title: Leukocytosis and neutrophilia predicts outcome in anal cancer.
abstract: Leukocytosis and neutrophilia could be the tip of the iceberg in the inflammatory tumor microenvironment. We aimed to validate their prognostic significance in a cohort of patients treated with definitive chemoradiation for anal squamous cell carcinoma (SCC).
  
  
  
  Clinical records from all consecutive patients treated in a single institution between 2006 and 2016 with curative-intent radiotherapy were retrospectively analyzed. Leukocytosis and neutrophilia, defined as leukocyte or neutrophil count over 10,000 and 7500/mm3, respectively, were studied in terms of overall survival (OS), progression (PFS), locoregional (LFS) and distant (DFS)-free survival.
  
  
  
  We identified 103 non-metastatic HIV-negative patients, with concurrent chemotherapy use in 78%. Twelve and 8% displayed baseline leukocytosis and neutrophilia, respectively. Estimated 3-year OS and PFS were 88% and 67%, respectively. In univariate analysis, both leukocytosis and neutrophilia were strongly associated with inferior OS, PFS, LFS and DFS (p<0.01). In multivariate analysis, leukocytosis and neutrophilia remained strongly associated with patient outcome (p<0.01), independently from tumor T and N-stage. Anemia was an independent predictor of worse OS and PFS, while chemoradiation overall treatment time below 50days improved PFS.
  
  
  
  Leukocytosis and neutrophilia are strong prognostic factors for OS, PFS, LFS and DFS in anal cancer treated with chemoradiation. These biomarkers could help identify patients with higher risk of tumor relapse that require treatment intensification.
authors.affiliation: Radiotherapy Department, Gustave Roussy Cancer Campus, Villejuif, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Schernberg
authors.affiliation: Radiotherapy Department, Gustave Roussy Cancer Campus, Villejuif, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Escande
authors.affiliation: Radiotherapy Department, Gustave Roussy Cancer Campus, Villejuif, France.
authors.forename: Eleonor
authors.initials: E
authors.lastname: Rivin Del Campo
authors.affiliation: Université Paris Sud, Université Paris Saclay, Faculté de médecine du Kremlin-Bicetre, Le Kremlin-Bicetre, France; Department of Medical Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Ducreux
authors.affiliation: Radiotherapy Department, Gustave Roussy Cancer Campus, Villejuif, France.
authors.forename: France
authors.initials: F
authors.lastname: Nguyen
authors.affiliation: Department of Surgery, Gustave Roussy, Université Paris-Saclay, Villejuif, France.
authors.forename: Diane
authors.initials: D
authors.lastname: Goere
authors.affiliation: Radiotherapy Department, Gustave Roussy Cancer Campus, Villejuif, France; INSERM1030, Gustave Roussy Cancer Campus, Villejuif, France; French Military Health Services Academy, Ecole du Val-de-Grâce, Paris, France; Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, France.
authors.forename: Cyrus
authors.initials: C
authors.lastname: Chargari
authors.affiliation: Radiotherapy Department, Gustave Roussy Cancer Campus, Villejuif, France; Université Paris Sud, Université Paris Saclay, Faculté de médecine du Kremlin-Bicetre, Le Kremlin-Bicetre, France; INSERM1030, Gustave Roussy Cancer Campus, Villejuif, France. Electronic address: eric.deutsch@gustaveroussy.fr.
authors.forename: Eric
authors.initials: E
authors.lastname: Deutsch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001005:Anus Neoplasms / Q000097:blood* / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D002294:Carcinoma, Squamous Cell / Q000097:blood* / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods; D018450:Disease Progression; D005260:Female; D006801:Humans; D007960:Leukocyte Disorders / Q000097:blood; D007964:Leukocytosis / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000378:metabolism*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers
keywords: Anal cancer; Biomarker; Concurrent chemoradiation; Leukocytosis; Neutrophilia; Prognostic factor