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. 2022 Oct 16;11(20):6091.
doi: 10.3390/jcm11206091.

Prognostic and Predictive Biomarkers in Patients with Locally Advanced Rectal Cancer (LARC) Treated with Preoperative Chemoradiotherapy

Alfonso Martín-Carnicero  1 , Enrique Ramalle-Gomara  2 , Susana Rubio-Mediavilla  3 , Martina Alonso-Lago  1 , Miriam Zorrilla-Larraga  1 , Isabel Manrique-Abós  1 , María E de Las Heras-Dueña  4 , Ignacio M Larrayoz  5   6 , Alfredo Martínez  7
Affiliations

Prognostic and Predictive Biomarkers in Patients with Locally Advanced Rectal Cancer (LARC) Treated with Preoperative Chemoradiotherapy

Alfonso Martín-Carnicero et al. J Clin Med. .

Abstract

Neoadjuvant chemoradiotherapy (CRT) is one of the standards of care in locally advanced rectal cancer (LARC). This retrospective study examines clinical, analytical, and pathological parameters collected from 77 patients with locally advanced (cT3-4 or cN+) rectal carcinoma diagnosed between 2007 and 2017 at our institution that were treated with preoperative CRT and surgery. In the prognosis analysis, lower hemoglobin levels (p = 0.008), lower lymphocyte/monocyte ratio (LMR) (p = 0.011), and higher platelet/lymphocyte ratio (PLR) (p = 0.029) in the second determination (Hb2, LMR2 and PLR2) were associated with the relapse group. The number of positive nodes after surgery (N+) showed a statistically significant association with relapse (p = 0.012). KRAS mutations were associated with a worse prognosis for 5 years progression-free and overall survival (p = 0.005 and 0.022; respectively). We propose a prognostic model based on four parameters (number of positive lymph nodes after surgery, hemoglobin levels, LMR, and PLR after neoadjuvant therapy) that can be a useful tool to estimate relapse risk. Moreover, bilirubin could be a useful parameter to predict the response to neoadjuvant CRT.

Keywords: KRAS mutations; bilirubin; hemoglobin; locally advanced rectal cancer; lymphocyte/monocyte ratio; neoadjuvant chemoradiotherapy; platelet/lymphocyte ratio; positive nodes after surgery; predictive biomarkers; prognostic biomarkers.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Timeline of blood draws. CRT: chemoradiotherapy; CT: chemotherapy.
Figure 2
Figure 2
Prognostic role of KRAS status. (a) Progression-free survival (PFS). (b) Overall survival (OS).
Figure 3
Figure 3
Prognostic role of Hb2 levels with a cut-off value of 12.3 g/dL. (a) Progression-free survival (PFS). (b) Overall survival (OS).
Figure 4
Figure 4
Prognostic role of LMR2 levels with a cut-off value of 1.26. (a) Progression-free survival (PFS). (b) Overall survival (OS).
Figure 5
Figure 5
Prognostic role of PLR2 levels with a cut-off value of 229.50. (a) Progression-free survival (PFS). (b) Overall survival (OS).
Figure 6
Figure 6
ROC curves for relapse (a) by Hb2, LMR2, and PLR2. (b) by Hb2, LMR2, PLR2, and N+.
See this image and copyright information in PMC

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