title: Circulating lymphocytes as predictors of sensitivity to preoperative chemoradiotherapy in rectal cancer cases.
abstract: OBJECTIVE
  The objective of this study was to identify clinical predictive factors for tumor response after neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer (LARC).
  
  
  METHODS
  All factors were evaluated in 88 patients with LARC treated with nCRT. After a long period of 4-8 weeks of chemoradiotherapy, 3 patients achieved clinical complete response (cCR) and thus aggressive surgery was avoided, and the remaining 85 patients underwent a curative-intent operation. The response to nCRT was evaluated by tumor regression grade (TRG) system.
  
  
  RESULTS
  There were 32 patients (36.4%) with good tumor regression (TRG 3-4) and 56 (63.6%) with poor tumor regression (TRG 0-2). Lymphocyte counts and ratios were higher in good response cases (P=0.01, 0.03, respectively) while neutrophil ratios and N/L ratios were higher in poor response cases (P=0.04, 0.02, respectively). High lymphocyte ratios before nCRT and good tumor regression (TRG3-4) were significantly associated with improved 5-year disease-free survival (P<0.05). Pretreatment nodal status was also significantly associated with 5-year disease-free survival and 5-year overall survival (P<0.05). Multivariate analysis confirmed that the pretreatment lymphocyte ratio and lymph nodal status were independent prognostic factors.
  
  
  CONCLUSIONS
  Our study suggested that LARC patients with high lymphocyte ratios before nCRT would have good tumor response and high 5-year DFS and OS.
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital and Institute, University of Jinan, Jinan, China.
authors.forename: Xue
authors.initials: X
authors.lastname: Dou
authors.forename: Ren-Ben
authors.initials: RB
authors.lastname: Wang
authors.forename: Hong-Jiang
authors.initials: HJ
authors.lastname: Yan
authors.forename: Shu-Mei
authors.initials: SM
authors.lastname: Jiang
authors.forename: Xiang-Jiao
authors.initials: XJ
authors.lastname: Meng
authors.forename: Kun-Li
authors.initials: KL
authors.lastname: Zhu
authors.forename: Xiao-Qing
authors.initials: XQ
authors.lastname: Xu
authors.forename: Dian-Bin
authors.initials: DB
authors.lastname: Mu
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D059248:Chemoradiotherapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009504:Neutrophils / Q000473:pathology*; D011300:Preoperative Care; D011379:Prognosis; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D012074:Remission Induction; D012680:Sensitivity and Specificity; D015996:Survival Rate