessed. The independent variables for pathologic complete response (pCR) to NCRT were determined by univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curve analysis was used to examine the performance of MRI with or without pretreatment blood biomarkers in predicting pCR using DeLong’s method. A nomogram was created and confirmed internally. Results Fifty-nine individuals with LARC satisfied the inclusion criteria, among which 23 showed pCR after NCRT. Logistic regression analysis demonstrated that pretreatment CEA (≤ 3 µg/L, OR = 0.151, P = 0.039), NLR (OR = 4.205, P = 0.027), LMR (OR = 0.447, P = 0.034), and PFR (OR = 0.940, P = 0.013) were independent predictors of pCR to NCRT. The AUCs of mrTRG alone and mrTRG plus the above four pretreatment blood biomarkers were 0.721 (P =0.0003) and 0.913 (P <0.0001), respectively. The constructed nomogram showed a C-index of 0.914. Conclusion Pretreatment blood biomarkers combined with MRI can help clinical efforts by better predicting the efficacy of NCRT in patients with locally advanced rectal cancer.
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Affiliation(s)
- Xinyu Shi
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Min Zhao
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bo Shi
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Guoliang Chen
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huihui Yao
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Junjie Chen
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Daiwei Wan
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wen Gu
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Songbing He
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Songbing He,
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11
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Zhang Z, Yi X, Pei Q, Fu Y, Li B, Liu H, Han Z, Chen C, Pang P, Lin H, Gong G, Yin H, Zai H, Chen BT. CT radiomics identifying non-responders to neoadjuvant chemoradiotherapy among patients with locally advanced rectal cancer. Cancer Med 2022; 12:2463-2473. [PMID: 35912919 PMCID: PMC9939108 DOI: 10.1002/cam4.5086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/05/2022] [Accepted: 05/07/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND PURPOSE Early detection of non-response to neoadjuvant chemoradiotherapy (nCRT) for locally advanced colorectal cancer (LARC) remains challenging. We aimed to assess whether pretreatment radiotherapy planning computed tomography (CT) radiomics could distinguish the patients with no response or no downstaging after nCRT from those with response and downstaging after nCRT. MATERIALS AND METHODS Patients with LARC who were treated with nCRT were retrospectively enrolled between March 2009 and March 2019. Traditional radiological characteristics were analyzed by visual inspection and radiomic features were analyzed through computational methods from the pretreatment radiotherapy planning CT images. Differentiation models were constructed using radiomic methods and clinicopathological characteristics for predicting non-response to nCRT. Model performance was assessed for classification efficiency, calibration, discrimination, and clinical application. RESULTS This study enrolled a total of 215 patients, including 151 patients in the training cohort (50 non-responders and 101 responders) and 64 patients in the validation cohort (21 non-responders and 43 responders). For predicting non-response, the model constructed with an ensemble machine learning method had higher performance with area under the curve (AUC) values of 0.92 and 0.89 as compared to the model constructed with the logistic regression method (AUC: 0.72 and 0.71 for the training and validation cohorts, respectively). Both decision curve and calibration curve analyses confirmed that the ensemble machine learning model had higher prediction performance. CONCLUSION Pretreatment CT radiomics achieved satisfying performance in predicting non-response to nCRT and could be helpful to assist in treatment planning for patients with LARC.
