Prognostic and predictive value of neutrophil-to-lymphocyte ratio after curative rectal cancer resection: A systematic review and meta-analysis

Hamid, Hytham K. S.; Davis, George N.; Trejo-Ávila, Mario; Igwe, P.O.; Marín, Andrés García

doi:10.1016/j.suronc.2021.101556

Cited by 29 publications

(23 citation statements)

References 54 publications

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“…Adequately predicting the response to neoadjuvant chemoradiotherapy (nCRT) in rectal cancer represents a key factor in order to achieve a fully personalized treatment approach, especially in the case of locally advanced disease presentation, which constitute a well-established indication for radiation therapy [127]. The identification of biomarkers able to predict patients' outcomes (i.e., response to nCRT) currently represents a priority in the radiotherapy research landscape, and imaging-derived response predictors are a topic of active investigation [128][129][130][131][132][133].…”

Section: Texture Analysis In Neoadjuvant Radiotherapy-a Focus On Rectal Cancermentioning

confidence: 99%

Radiomics in the Setting of Neoadjuvant Radiotherapy: A New Approach for Tailored Treatment

Nardone

Boldrini

Grassi

et al. 2021

Cancers

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Introduction: Neoadjuvant radiotherapy is currently used mainly in locally advanced rectal cancer and sarcoma and in a subset of non-small cell lung cancer and esophageal cancer, whereas in other diseases it is under investigation. The evaluation of the efficacy of the induction strategy is made possible by performing imaging investigations before and after the neoadjuvant therapy and is usually challenging. In the last decade, texture analysis (TA) has been developed to help the radiologist to quantify and identify the parameters related to tumor heterogeneity, which cannot be appreciated by the naked eye. The aim of this narrative is to review the impact of TA on the prediction of response to neoadjuvant radiotherapy and or chemoradiotherapy. Materials and Methods: Key references were derived from a PubMed query. Hand searching and ClinicalTrials.gov were also used. Results: This paper contains a narrative report and a critical discussion of radiomics approaches in different fields of neoadjuvant radiotherapy, including esophageal cancer, lung cancer, sarcoma, and rectal cancer. Conclusions: Radiomics can shed a light on the setting of neoadjuvant therapies that can be used to tailor subsequent approaches or even to avoid surgery in the future. At the same, these results need to be validated in prospective and multicenter trials.

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Section: Texture Analysis In Neoadjuvant Radiotherapy-a Focus On Rectal Cancermentioning

confidence: 99%

Radiomics in the Setting of Neoadjuvant Radiotherapy: A New Approach for Tailored Treatment

Nardone

Boldrini

Grassi

et al. 2021

Cancers

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“…Recently, Hamid et al (43) conducted a meta-analysis regarding the prognostic impact of NLR in rectal cancer patients undergoing curative resection and noted that pretreatment NLR is significantly correlated with DFS and OS. However, they analyzed mixed populations treated with surgery alone or preoperative CRT followed by surgery.…”

Section: Discussionmentioning

confidence: 99%

Meta-Analysis on the Neutrophil-Lymphocyte Ratio in Rectal Cancer Treated With Preoperative Chemoradiotherapy: Prognostic Value of Pre- and Post-Chemoradiotherapy Neutrophil-Lymphocyte Ratio

2022

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BackgroundTo evaluate the prognostic value of neutrophil-lymphocyte ratio (NLR) in rectal cancer patients treated with preoperative chemoradiotherapy (CRT) and curative surgery.MethodsA comprehensive search of the EMBASE and PubMed databases was performed to screen studies that compared treatment outcomes according to the pre-CRT and/or post-CRT NLR in patients receiving preoperative CRT and curative surgery for locally advanced rectal cancer. Hazard ratios (HRs) for disease-free survival (DFS) and/or overall survival (OS) were extracted, and a random-effects model was used for pooled analysis.ResultsTotally, 22 retrospective studies comprising 6316 patients were included. Preoperative CRT was administered with concurrent chemotherapy (mostly fluoropyrimidine-based regimens). The elevated pre-CRT NLR was significantly associated with an increased risk of recurrence (HR, 1.54; 95% confidence interval [CI], 1.31-1.81) and death (HR, 2.14; 95% CI, 1.61-2.84). Post-CRT NLR was reported in only 3 of 22 studies, and the correlation was not statistically significant for recurrence (HR, 1.44; 95% CI, 0.86-2.41) or death (HR, 2.38; 95% CI, 0.94-6.07).ConclusionsElevated pre-CRT NRL, but not post-CRT NRL, is associated with inferior DFS and OS. Further studies are needed to confirm the prognostic value of NLR in rectal cancer patients receiving preoperative CRT.

