The combination of pre-neoadjuvant chemoradiotherapy inflammation biomarkers could be a prognostic marker for rectal cancer patients

Abstract

The neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) have a strong association with prognosis in patients with Stage II/III rectal cancer (RC). We attempted to explore a new system combining these two ratios, named the NLM score, and examine its prognostic value in Stage II/III RC patients undergoing neoadjuvant chemoradiotherapy (NCRT). We retrospectively analyzed data of 237 stage II/III RC patients who underwent NCRT followed by standard TME in our hospital and defined the NLM score as follows: Score 2: pre-NCRT NLR > 2.565 and pre-NCRT LMR < 2.410. Score 1: (pre-NCRT NLR > 2.565 and pre-NCRT LMR > 2.410) OR (pre-NCRT NLR < 2.565 and pre-NCRT LMR < 2.410). Score 0: pre-NCRT NLR < 2.565 and pre-NCRT LMR > 2.410. Multivariate analyses implied that lower ypTNM stage (stage 0-I vs. II-III) (hazard ratio [HR] 0.420, 95% confidence interval [CI] 0.180-0.980 for OS; HR 0.375, 95% CI 0.163-0.862 for DFS) and an NLM score ≤ 1 (HR 0.288, 95% CI 0.134-0.619 for OS; HR 0.229, 95% CI 0.107-0.494 for DFS) could independently predict better overall survival (OS) and disease-free survival (DFS). The novel scoring system, which integrated pre-NCRT NLR and pre-NCRT LMR, was an independent prognostic factor in stage II/III RC patients undergoing NRCT and had better predictive values than these ratios alone.

Figure 1

The pre-NCRT NLR > 2.565 had significantly worse OS and DFS than the pre-NCRT NLR < 2.565 (OS, p = 0.002, A; DFS, p = 0.002, B).

Figure 2

The pre-NCRT LMR < 2.410 had significantly worse OS and DFS than pre-NCRT LMR > 2.410 (OS, p = 0.001, A; DFS, p = 0.001, B).

Figure 3

The higher NLM score predicted the worse OS and DFS (OS, A; DFS, B).