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Affiliation(s)
- Zinan Zhang
- Department of Radiology (Xiangya Hospital)Central South UniversityChangshaHunanP.R. China,Department of Gastroenterology (The Third Xiangya Hospital)Central South UniversityChangshaHunanP.R. China
| | - Xiaoping Yi
- Department of Radiology (Xiangya Hospital)Central South UniversityChangshaHunanP.R. China,National Engineering Research Center of Personalized Diagnostic and Therapeutic TechnologyXiangya HospitalChangshaHunanP.R. China,National Clinical Research Center for Geriatric Disorders (Xiangya Hospital)Central South UniversityChangshaHunanP.R. China,Hunan Key Laboratory of Skin Cancer and PsoriasisChangshaHunanP.R. China,Hunan Engineering Research Center of Skin Health and DiseaseChangshaHunanP.R. China
| | - Qian Pei
- Department of General Surgery (Xiangya Hospital)Central South UniversityChangshaHunanP.R. China
| | - Yan Fu
- Department of Radiology (Xiangya Hospital)Central South UniversityChangshaHunanP.R. China,National Engineering Research Center of Personalized Diagnostic and Therapeutic TechnologyXiangya HospitalChangshaHunanP.R. China
| | - Bin Li
- Department of Oncology (Xiangya Hospital)Central South UniversityChangshaHunanP.R. China
| | - Haipeng Liu
- Department of Radiology (Xiangya Hospital)Central South UniversityChangshaHunanP.R. China
| | - Zaide Han
- Department of Radiology (Xiangya Hospital)Central South UniversityChangshaHunanP.R. China
| | - Changyong Chen
- Department of Radiology (Xiangya Hospital)Central South UniversityChangshaHunanP.R. China
| | - Peipei Pang
- Department of Pharmaceuticals and DiagnosisGE HealthcareChangshaP.R. China
| | - Huashan Lin
- Department of Pharmaceuticals and DiagnosisGE HealthcareChangshaP.R. China
| | - Guanghui Gong
- Department of Pathology, Xiangya HospitalCentral South UniversityChangshaHunanP.R. China
| | - Hongling Yin
- Department of Pathology, Xiangya HospitalCentral South UniversityChangshaHunanP.R. China
| | - Hongyan Zai
- Department of General Surgery (Xiangya Hospital)Central South UniversityChangshaHunanP.R. China
| | - Bihong T. Chen
- Department of Diagnostic RadiologyCity of Hope National Medical CenterDuarteCaliforniaUSA
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12
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Mao Y, Pei Q, Fu Y, Liu H, Chen C, Li H, Gong G, Yin H, Pang P, Lin H, Xu B, Zai H, Yi X, Chen BT. Pre-Treatment Computed Tomography Radiomics for Predicting the Response to Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer: A Retrospective Study. Front Oncol 2022; 12:850774. [PMID: 35619922 PMCID: PMC9127861 DOI: 10.3389/fonc.2022.850774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/01/2022] [Indexed: 11/26/2022] Open
Abstract
Background and Purpose Computerized tomography (CT) scans are commonly performed to assist in diagnosis and treatment of locally advanced rectal cancer (LARC). This study assessed the usefulness of pretreatment CT-based radiomics for predicting pathological complete response (pCR) of LARC to neoadjuvant chemoradiotherapy (nCRT). Materials and Methods Patients with LARC who underwent nCRT followed by total mesorectal excision surgery from July 2010 to December 2018 were enrolled in this retrospective study. A total of 340 radiomic features were extracted from pretreatment contrast-enhanced CT images. The most relevant features to pCR were selected using the least absolute shrinkage and selection operator (LASSO) method and a radiomic signature was generated. Predictive models were built with radiomic features and clinico-pathological variables. Model performance was assessed with decision curve analysis and was validated in an independent cohort. Results The pCR was achieved in 44 of the 216 consecutive patients (20.4%) in this study. The model with the best performance used both radiomics and clinical variables including radiomic signatures, distance to anal verge, lymphocyte-to-monocyte ratio, and carcinoembryonic antigen. This combined model discriminated between patients with and without pCR with an area under the curve of 0.926 and 0.872 in the training and the validation cohorts, respectively. The combined model also showed better performance than models built with radiomic or clinical variables alone. Conclusion Our combined predictive model was robust in differentiating patients with and without response to nCRT.
