Can splenic characteristics predict rectal cancer chemotherapy toxicity and treatment outcomes in rectal cancer patients?

Abstract

Introduction: Rectal cancer requires multidisciplinary management, including chemotherapy treatment, for successful clinical outcomes. Splenic characteristics on CT imaging has been proposed to reflect immune function. This study explores whether splenic size and splenic density on pre-treatment computer tomography (CT) scans predicts chemotherapy dose limiting toxicities (DLT) and cancer outcomes in rectal cancer patients.

Methods: A retrospective study of rectal cancer patients who received chemotherapy treatment with curative intent from February 2013 to March 2023 was conducted. Pre-treatment CT scans were collected for measurement of splenic volume and density. Receiver operating characteristics (ROC) analyses of splenic density and volume was performed to calculate the area under the curve (AUC). The AUC was used to determine association with overall survival (OS), disease free survival (DFS) and DLT.

Results: 234 patients were included, 98 (41.8%) patients were classified as having diffuse reduction of spleen density (DROSD). The DROSD group experienced significantly reduced dose limiting toxicities (13.3% vs 24.3%, p = 0.045). There was no significant association between OS or DFS with splenic volume or density.

Conclusion: This study has shown that DROSD is an independent predictive factor for reduced DLT in rectal cancer patients undergoing chemotherapy treatment. Further research is needed to validate findings and elucidate underlying mechanisms.