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. 2018 Apr 27;9(32):22368-22382.
doi: 10.18632/oncotarget.25023.

Outcomes prediction in pre-operative radiotherapy locally advanced rectal cancer: leucocyte assessment as immune biomarker

Alexis Vallard  1 , Max-Adrien Garcia  2 , Peng Diao  3 , Sophie Espenel  1 , Guy de Laroche  1 , Jean-Baptiste Guy  1 , Majed Ben Mrad  1 , Chloé Rancoule  1 , David Kaczmarek  4 , Thierry Muron  5 , Gregoire Pigné  1 , Jack Porcheron  6 , Michel Peoc'h  7 , Jean-Marc Phelip  8 , Julien Langrand-Escure  1 , Nicolas Magné  1
Affiliations

Outcomes prediction in pre-operative radiotherapy locally advanced rectal cancer: leucocyte assessment as immune biomarker

Alexis Vallard et al. Oncotarget. .

Abstract

Objective: Leukocytes are hypothesized to reflect the inflammatory tumor microenvironment. We aimed to validate their prognostic significance in a large cohort of patients treated with pre-operative radiation for locally advanced rectal cancer (RC).

Results: From 2004 to 2015, 257 RC patients with available biological data underwent a pre-operative radiotherapy, with a median age of 66 years. The median rectal EQD2 was 49.2Gy. Most of patients experienced concurrent chemotherapy (n = 245, 95.4%), mainly with 5-FU (83.3%). Clear surgical margins (i.e. complete resection) were achieved in 234 patients (91.1%). A complete (Mandard TRG1: n = 35, 13.6%) or almost complete pathological response (Mandard TRG2: n = 56, 21.8%) were achieved in 91 patients (35.4%). With a median follow-up of 46.1 months, 8 patients (3.1%) experienced local relapse, 38 (14.8%) experienced metastases and 45 (17.5%) died. Elevated pre-radiation neutrophil to lymphocyte ratio (NLR > 2.8) was identified as an independent predictive factor of increased local relapse, of decreased progression-free survival and overall survival in multivariate analysis. Elevated NLR was marginally associated with incomplete pathological response in multivariate analysis, suggesting a possible value as a biomarker of radio-sensitivity.

Conclusions: Pre-radiation NLR is a simple and robust biomarker for risk stratification in locally advanced RC patients undergoing pre-operative radiotherapy, and might select the subpopulation eligible to treatment intensification or to neoadjuvant chemotherapy.

Material and methods: Clinical records from consecutive patients treated in a single institution between 2004 and 2015 with curative-intent radiotherapy were retrospectively analyzed. Classical prognosis factors of RC and peripheral immune markers based on lymphocytes and neutrophil counts were studied.

Keywords: chemoradiation; lymphocyte; neutrophil; ratio; rectal cancer.

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Conflict of interest statement

CONFLICTS OF INTEREST Authots declare no conflicts of interest.

Figures

Figure 1
Figure 1. Overall survival depending on the pre-radiation Neutrophil to Lymphocyte Ratio (NLR). (HR 2.23 CI 95% (1.14–2.36), p = 0.02)
See this image and copyright information in PMC

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