Baseline neutrophil–lymphocyte ratio and platelet–lymphocyte ratio in rectal cancer patients following neoadjuvant chemoradiotherapy

Kim, Tae Gyu; Park, Won; Kim, Hakyoung; Choi, Doo Ho; Park, Hee Chul; Kim, Seok-Hyung; Cho, Yong Beom; Yun, Sukchang; Kim, Hee Cheol; Lee, Woo Yong; Lee, Jeeyun; Kang, Ki Mun

doi:10.1177/0300891618792476

Cited by 44 publications

(56 citation statements)

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“…To our knowledge, this is the largest reported study of the prognostic and predictive impact of NLR and/or PLR in this patient population. Previous studies have reported conflicting results in this setting, with some demonstrating poorer prognosis with higher NLR and/or PLR [39,40], while others did not observe any significant association [27]. Two prior meta-analyses investigating the prognostic role of NLR and PLR across a range of solid tumours demonstrated an association with adverse OS for both biomarkers in combined study populations of over 40,000 and 12,000 patients, respectively [19,20].…”

Section: Discussionmentioning

confidence: 95%

“…With regard to their role in predicting response to neoadjuvant therapy, a recent systematic review and metaanalysis demonstrated an increased likelihood of pCR in patients with rectal cancer and low NLR receiving neoadjuvant chemotherapy +/− radiation (OR 2.01, 95% CI 1.14-3.55, p = 0.02) [42], which is inconsistent with our results. In addition, a recent study identified elevated PLR (> 133.4) to be a significant predictor of poor pathologic response in rectal cancer patients following nCRT [40]. The reasons for these discrepancies are unclear but may be related to differences in study design and analysis.…”

Section: Discussionmentioning

confidence: 99%

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Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as predictive and prognostic markers in patients with locally advanced rectal cancer treated with neoadjuvant chemoradiation.

Dudani

Marginean

Tang

et al. 2017

JCO

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758 Background: A standard therapy for locally advanced rectal cancer (LARC) includes fluoropyrimidine (FP)-based neoadjuvant chemoradiation (nCRT). Previous studies have inconsistently demonstrated that baseline neutrophil- and platelet-to-lymphocyte ratios (NLR and PLR) are predictive of response to nCRT or prognostic of outcomes in LARC. Methods: We performed a review of patients with LARC undergoing nCRT followed by surgery with curative intent from 2005-2013 in 3 academic cancer centers from 2 Canadian provinces. Data regarding demographics, staging, baseline hematologic variables (<4 weeks prior/up to 2 weeks after initiating nCRT) and treatment details were collected. Outcome measures of interest were pathological complete response (pCR), disease-free survival (DFS) and overall survival (OS). Logistic regression and Cox proportional hazard models were used to assess for an association between baseline hematologic variables and outcomes. Results: Of 1081 identified patients, 845 were included in the DFS/OS analysis. Median age was 61 (range 23-87), 70% male, 85% performance status (PS) 0-1. 31% and 67% had clinical stage II and III disease, respectively. 25% had elevated NLR (≥ 4), and 64% had elevated PLR (≥ 150). 98% of patients received FP-based nCRT, with 96% receiving ≥ 44 Gy (median 50 Gy [range 20-74]). 80% completed neoadjuvant chemotherapy and 94% completed neoadjuvant radiotherapy, with a pCR rate of 23%. After a median follow up time of 64 months, 6% developed local recurrence, 20% developed distant recurrence and 19% have died. 5-year OS and DFS were 78% (95% CI 74-81%) and 76% (95% CI 73-79%), respectively. In multivariate analyses, elevated baseline NLR and PLR were not prognostic for OS or DFS. Elevated NLR was a negative predictor of pCR (OR 0.61, p=0.037, 95% CI 0.38-0.97); there was no association with elevated PLR. Conclusions: Elevated NLR was a negative predictor of pCR, but not prognostic for DFS and OS. PLR was neither predictive nor prognostic.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as predictive and prognostic markers in patients with locally advanced rectal cancer treated with neoadjuvant chemoradiation.