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Affiliation(s)
- Yitao Mao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Central South University, Changsha, China
| | - Qian Pei
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Yan Fu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
| | - Haipeng Liu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Changyong Chen
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Haiping Li
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Guanghui Gong
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Hongling Yin
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Peipei Pang
- Department of Pharmaceuticals Diagnosis, General Electrics Healthcare, Changsha, China
| | - Huashan Lin
- Department of Pharmaceuticals Diagnosis, General Electrics Healthcare, Changsha, China
| | - Biaoxiang Xu
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Hongyan Zai
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoping Yi
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
| | - Bihong T Chen
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, United States
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13
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Wu DZ, Zhong JM, Jiang WP, Liao ZS, Huang SH, Sun YW, Lin Y, Ye DX, Pan C, Jiang WZ. Preoperative combination score of neutrophils, monocytes, and lymphocytes as a predictor for locally advanced rectal cancer. Int J Colorectal Dis 2022; 37:1097-1106. [PMID: 35419711 DOI: 10.1007/s00384-022-04143-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the prognostic value of baseline peripheral blood neutrophils, monocytes, and lymphocytes on locally advanced rectal cancer (LARC) patients. METHODS Clinicopathologic data of 317 LARC patients during July 2010 and October 2016 were retrospectively gathered. X-tile software was used to acquire the optimal cutoff values of neutrophils, monocytes, and lymphocytes. Peripheral blood immune score (PBIS) system was proposed and built based on neutrophils, monocytes, and lymphocytes. The Cox model was used to analyze the associations between clinicopathological characteristics and potential outcomes. C-index was used to assess model performance. A nomogram was constructed to predict prognosis, and a calibration plot was used to verify the accuracy of the nomogram prediction model. RESULTS Cutoff values of neutrophils, lymphocytes, and monocytes were 4.46 (× 109/L), 1.66 (× 109/L), and 0.39 (× 109/L), respectively. PBIS was related to sex (P < 0.001), tumor length (P = 0.003), and tumor thickness (P = 0.014). Multivariate Cox regression analysis revealed that PBIS (HR = 0.707, 95% CI: 0.549-0.912, P = 0.008) was an independent predictor of DFS. High PBIS (HR = 0.697, 95% CI: 0.492-0.988, P = 0.043) and high lymphocyte count (HR = 0.511, 95%CI: 0.273-0.958, P = 0.036) were favorable factors of OS. Both C-index (0.74, 95% CI: 0.549-0.912) and the calibration plot showed good prediction ability of the nomogram for DFS. CONCLUSION PBIS, composed of baseline peripheral blood neutrophils, monocytes, and lymphocytes, is an independent predictor of the prognosis of LARC. Combination of PBIS and ypTNM stage may be a promising marker to guide adjuvant therapy after the operation.
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Affiliation(s)
- Da-Zhang Wu
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.,Department of General Surgery, Quanzhou Hospital of Traditional Chinese Medicine, Quanzhou, Fujian, China
| | - Jing-Ming Zhong
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Wei-Ping Jiang
- Department of Radiation Oncology, Zhongshan Hospital, affiliated to Xiamen University, Xiamen, Fujian, China
| | - Ze-Song Liao
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Sheng-Hui Huang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Yan-Wu Sun
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Yu Lin
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Dao-Xiong Ye
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Chi Pan
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
| | - Wei-Zhong Jiang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
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14
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Karakaya S, Karadağ İ, Yılmaz ME, Çakmak Öksüzoğlu ÖB. High Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Low Lymphocyte Levels Are Correlated With Worse Pathological Complete Response Rates. Cureus 2022; 14:e22972. [PMID: 35415045 PMCID: PMC8990043 DOI: 10.7759/cureus.22972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To investigate the effect of hemogram parameters on predicting pathological complete response (pCR) in locally advanced rectal cancer. METHODOLOGY A total of 227 patients with rectal cancer treated with neoadjuvant concurrent chemoradiotherapy (CRT) were retrospectively analyzed. All patients were divided into two subgroups as high or low hemogram parameters according to the cut-off value obtained using the receiver operating characteristic (ROC) curve. RESULTS In patients with low neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) levels, pCR rate was statistically significantly higher than the group with high NLR and PLR levels (for NLR: 39.77% vs. 5.34%; p<0.001, for PLR: 32.38% vs 7.01%; p<0.001 respectively). In addition, the pCR rate was significantly better in patients with high lymphocyte levels compared to the group with low lymphocyte levels (33.33% vs. 7.5%; p<0.001, respectively). According to the multivariate logistic regression analysis result, NLR and PLR levels were considered as independent predictors to predict pathological complete response [p<0.001, HR: 0.128 (95% CI=0.051 - 0.322) for NLR; p=0.017, HR: 0.332 (95% CI=0.134 - 0.821) for PLR, respectively]. CONCLUSION Our study showed that high NLR, PLR, and low lymphocyte levels were correlated with worse pCR rates. In addition to that, NLR and PLR emerged as independent predictive markers.
