The Pre-treatment Systemic Inflammatory Response Biomarkers are Important Determinant of Prognosis for Patients Undergoing Neoadjuvant Therapy for Rectal Cancer

Purpose: To evaluate the prognostic potential of inflammatory response biomarkers neutrophil to lymphocyte ratio (NLR), derived neutrophil to lymphocyte ratio (dNLR), platelet to lymphocyte ratio (PLR) and lymphocyte to monocyte ratio (LMR) in predicting the outcome of rectal cancer patients undergoing neoadjuvant chemoradiation prior to surgery. Methods: Retrospective review of T3/T4, or N+ rectal cancer treated with neoadjuvant chemoradiation 50.4 Gy concurrently with either 5 FU (1 g/m2/d) or Capecitabine 825 mg/m2 twice daily. Four additional cycles of 5-FU chemotherapy (500 mg/m2/d, i.v. bolus) or capecitabine (2500 mg/m2 days 1-14, repeated day 22), were applied post-operatively. Pre-treatment NLR, dNLR, PLR and LMR calculated from peripheral blood cell were compared with clinicopathological parameters. The prognostic value of baseline NLR, dNLR, PLR and LMR for disease free survival (DFS) and overall survival (OS) were assessed using Log rank and Cox regression. Results: The final analysis included 80 patients, the receiver operating curve (ROC) calculated cut off values of baseline NLR, dNLR, LMR and PLR in predicting outcome were 3, 2.1, 4.9 and 169 respectively. Elevated NLR, dNLR, PLR, LMR, age of patients (≥50 years), depth of invasion ≥T3, lymph node N1-N2, stage III, grade 3 tumors, and partial response to preoperative chemoradiation were significantly associated with decreased OS, and DFS. Multivariate analysis revealed that elevated NLR and dNLR were independent Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation factors for worse OS and DFS hazard ratio (HR) 2.34 (95% CI=3.41-7.24), 4.53 (95% CI, 2.61-8.32) and DSF with (HR) 1.84 (95% CI=2.27-5.36), 4.23 (95% CI=3.49-9.52) respectively. Conclusion: The baseline NLR, dNLR, LMR and PLR showed a significant association with different clinicopathological prognostic factors in rectal cancer patients receiving preoperative chemoradiation. Additionally, NLR, dNLR may be considered as potential independent prognostic indicators of clinical outcomes. including gastric cancer, colorectal cancer, hepatocellular carcinoma, non-small cell lung cancer, breast cancer and pancreatic cancer. [12,13] An elevated NLR has been found to be an indicator of poor prognosis in patients with CRC [14]. On the other hand, PLR role as prognostic indicator was found to be inconsistent as it was associated with decreased survival in some studies [15,16], whereas others did not demonstrate the relationship between prognosis and PLR [17,18]. However, only one or two inflammatory biomarkers have been evaluated for the prognosis of patients with rectal cancer according to previous reports [19-21]. Moreover, the optimal cut-off values of the biomarkers from these studies were still inconsistent. Consequently, further study on the prognostic values of these biomarkers in patients with rectal cancer is necessary. This study aimed to evaluate the prognostic potential of Citation: Zaghloul H, Abbas A (2017) The Pre-treatment Systemic Inflammatory Response Biomarkers are Important Determinant of Prognosis for Patients Undergoing Neoadjuvant Therapy for Rectal Cancer. J Cancer Sci Ther 9: 451-459. doi: 10.4172/1948-5956.1000458 J Cancer Sci Ther, an open access journal ISSN: 1948-5956 Volume 9(5) 451-459 (2017) 452 NLR, dNLR, PLR and LMR biomarkers in predicting the outcome of rectal cancer patients undergoing neoadjuvant chemoradiation prior to surgical resection. Material and Methods Retrospective review of rectal cancer patients treated at or referred to Clinical Oncology department Alexandria University and Surgical Oncology department and National Cancer Institute Cairo University between January 2012 and February 2016 after obtaining institutional board approval (IRB) approval. All patients signed informed consent. Medical records were reviewed to select rectal cancer who received neoadjuvant chemoradiation prior to surgical resection to determine known prognostic variables including: age, histology, grade, surgical stage, response to neoadjuvant chemoradiation, in addition to the tested pre-treatment prognostic biomarkers neutrophil count to lymphocyte count (NLR), derived neutrophil to lymphocyte ratio (dNLR) was constructed as follows: dNLR=neutrophil count to (white cell countneutrophil count), platelet to lymphocyte ratio (PLR) and lymphocyte to monocyte ratio (LMR) were calculated from peripheral blood cell count which were calculated from peripheral blood count.