Lee Joo Ho, Song Changhoon, Kang Sung-Bum, Lee Hye Seung, Lee Keun-Wook, Kim Jae-Sung
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Anticancer Res. 2018 Dec;38(12):6905-6910. doi: 10.21873/anticanres.13067.
This study evaluated the efficacy of haematological markers for predicting the pathological complete regression (pCR) during and after neoadjuvant chemoradiotherapy (CRT) in patients with locally advanced rectal cancer (LARC).
A total of 297 patients with LARC underwent neoadjuvant CRT followed by surgical resection. Complete blood counts (CBCs) were performed before CRT, 3 weeks after the start of CRT (intra-therapy), and 4 weeks after CRT. Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) were calculated using the serial CBC test. The ratio of change in PLR (cPLR) and NLR (cNLR) was calculated as the increase from the pre-therapy value to intra-therapy or post-therapy value divided by the pre-therapy value. Chi-square and t-test for univariate analysis and multivariate logistic regression were performed to identify significant predictors for pCR. Receiver operating characteristic (ROC) analysis was used to compare predictive values.
The overall rate of pCR was 15.9%. Pre-therapy high haemoglobin and low NLR; intra-therapy high PLR, high NLR, high cPLR, and high cNLR; and post-therapy low white blood cell count (WBC), high haemoglobin, and high cPLR were significantly associated with pCR. In multivariate logistic regression, pre-therapy high haemoglobin [odds ratio (OR)=1.500, p=0.016], high intra-therapy PLR (OR=1.006, p=0.011), high intra-therapy cPLR (OR=4.948, p<0.001), and low post-therapy WBC (OR=0.639, p=0.003) were significant predictors for pCR. ROC analysis showed that high intra-therapy cPLR was the most accurate predictor of pCR (area under the curve=0.741).
Changes of PLR during neoadjuvant CRT for LARC are significant predictors of pCR.
本研究评估了血液学标志物在预测局部晚期直肠癌（LARC）患者新辅助放化疗（CRT）期间及之后病理完全缓解（pCR）方面的疗效。
共有297例LARC患者接受了新辅助CRT，随后进行手术切除。在CRT前、CRT开始后3周（治疗期间）以及CRT后4周进行全血细胞计数（CBC）。使用系列CBC检测计算血小板与淋巴细胞比值（PLR）和中性粒细胞与淋巴细胞比值（NLR）。PLR（cPLR）和NLR（cNLR）的变化率计算为从治疗前值到治疗期间或治疗后值的增加量除以治疗前值。进行卡方检验和t检验用于单因素分析，并进行多因素逻辑回归以确定pCR的显著预测因素。采用受试者工作特征（ROC）分析比较预测价值。
pCR的总体发生率为15.9%。治疗前高血红蛋白和低NLR；治疗期间高PLR、高NLR、高cPLR和高cNLR；以及治疗后低白细胞计数（WBC）、高血红蛋白和高cPLR与pCR显著相关。在多因素逻辑回归中，治疗前高血红蛋白[比值比（OR）=1.500，p = 0.016]、治疗期间高PLR（OR = 1.006，p = 0.011）、治疗期间高cPLR（OR = 4.948，p < 0.001）和治疗后低WBC（OR = 0.639，p = 0.003）是pCR的显著预测因素。ROC分析表明，治疗期间高cPLR是pCR最准确的预测因素（曲线下面积=0.741）。
LARC新辅助CRT期间PLR的变化是pCR的显著预测因素。