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Affiliation(s)
- Serdar Karakaya
- Medical Oncology, Health Science University, Atatürk Chest Diseases and Chest Surgery Training and Research Hospital, Ankara, TUR
| | - İbrahim Karadağ
- Department of Medical Oncology, Çorum Hittite University Erol Olçok Training and Research Hospital, Çorum, TUR
| | - Mehmet Emin Yılmaz
- Department of Internal Medicine, Health Sciences University, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, TUR
| | - Ömür Berna Çakmak Öksüzoğlu
- Department of Medical Oncology, Health Sciences University, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, TUR
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15
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Hamid HKS, Emile SH, Davis GN. Prognostic Significance of Lymphocyte-to-Monocyte and Platelet-to-Lymphocyte Ratio in Rectal Cancer: A Systematic Review, Meta-analysis, and Meta-regression. Dis Colon Rectum 2022; 65:178-187. [PMID: 34775400 DOI: 10.1097/dcr.0000000000002291] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The low lymphocyte-to-monocyte ratio and high platelet-to-lymphocyte ratio have been reported to be poor prognostic indicators in various solid tumors, but the prognostic significance in rectal cancer remains controversial. OBJECTIVES We sought to determine the prognostic value of the lymphocyte-to-monocyte ratio and the platelet-to-lymphocyte ratio following curative-intent surgery for rectal cancer. DATA SOURCES Following PRISMA guidelines (PROSPERO, ID: CRD42020190880), PubMed and Embase databases were searched through January 2021 including 3 other registered medical databases. STUDY SELECTION Studies evaluating the impact of pretreatment lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratio on overall or disease-free survival in patients undergoing curative rectal cancer resection were selected. MAIN OUTCOMES MEASURES The main outcome measures were overall and disease-free survival. RESULTS A total of 23 studies (6683 patients) were included; lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratio were evaluated in 14 and 16 studies. A low lymphocyte-to-monocyte ratio was associated with poorer overall survival (HR, 1.57; 95% CI, 1.29-1.90; p < 0.001) and disease-free survival (HR, 1.29; 95% CI, 1.13-1.46; p < 0.001). However, when the analysis was limited to patients treated with surgery alone or to those with stage I to III tumors, lymphocyte-to-monocyte ratio was not a predictor of overall survival and disease-free survival. The platelet-to-lymphocyte ratio did not predict for overall or disease-free survival, regardless of the treatment modality, studied population, tumor stage, or cutoff value. Finally, a low lymphocyte-to-monocyte ratio, but not a high platelet-to-lymphocyte ratio, was inversely correlated with complete pathologic response rate. LIMITATIONS The retrospective nature of most included studies was a limitation. CONCLUSIONS Pretreatment lymphocyte-to-monocyte ratio, but not platelet-to-lymphocyte ratio, correlates with tumor response to neoadjuvant chemoradiotherapy and poorer prognosis after curative-intent surgery for rectal cancer, and it potentially represents a simple and reliable biomarker that could help optimize individualized clinical decision-making in high-risk patients. REGISTRATION https://www.crd.york.ac.uk/prospero/; ID: CRD42020190880.
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Affiliation(s)
- Hytham K S Hamid
- Department of Surgery, East Kent Hospitals University NHS Foundation Trust, Ashford, United Kingdom
| | - Sameh H Emile
- Colorectal Surgery Unit, Department of General Surgery, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
| | - George N Davis
- Department of Surgery, Dorset County Hospital NHS Foundation Trust, Dorchester, United Kingdom
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16
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Kim J, Sohn KA, Kwak JH, Kim MJ, Ryoo SB, Jeong SY, Park KJ, Kang HC, Chie EK, Jung SH, Kim D, Park JW. A Novel Scoring System for Response of Preoperative Chemoradiotherapy in Locally Advanced Rectal Cancer Using Early-Treatment Blood Features Derived From Machine Learning. Front Oncol 2021; 11:790894. [PMID: 34912724 PMCID: PMC8666428 DOI: 10.3389/fonc.2021.790894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/05/2021] [Indexed: 11/25/2022] Open
Abstract
Background Preoperative chemoradiotherapy (CRT) is a standard treatment for locally advanced rectal cancer (LARC). However, individual responses to preoperative CRT vary from patient to patient. The aim of this study is to develop a scoring system for the response of preoperative CRT in LARC using blood features derived from machine learning. Methods Patients who underwent total mesorectal excision after preoperative CRT were included in this study. The performance of machine learning models using blood features before CRT (pre-CRT) and from 1 to 2 weeks after CRT (early-CRT) was evaluated. Based on the best model, important features were selected. The scoring system was developed from the selected model and features. The performance of the new scoring system was compared with those of systemic inflammatory indicators: neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and the prognostic nutritional index. Results The models using early-CRT blood features had better performances than those using pre-CRT blood features. Based on the ridge regression model, which showed the best performance among the machine learning models (AUROC 0.6322 and AUPRC 0.5965), a novel scoring system for the response of preoperative CRT, named Response Prediction Score (RPS), was developed. The RPS system showed higher predictive power (AUROC 0.6747) than single blood features and systemic inflammatory indicators and stratified the tumor regression grade and overall downstaging clearly. Conclusion We discovered that we can more accurately predict CRT response by using early-treatment blood data. With larger data, we can develop a more accurate and reliable indicator that can be used in real daily practices. In the future, we urge the collection of early-treatment blood data and pre-treatment blood data.
