Neoadjuvant chemoradiotherapy of rectal carcinoma : Baseline hematologic parameters influencing outcomes.
BACKGROUND
The link between the blood count and a systemic inflammatory response (SIR) is indisputable and well described. Pretreatment hematological parameters may predict the overall clinical outcomes in many types of cancer. Thus, this study aims to systematically evaluate the relationship between baseline blood count levels and treatment response in rectal cancer patients treated with neoadjuvant chemoradiotherapy.


METHODS
From 2009-2015, 173 patients with locally advanced rectal cancer were retrospectively enrolled in the study and analyzed. The baseline blood count was recorded in all patients 1 week before chemoradiation. Tumor response was evaluated through pathologic findings. Blood count levels which included RBC (red blood cells), Hb (hemoglobin), PLT (platelet count), neutrophil count, WBC (white blood cells), NLR (neutrophil-to-lymphocyte ratio), and PLR (platelet-to-lymphocyte ratio) were analyzed in relation to tumor downstaging, pCR (pathologic complete response), OS (overall survival), and DFS (disease-free survival).


RESULTS
Hb levels were associated with a response in logistic regression analysis: pCR (p = 0.05; OR 1.04, 95 % CI 1.00-1.07); T downstaging (p = 0.006; OR 1.03, 95 % CI 1.01-1.05); N downstaging (p = 0.09; OR 1.02, 95 % CI 1.00-1.04); T or N downstaging (p = 0.007; OR 1.04, 95 % CI 1.01-1.07); T and N downstaging (p = 0.02; OR 1.02, 95 % CI 1.00-1.04); Hb and RBC were the most significant parameters influencing OS; PLT was a negative prognostic factor for OS and DFS (p = 0.008 for OS); an NLR value of 2.8 was associated with the greatest significance for OS (p = 0.03) and primary tumor downstaging (p = 0.02).


CONCLUSIONS
Knowledge of pretreatment hematological parameters appears to be an important prognostic factor in patients with rectal carcinoma.
Department of Oncology and Radiotherapy, University Hospital in Hradec Králové, Sokolská 581, 500 05, Hradec Králové, Czech Republic. miroslav.hodek@fnhk.cz.
Miroslav
M
Hodek
Department of Oncology and Radiotherapy, University Hospital in Hradec Králové, Sokolská 581, 500 05, Hradec Králové, Czech Republic.
Igor
I
Sirák
Department of Surgery, University Hospital in Hradec Králové, Hradec Králové, Czech Republic.
Alexander
A
Ferko
Department of Surgery, University Hospital in Hradec Králové, Hradec Králové, Czech Republic.
Július
J
Örhalmi
Fingerland Department of Pathology, University Hospital in Hradec Králové, Hradec Králové, Czech Republic.
Eva
E
Hovorková
Fingerland Department of Pathology, University Hospital in Hradec Králové, Hradec Králové, Czech Republic.
Dimitar
D
Hadži Nikolov
Department of Oncology and Radiotherapy, University Hospital in Hradec Králové, Sokolská 581, 500 05, Hradec Králové, Czech Republic.
Petr
P
Paluska
Department of Oncology and Radiotherapy, University Hospital in Hradec Králové, Sokolská 581, 500 05, Hradec Králové, Czech Republic.
Jindřich
J
Kopecký
Department of Oncology and Radiotherapy, University Hospital in Hradec Králové, Sokolská 581, 500 05, Hradec Králové, Czech Republic.
Jiří
J
Petera
Department of Oncology and Radiotherapy, University Hospital in Hradec Králové, Sokolská 581, 500 05, Hradec Králové, Czech Republic.
Milan
M
Vošmik
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001772:Blood Cell Count / Q000706:statistics & numerical data*; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods*; D018153:Czech Republic / Q000453:epidemiology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D015995:Prevalence; D011379:Prognosis; D012004:Rectal Neoplasms / Q000097:blood* / Q000401:mortality / Q000628:therapy*; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome; D047368:Tumor Burden / Q000528:radiation effects
Blood platelets; Hemoglobin level; Neoadjuvant Treatment; Neutrophil-to-lymphocyte ratio; Tumor regression