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“…In fact, several studies and meta-analyses have supported the prognostic and predictive values of NLR in patients with rectal cancer with or without NACRT. A meta-analysis by Hamid et al demonstrated that high NLR was a poor prognostic factor and associated with unfavorable OS (HR = 1.92, 95% CI = 1.60–2.30, p < 0.001) and DFS (HR = 1.83, 95% CI = 1.51–2.22, p < 0.001) [ 38 ]. Besides, the meta-analysis showed that low NLR was a significant predictor of pCR (OR = 1.62, 95% CI = 1.16–2.27, p = 0.004).…”

Section: Discussionmentioning

confidence: 99%

“…In another study analyzing 115 patients with LARC who received NACRT, the median survival rate was significantly lower in the high-NLR (>5) group than it was in the low-NLR (≤5) group (18.8 vs. 54.4 months, p < 0.001) [ 39 ]. However, a meta-analysis of 7,553 patients (with NLR cutoff levels ranging from 1.75 to 5) with rectal cancer revealed that an NLR of ≥4 was not associated with OS or DFS [ 38 ]. Overall, most studies have focused on the impacts of the NLR on downstaging or survival in patients with LARC following NACRT, and researchers have usually demonstrated correlations between high NLR values and poor oncological outcomes [ 17 , 18 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Pretreatment Neutrophil-to-Lymphocyte Ratio Associated with Tumor Recurrence and Survival in Patients Achieving a Pathological Complete Response Following Neoadjuvant Chemoradiotherapy for Rectal Cancer

Huang

Tsai

Huang

et al. 2021

Cancers

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The clinical influence of the neutrophil-to-lymphocyte ratio (NLR) in predicting outcomes in patients with locally advanced rectal cancer (LARC) who achieve a pathological complete response (pCR) to neoadjuvant chemoradiotherapy (NACRT) has seldom been investigated. We retrospectively recruited 102 patients with LARC who achieved a pCR to NACRT and the association of NLR status with survival and tumor recurrence in the patients was analyzed. Thirteen patients (12.7%) developed tumor recurrence. A high NLR (≥3.2) was significantly associated with tumor recurrence (p = 0.039). The 5-year OS rates in patients with a low NLR and patients with a high NLR were 95.1% and 77.7%, respectively (p = 0.014); the 5-year DFS rates in patients with low NLR and patients with a high NLR were 90.6% and 71.3%, respectively (p = 0.031). The Cox proportional hazards model indicated that an NLR of ≥3.2 was an independent poor prognostic factor for DFS (hazard ratio [HR] = 3.12, 95% confidence interval [CI] = 1.06–9.46, p = 0.048) and OS (HR = 6.96, 95% CI = 1.53–35.51, p = 0.013). A pretreatment high NLR (≥3.2) was a promising predictor of reduced OS and DFS in patients with LARC who achieved a pCR to NACRT.

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Prognostic and predictive value of neutrophil-to-lymphocyte ratio after curative rectal cancer resection: A systematic review and meta-analysis

Cited by 29 publications

References 54 publications

Radiomics in the Setting of Neoadjuvant Radiotherapy: A New Approach for Tailored Treatment

Radiomics in the Setting of Neoadjuvant Radiotherapy: A New Approach for Tailored Treatment

Meta-Analysis on the Neutrophil-Lymphocyte Ratio in Rectal Cancer Treated With Preoperative Chemoradiotherapy: Prognostic Value of Pre- and Post-Chemoradiotherapy Neutrophil-Lymphocyte Ratio

Pretreatment Neutrophil-to-Lymphocyte Ratio Associated with Tumor Recurrence and Survival in Patients Achieving a Pathological Complete Response Following Neoadjuvant Chemoradiotherapy for Rectal Cancer

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