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Affiliation(s)
- Jaesik Kim
- Department of Computer Engineering, Ajou University, Suwon, South Korea.,Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA, United States
| | - Kyung-Ah Sohn
- Department of Computer Engineering, Ajou University, Suwon, South Korea.,Department of Artificial Intelligence, Ajou University, Suwon, South Korea
| | - Jung-Hak Kwak
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Min Jung Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea.,Cancer Research Institute, Seoul National University, Seoul, South Korea
| | - Seung-Bum Ryoo
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Seung-Yong Jeong
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea.,Cancer Research Institute, Seoul National University, Seoul, South Korea
| | - Kyu Joo Park
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Hyun-Cheol Kang
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, South Korea
| | - Eui Kyu Chie
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, South Korea.,Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, South Korea
| | - Sang-Hyuk Jung
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA, United States.,Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, South Korea
| | - Dokyoon Kim
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA, United States
| | - Ji Won Park
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA, United States.,Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea.,Cancer Research Institute, Seoul National University, Seoul, South Korea
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17
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Mendis S, To YH, Tie J. Biomarkers in Locally Advanced Rectal Cancer: A Review. Clin Colorectal Cancer 2021; 21:36-44. [PMID: 34961731 DOI: 10.1016/j.clcc.2021.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/12/2021] [Accepted: 11/17/2021] [Indexed: 11/03/2022]
Abstract
Locally advanced rectal cancers (LARC) are the subject of a rapidly evolving treatment paradigm. The critical timepoints where management decisions are required during the care of the LARC patient are: prior to the institution of any treatment, post neoadjuvant therapy and post-surgery. This article reviews the clinical, imaging, blood-based, tissue-based, and molecular biomarkers that can assist clinicians at these timepoints in the patient's management, in prognosticating for their LARC patients or in predicting responses to therapy in the multi-modality neoadjuvant treatment era.
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Affiliation(s)
- Shehara Mendis
- Walter and Eliza Hall Institute, 1G Royal Parade, Parkville VIC 3052, Australia; 2. Western Health, Melbourne, VIC, Australia.
| | - Yat Hang To
- Walter and Eliza Hall Institute, 1G Royal Parade, Parkville VIC 3052, Australia; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Jeanne Tie
- Walter and Eliza Hall Institute, 1G Royal Parade, Parkville VIC 3052, Australia; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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18
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Morais M, Fonseca T, Machado-Neves R, Honavar M, Coelho AR, Lopes J, Barbosa E, Guerreiro E, Carneiro S. Can pretreatment blood biomarkers predict pathological response to neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer? Future Oncol 2021; 17:4947-4957. [PMID: 34734533 DOI: 10.2217/fon-2021-0707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aims: To investigate the value of previously described pretreatment hematological and biochemical biomarkers as predictors of pathological response. Methods: The authors performed a retrospective analysis of 191 patients with locally advanced rectal cancer who underwent long-course neoadjuvant chemoradiotherapy at two Portuguese centers. The authors performed logistic regression analysis to search for predictive markers of pathological complete and good response. Results: High platelet-neutrophil index (p = 0.042) and clinical tumor stage >2 (p = 0.015) were predictive of poor response. None of the analyzed biomarkers predicted pathological complete response in this study. Conclusion: A high platelet-neutrophil index before neoadjuvant chemoradiotherapy could help predict poorer pathological response in patients with locally advanced rectal cancer. However, no other blood biomarker predicted incomplete or poor response in this study.
