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. 2025 Jun 12;56(1):134.
doi: 10.1007/s12029-025-01255-3.

Response Prediction to Neoadjuvant Chemoradiotherapy in Rectal Cancer Based on Systemic Inflammatory Markers (NLR, PLR, and LMR)

Roger Beltrati Coser  1 , Caio Sergio R Nahas  2 , Alex Jones Flores Cassenote  3 , Omar S T Ghani  3 , Rafaela B B Pinheiro  4 , Sergio Carlos Nahas  2 , Carlos Frederico S Marques  2
Affiliations

Response Prediction to Neoadjuvant Chemoradiotherapy in Rectal Cancer Based on Systemic Inflammatory Markers (NLR, PLR, and LMR)

Roger Beltrati Coser et al. J Gastrointest Cancer. .

Abstract

Purpose: This study aimed to evaluate whether systemic inflammatory markers-neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR)-can predict tumor response to neoadjuvant chemoradiotherapy (nCRT) in patients with rectal cancer.

Methods: A retrospective, single-center study included 396 patients with biopsy-proven rectal cancer (clinical stage T2-4NxM0 or any T N + M0) treated with curative intent. All patients underwent standardized nCRT, followed by either radical surgery with total mesorectal excision (TME) or non-operative management in cases of sustained complete clinical response (cCR). Pre-treatment NLR, PLR, and LMR were calculated from baseline blood counts. Tumor response was categorized using tumor regression grade (TRG): TRG 0 (complete response), TRG 1 (almost complete), TRG 2 (partial), and TRG 3 (no response).

Results: Incomplete responders (TRG 1-3) had higher NLR (p < 0.001), PLR (p = 0.002), and carcinoembryonic antigen (CEA, p < 0.001), and were more frequently male (p = 0.021). Complete responders (TRG 0) were more associated with higher LMR (p < 0.001), elevated hemoglobin levels (p = 0.049), more comorbidities (p = 0.001), and greater use of antihypertensives (p = 0.012) and antiplatelet/anticoagulant drugs (p = 0.045). Risk estimates of incomplete response were as follows: NLR > 2.08 (RR 2.30, 95% CI 1.60-3.31), PLR > 129.36 (RR 1.79, 95% CI 1.25-2.05), and LMR > 2.67 (RR 0.42, 95% CI 0.26-0.66).

Conclusion: Pre-treatment NLR, PLR, and LMR are predictors of response to nCRT in patients with rectal cancer. An NLR > 2.08 is an independent predictor of incomplete response to nCRT. These findings contribute a cost-effective and readily available tool to the rectal cancer management arsenal.

Keywords: Lymphocyte-to-monocyte ratio (LMR); Neoadjuvant therapy; Neutrophil-to-lymphocyte ratio (NLR); Platelet-to-lymphocyte ratio (PLR); Rectal cancer.

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Conflict of interest statement

Declarations. Conflict of Interest: The authors declare no competing interests.

References

    1. Group GTS. Prolongation of the disease-free interval in surgically treated rectal carcinoma. N Engl J Med. 1985;312(23):1465–72. - DOI
    1. Sauer R, Fietkau R, Wittekind C, Rödel C, Martus P, Hohenberger W, et al. Adjuvant vs. neoadjuvant radiochemotherapy for locally advanced rectal cancer: the German trial CAO/ARO/AIO-94. Colorectal Dis. 2003;5(5):406–15.
    1. Maas M, Nelemans PJ, Valentini V, Das P, Rödel C, Kuo LJ, et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol. 2010;11(9):835–44. - DOI - PubMed
    1. Habr-Gama A, de Souza PM, Ribeiro U, Nadalin W, Gansl R, Sousa AH, et al. Low rectal cancer: impact of radiation and chemotherapy on surgical treatment. Dis Colon Rectum. 1998;41(9):1087–96. - DOI - PubMed
    1. Habr-Gama A, Perez R, Proscurshim I, Gama-Rodrigues J. Complete clinical response after neoadjuvant chemoradiation for distal rectal cancer. Surg Oncol Clin N Am. 2010;19(4):829–45. - DOI - PubMed

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