Dudani

Marginean

Tang

et al. 2017

JCO

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“…NLR, PLR and MLR are known to be predictors of pathological response in LARC patients. Kim et al suggested that NLR<2.0 and PLR<133.4 before CRT were associated with better tumor response (26). Kim et al claimed that patients with baseline NLR>3 had poor tumor response (17), while…”

Section: Discussionmentioning

confidence: 99%

Systemic inflammation-based predictors of pathological response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer patients: A propensity score matching analysis

Huang

et al. 2020

Preprint

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Background: In the management of locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (CRT), the relationship between systemic inflammation-based predictors and tumor response remains unclear. This study aimed to determine whether these inflammatory factors can predict tumor response.Methods: Totally 205 LARC patients underwent neoadjuvant CRT and curative surgery between 2008 and 2017 were analyzed. After propensity score matching, 146 patients (73 matched pairs) were enrolled in this study. The hematological parameters were collected and their relationship with tumor response was investigated.Results: After propensity score matching, the neutrophil-lymphocyte-ratio (NLR) and platelet-lymphocyte-ratio (PLR) before CRT in good response group were significantly lower than those in poor response group, while there was no significant difference in all hematological characteristics between two groups after CRT. The cutoff values of pre-CRT NLR and pre-CRT PLR were 3.10 and 198.7 after receiver operating characteristic analysis. Multivariate analysis model indicated that pre-CRT PLR was not related with tumor response, while pre-CRT NLR≥3.1 was the predictor of poor tumor response (OR=2.047, 95%CI =1.241-3.377, p=0.005). Besides, patients with NLR≥3.1 had a significantly poor tumor regression grade rates compared with patients with NLR<3.1 (p=0.036).Conclusion: The increased NLR before CRT can be regarded as a hematological factor for poor tumor response in LARC, and higher NLR also represents worse tumor regression grade.

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“…Data for eight blood-based measurements that had previously been reported in association with rectal cancer were collected. These included the neutrophil-to-lymphocyte ratio (20)(21)(22), platelet-to-lymphocyte ratio (20,21), lymphocyte-to-monocyte ratio (20,23), neutrophil-to-albumin ratio (24), serum albumin level (13), serum CEA level (14,15), hemoglobin concentration (25), and platelet count (26). The samples were acquired before the beginning of nCRT, and the results were standardized by linearly normalizing each feature to the range 0-1.…”

Section: Methodsmentioning

confidence: 99%

Combining Radiomics and Blood Test Biomarkers to Predict the Response of Locally Advanced Rectal Cancer to Chemoradiation

Jeon

Song

Chie

et al. 2020

In Vivo

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Background/Aim: A noninvasive method for predicting a patient's response to neoadjuvant chemoradiotherapy (nCRT) for locally advanced rectal cancer would be useful because this would help determine the subsequent treatment strategy. Two types of noninvasive biomarkers have previously been studied, based on radiomics and based on blood test parameters. We hypothesized that a combination of both types would provide a better predictive power, and this has not previously been investigated. Patients and Methods: Data from 135 patients with locally advanced rectal cancer who underwent nCRT were retrospectively allocated into training and validation cohorts in a 2:1 ratio. Sixty-five radiomics features were extracted from tumors segmented on T2-weighted magnetic resonance images. An elastic net was applied to generate four models for discerning the patients with good responses to nCRT based on radiomics features (model R), blood biomarkers (model B), both (model RB), and a linear combination of models R and B (model R+B). Results: Among 65 radiomics features, 17 were selected as robust features for model development. The AUC values of model R, model B, model RB, and model R+B achieved 0.751, 0.627, 0.785, and 0.711 in the training cohort (n=90), and 0.705, 0.603, 0.679, and 0.705 in validation cohort (n=45), respectively. In the entire cohort, models RB and R+B demonstrated a significantly better performance than model B but not R. There was no correlation between the scores of models R and B (p=0.76). Radiomics features had a greater influence than blood biomarkers on models RB and R+B. Conclusion: A non-redundancy between radiomics features and blood-based biomarkers was observed. Furthermore, radiomics features are more valuable in terms of predicting response to nCRT. The importance of combining noninvasive biomarkers in future investigations is highlighted. Neoadjuvant chemoradiotherapy (nCRT) is the standard treatment for locally advanced rectal cancer (LARC). The patient's response to nCRT is associated with disease outcome (1) and is often used to determine the subsequent 2955 This article is freely accessible online.

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Baseline neutrophil–lymphocyte ratio and platelet–lymphocyte ratio in rectal cancer patients following neoadjuvant chemoradiotherapy

Abstract: Elevated NLR and PLR levels can be considered as predictors of poor pathologic response, and NLR can be considered a prognosticator in patients who underwent neoadjuvant chemoradiotherapy for locally advanced rectal cancer.

Cited by 44 publications

References 30 publications

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as predictive and prognostic markers in patients with locally advanced rectal cancer treated with neoadjuvant chemoradiation.

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as predictive and prognostic markers in patients with locally advanced rectal cancer treated with neoadjuvant chemoradiation.

Systemic inflammation-based predictors of pathological response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer patients: A propensity score matching analysis

Combining Radiomics and Blood Test Biomarkers to Predict the Response of Locally Advanced Rectal Cancer to Chemoradiation

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