Systemic Inflammatory Response After Preoperative Chemoradiotherapy Can Affect Oncologic Outcomes in Locally Advanced Rectal Cancer.
Systemic inflammatory response (SIR) has been reported to be an important determinant of disease progression and survival in patients with colorectal cancer. This study investigated the prognostic relevance of changes in the platelet count on survival and the predictive value of changes in platelet/lymphocyte ratio (PLR) and neutrophil/lymphocyte ratio (NLR) on the pathological tumor response to preoperative chemoradiotherapy (CRT) in patients with locally advanced rectal cancer (LARC).



From 2006 to 2015, 291 consecutive patients with LARC who were treated with preoperative CRT followed by curative surgery at the Kyungpook National University Medical Center (Daegu, Korea) were retrospectively analyzed. A cut-off value of 370×103/μl for the platelet count was used and a PLR ≥235 was defined as high. Any change in the PLR or NLR was calculated based on subtracting the pre-CRT PLR or NLR from the post-CRT values.



A total of 17.5% patients had stage II and 82.5% had stage III LARC. Initially high NLR and PLR were significantly associated with poor clinical outcomes. Patients who maintained a high platelet count after CRT also had an advanced pathological stage (p=0.028), low pathological complete response rate (p=0.048), and high relapse rate (p=0.021). For patients with an initially low PLR, the multiple logistic regression analysis revealed that a high PLR change (odds ratio (OR)=2.301, 95% confidence interval (CI)=1.269-4.174; p=0.006) and clinical stage II compared to stage III (OR=1.878, 95% CI=1.231-2.865; p=0.003) were significant independent markers predictive of a good response to CRT.



The present results suggest that platelet and PLR change after preoperative CRT, along with the initial platelet count, can be used as prognostic and predictive markers for the oncological outcomes in patients with LARC.
Department of Oncology/Hematology, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Kyungpook National University Cancer Research Institute, Daegu, Republic of Korea.
In Hee
IH
Lee
Department of Oncology/Hematology, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Kyungpook National University Cancer Research Institute, Daegu, Republic of Korea.
Soyoon
S
Hwang
Department of Oncology/Hematology, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Kyungpook National University Cancer Research Institute, Daegu, Republic of Korea.
Soo Jung
SJ
Lee
Department of Oncology/Hematology, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Kyungpook National University Cancer Research Institute, Daegu, Republic of Korea.
Byung Woog
BW
Kang
Department of Oncology/Hematology, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Kyungpook National University Cancer Research Institute, Daegu, Republic of Korea.
Dongwon
D
Baek
Department of Surgery, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, Republic of Korea.
Hye Jin
HJ
Kim
Department of Surgery, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, Republic of Korea.
Su Yeon
SY
Park
Department of Surgery, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, Republic of Korea.
Jun Seok
JS
Park
Department of Surgery, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, Republic of Korea.
Gyu Seog
GS
Choi
Department of Radiation oncology, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea.
Jae Chul
JC
Kim
Department of Radiology, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, Republic of Korea.
Seung Hyun
SH
Cho
Department of Oncology/Hematology, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Kyungpook National University Cancer Research Institute, Daegu, Republic of Korea jkk21c@knu.ac.kr.
Jong Gwang
JG
Kim
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007249:Inflammation / Q000503:physiopathology*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010976:Platelet Count; D057234:Preoperative Period; D011379:Prognosis; D012004:Rectal Neoplasms / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
Rectal cancer; chemoradiotherapy; platelet/lymphocyte ratio; predictive marker