Department of Pathology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, China.
Department of Orthopedics, Guangzhou Huaxin Orthopedic Hospital, Guangzhou, China.
Biosci Rep. 2019 Mar 26;39(3). doi: 10.1042/BSR20190003. Print 2019 Mar 29.
Neoadjuvant chemoradiotherapy (nCRT) followed by surgery is the standard treatment for locally advanced rectal cancer. Here, we analyzed the impact of local and systemic environments on the tumor response to preoperative chemoradiotherapy in rectal cancer. We recruited 141 patients with rectal cancer treated with nCRT. We evaluated the local tumor environment, including tumor-infiltrating lymphocytes (TILs), intratumor budding (ITB), and the systemic inflammatory environment, including the neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) level. Our finding revealed that tumor regression was significantly associated with the density of CD8+ TILs in the intraepithelial, the presence of ITB, the combination of NLR and CRP (NLR-CRP) value, and the combination of CD8+ intraepithelial TIL (iTIL) density and ITB presence. Moreover, multivariate analysis showed that only the combination of CD8+ iTILs and ITB was an independent predictive factor for the pathological response to nCRT in rectal cancer. Our finding demonstrate that the local tumor environment was a better predictor of the tumor response than the systemic environment and thus provided new insight into screening for patients who are more likely to benefit from cancer treatment.
新辅助放化疗（nCRT）后手术是局部进展期直肠癌的标准治疗方法。在这里，我们分析了局部和全身环境对直肠癌术前放化疗肿瘤反应的影响。我们招募了 141 例接受 nCRT 治疗的直肠癌患者。我们评估了局部肿瘤环境，包括肿瘤浸润淋巴细胞（TILs）、肿瘤内芽（ITB）以及全身炎症环境，包括中性粒细胞与淋巴细胞比值（NLR）和 C 反应蛋白（CRP）水平。我们的研究结果表明，肿瘤消退与上皮内 CD8+TILs 的密度、ITB 的存在、NLR 和 CRP（NLR-CRP）值的组合以及 CD8+上皮内 TIL（iTIL）密度和 ITB 存在的组合显著相关。此外，多变量分析表明，只有 CD8+iTILs 和 ITB 的组合是直肠癌 nCRT 病理反应的独立预测因素。我们的研究结果表明，局部肿瘤环境是预测肿瘤反应的更好指标，而不是全身环境，从而为筛选更有可能从癌症治疗中获益的患者提供了新的见解。