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Affiliation(s)
- Marina Morais
- Surgery Department, Unidade Local de Saúde de Matosinhos
| | - Telma Fonseca
- Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | | | - Ana Rita Coelho
- Pathologic Anatomy Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Joanne Lopes
- Pathologic Anatomy Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Elisabete Barbosa
- Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | - Silvestre Carneiro
- Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
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Sawada R, Akiyoshi T. ASO Author Reflections: Combinations of Systemic Inflammatory Markers and CD8+ Tumor-infiltrating Lymphocyte Density: Predictive Utility for Response to Neoadjuvant Chemoradiotherapy in Rectal Cancer. Ann Surg Oncol 2021; 28:6199-6200. [PMID: 33876351 DOI: 10.1245/s10434-021-10019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/01/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Ryuichiro Sawada
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Takashi Akiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan.
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Sawada R, Akiyoshi T, Kitagawa Y, Hiyoshi Y, Mukai T, Nagasaki T, Yamaguchi T, Konishi T, Yamamoto N, Ueno M, Fukunaga Y. Systemic Inflammatory Markers Combined with Tumor-Infiltrating Lymphocyte Density for the Improved Prediction of Response to Neoadjuvant Chemoradiotherapy in Rectal Cancer. Ann Surg Oncol 2021; 28:6189-6198. [PMID: 33876358 DOI: 10.1245/s10434-021-09975-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/24/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Previous studies have reported the utility of systemic inflammatory markers and CD8+ tumor-infiltrating lymphocyte (TIL) separately in predicting response to chemoradiotherapy (CRT) in rectal cancer; however, the efficacy of combining these markers remains unclear. OBJECTIVE This study aimed to elucidate the predictive efficacy of systemic inflammatory markers combined with CD8+ TIL density on response to neoadjuvant CRT in locally advanced rectal cancer. METHODS Ten systemic inflammatory markers and CD8+ TIL density were assessed in 267 patients with rectal cancer using pretreatment clinical data and biopsy samples. Response to CRT was determined using the Dworak tumor regression grade (TRG), with good responders classified as TRG3-4. RESULTS Receiver operating characteristic curve analysis showed high areas under the curve for the lymphocyte-to-C-reactive protein ratio (LCR) and neutrophil × monocyte (N × M) value (0.58 and 0.62, respectively). In the multivariate analysis, LCR, N × M value, and CD8+ TIL density were independently associated with good responders (p = 0.016, 0.005, and 0.002, respectively). Stratified analysis with these three markers showed a positive correlation between TRG3-4 ratio and the number of positive predictive factors (8.2%, 20.0%, 34.2%, and 59.1% in patients with 0, 1, 2, and 3 predictors, respectively). Overall and disease-free survival were significantly worse in patients with zero factors present compared with those with one to three factors present. CONCLUSIONS LCR, N × M value, and CD8+ TIL density are independently associated with response to CRT. Assessing local TIL density along with systemic inflammatory markers may be useful for selecting a multimodal neoadjuvant approach in rectal cancer therapy.
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Affiliation(s)
- Ryuichiro Sawada
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takashi Akiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - Yusuke Kitagawa
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yukiharu Hiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiki Mukai
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiya Nagasaki
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomohiro Yamaguchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tsuyoshi Konishi
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Noriko Yamamoto
- Department of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masashi Ueno
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Yosuke Fukunaga
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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21
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Wilson K, Flood M, Narasimhan V, Pham T, Warrier S, Ramsay R, Michael M, Heriot A. Complete pathological response in rectal cancer utilising novel treatment strategies for neo-adjuvant therapy: A systematic review. Eur J Surg Oncol 2021; 47:1862-1874. [PMID: 33814240 DOI: 10.1016/j.ejso.2021.03.245] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/07/2021] [Accepted: 03/17/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Locally advanced rectal cancer is routinely treated with neo-adjuvant long course chemoradiotherapy or short course radiotherapy, followed by total mesorectal excision. Not all patients respond to this treatment and there has been an emergence of novel treatment strategies designed to improve outcomes for these patients. This systematic review aims to assess the current novel neo-adjuvant treatment strategies being utilised in the treatment of patients with rectal cancer and how these impact pathological complete response (pCR) rates. METHODS A systematic review of the literature was performed to evaluate pathological response in patients with rectal cancer receiving novel neo-adjuvant therapy. EMBASE and Medline electronic databases were searched for relevant articles. Articles published between January 2008 and February 2019 were retrieved. Included studies underwent critical appraisal and complete pathological response rates were recorded. RESULTS Of the initial 1074 articles identified, 217 articles fulfilled the inclusion criteria, of these 60 articles (4359 patients) were included. Neo-adjuvant therapy delivered included novel long course chemoradiation therapy, neoadjuvant chemotherapy alone, addition of a biological agent, total neo-adjuvant therapy, novel short course radiation therapy and studies utilising biomarkers to select patients for therapy. Complete pathological response rates ranged from 0 to 60%. CONCLUSION A validated novel neo-adjuvant therapy that significantly increases pCR rates in patients with rectal cancer has not been identified.
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Affiliation(s)
- K Wilson
- Peter MacCallum Cancer Centre, Department of Surgical Oncology, Australia; Differentiation and Transcription Laboratory, Sir Peter MacCallum Cancer Centre, Australia; Sir Peter MacCallum Dept. of Oncology, University of Melbourne, Australia.
| | - M Flood
- Peter MacCallum Cancer Centre, Department of Surgical Oncology, Australia; Differentiation and Transcription Laboratory, Sir Peter MacCallum Cancer Centre, Australia; Sir Peter MacCallum Dept. of Oncology, University of Melbourne, Australia
| | - V Narasimhan
- Peter MacCallum Cancer Centre, Department of Surgical Oncology, Australia; Differentiation and Transcription Laboratory, Sir Peter MacCallum Cancer Centre, Australia; Sir Peter MacCallum Dept. of Oncology, University of Melbourne, Australia
| | - T Pham
- Peter MacCallum Cancer Centre, Department of Surgical Oncology, Australia; Differentiation and Transcription Laboratory, Sir Peter MacCallum Cancer Centre, Australia; Sir Peter MacCallum Dept. of Oncology, University of Melbourne, Australia
| | - S Warrier
- Peter MacCallum Cancer Centre, Department of Surgical Oncology, Australia
| | - R Ramsay
- Peter MacCallum Cancer Centre, Department of Surgical Oncology, Australia; Differentiation and Transcription Laboratory, Sir Peter MacCallum Cancer Centre, Australia
| | - M Michael
- Peter MacCallum Cancer Centre, Department of Medical Oncology, Australia; Sir Peter MacCallum Dept. of Oncology, University of Melbourne, Australia
| | - A Heriot
- Peter MacCallum Cancer Centre, Department of Surgical Oncology, Australia; Sir Peter MacCallum Dept. of Oncology, University of Melbourne, Australia
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22
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Hamid HKS, Davis GN, Trejo-Avila M, Igwe PO, Garcia-Marín A. Prognostic and predictive value of neutrophil-to-lymphocyte ratio after curative rectal cancer resection: A systematic review and meta-analysis. Surg Oncol 2021; 37:101556. [PMID: 33819850 DOI: 10.1016/j.suronc.2021.101556] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Neutrophil-to-lymphocyte ratio (NLR) has been shown to be associated with poor prognosis in numerous solid malignancies. Here, we quantify the prognostic value of NLR in rectal cancer patients undergoing curative-intent surgery, and compare it with platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR). METHODS A comprehensive search of several electronic databases was performed through January 2021, to identify studies evaluating the prognostic impact of pretreatment NLR in patients undergoing curative rectal cancer resection. The endpoints were overall survival (OS), disease-free survival (DFS), and clinicopathologic parameters. The pooled hazard ratio (HR) or odds ratio with 95% confidence interval (CI) were calculated. RESULTS Thirty-one studies comprising 7553 patients were assessed. All studies evaluated NLR; thirteen and six evaluated PLR and LMR, respectively. High NLR was associated with worse OS (HR 1.92, 95% CI 1.60-2.30, P < 0.001) and DFS (HR 1.83, 95% CI 1.51-2.22, P < 0.001), and the results were consistent in all subgroup analyses by treatment modality, tumor stage, study location, and NLR cut-off value, except for the subgroups limited to cohorts with cut-off value ≥ 4. The size of effect of NLR on OS and DFS was greater than that of PLR, and similar to that of LMR. Finally, high NLR was associated with lower rate of pathologic complete response. CONCLUSIONS In the setting of curative rectal cancer resection, pretreatment NLR correlates with tumor response to neoadjuvant therapy, and along with LMR, is a robust predictor of poorer prognosis. These biomarkers may thus help risk-stratify patients for individualized treatments and enhanced surveillance.
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Affiliation(s)
- Hytham K S Hamid
- Department of Surgery, East Kent Hospitals NHS Foundation Trust, Ashford, UK.
| | - George N Davis
- Department of Surgery, Dorset County Hospital NHS Foundation Trust, Dorchester, UK
| | - Mario Trejo-Avila
- Department of Surgery, General Hospital Dr. Manuel Gea Gonzalez, Mexico City, Mexico
| | - Patrick O Igwe
- Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
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Wang Y, Chen L, Zhang B, Song W, Zhou G, Xie L, Yu D. Pretreatment Inflammatory-Nutritional Biomarkers Predict Responses to Neoadjuvant Chemoradiotherapy and Survival in Locally Advanced Rectal Cancer. Front Oncol 2021; 11:639909. [PMID: 33816284 PMCID: PMC8010250 DOI: 10.3389/fonc.2021.639909] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/03/2021] [Indexed: 12/18/2022] Open
Abstract
Background To 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). Methods Patients 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). Results A 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. Conclusion The 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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Affiliation(s)
- Yijun Wang
- Department of Radiation Oncology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Lejun Chen
- Department of Radiation Oncology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Biyun Zhang
- Department of Radiation Oncology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Wei Song
- Department of Radiation Oncology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Guowei Zhou
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Ling Xie
- Department of Pathology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Dahai Yu
- Department of Radiation Oncology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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Ren Y, Wang Z, Xie J, Wang P. Prognostic Value of the post-operative Red Blood Cell Distribution Width in rectal cancer patients with neoadjuvant chemoradiation followed surgery. Biosci Rep 2020; 40:BSR20201822. [PMID: 33141155 PMCID: PMC7753744 DOI: 10.1042/bsr20201822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/17/2020] [Accepted: 10/26/2020] [Indexed: 02/07/2023] Open
Abstract
Purposes Several studies have reported that elevated red cell distribution width (RDW) is related to poor prognosis in several cancers; however, the prognostic significance of perioperative RDW in rectal cancer patients which received neoadjuvant chemoradiation therapy (NACRT) is unclear. Methods A total of 120 rectal cancer patients who received NACRT followed surgery were retrospectively reviewed from Affiliated Cancer Hospital of Zhengzhou University between 2013 to 2015. Data for peripheral blood tests prior to the initiation of NACRT,before surgery and first chemotherapy after surgery were collected,respectively. The optimal cutoff values of RDW was determined by ROC analysis, respectively. The relationship between RDW and the prognosis of patients was evaluated by, respectively. Results The post-operative RDWHigh (≥15.55) patients had significantly worse five-year overall survival (OS, P=0.001) and disease-free survival (DFS, P=0.001) than the post-operative RDWLow (<15.55) patients, respectively. Whereas high pre-operative RDW (≥16.45) was the only marker correlated with worse DFS (P=0.005) than the pre-operative RDWLow (<16.45)patients, no relationship was found between pre-RDW and prognosis(OS, P=0.069; DFS, P=0.133). Multivariate analysis showed post-operative RDW had better predictive value than pre-RDW and pre-operative RDW. Conclusion Post-operative RDW might be a useful prognostic indicator in rectal cancer patients received neoadjuvant chemoradiation.
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Affiliation(s)
- Yingkun Ren
- General Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan province, China
| | - Zhiling Wang
- Department of SICU, Affiliated Children's Hospital of Zhengzhou University, Henan Children’s Hospital, Zhengzhou, Henan province, China
| | - Jianguo Xie
- General Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan province, China
| | - Peijun Wang
- General Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan province, China
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