The Ottawa Hospital Cancer Centre/University of Ottawa, Ottawa, Ontario, Canada.
Present address: Division of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, 1331 29 St NW, Calgary, AB, T2N 4N2, Canada.
BMC Cancer. 2019 Jul 5;19(1):664. doi: 10.1186/s12885-019-5892-x.
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.
We reviewed patients with LARC undergoing nCRT followed by surgery from 2005 to 2013 across 8 Canadian cancer centres. 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 associations between baseline hematologic variables and outcomes.
Of 1527 identified patients, 1237 (81%) were included in the DFS/OS analysis. Median age was 62 (range 23-88), 69% were male, and 80% had performance status (PS) 0-1. Twenty-six percent had elevated NLR (≥ 4), and 66% had elevated PLR (≥ 150). Ninety-seven percent of patients received FP-based nCRT, with 96% receiving ≥44 Gy. 81% completed neoadjuvant chemotherapy and 95% completed neoadjuvant radiotherapy, with a pCR rate of 18%. After a median follow-up time of 71 months, 8% developed local recurrence, 22% developed distant recurrence and 24% died. 5-year DFS and OS were 69% (95% CI 66-72%) and 79% (95% CI 77-82%), respectively. In multivariate analyses, elevated baseline NLR and PLR were neither prognostic for DFS and OS nor predictive of pCR.
NLR and PLR were not found to be independently prognostic for DFS or OS and did not predict for pCR in patients with LARC undergoing nCRT followed by surgery.
局部晚期直肠癌（LARC）的标准治疗包括氟嘧啶（FP）为基础的新辅助放化疗（nCRT）。先前的研究不一致地表明，基线中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）与 nCRT 反应或 LARC 预后相关。
我们回顾了 2005 年至 2013 年间在 8 个加拿大癌症中心接受 nCRT 治疗后行手术的 LARC 患者。感兴趣的结局测量包括病理完全缓解（pCR）、无病生存（DFS）和总生存（OS）。逻辑回归和 Cox 比例风险模型用于评估基线血液学变量与结局之间的关系。
在 1527 例确定的患者中，有 1237 例（81%）纳入 DFS/OS 分析。中位年龄为 62 岁（范围 23-88 岁），69%为男性，80%为 PS 0-1。26%的患者 NLR 升高（≥4），66%的患者 PLR 升高（≥150）。97%的患者接受 FP 为基础的 nCRT，其中 96%接受≥44Gy。81%的患者完成新辅助化疗，95%的患者完成新辅助放疗，pCR 率为 18%。中位随访时间为 71 个月后，8%发生局部复发，22%发生远处复发，24%死亡。5 年 DFS 和 OS 分别为 69%（95%CI 66-72%）和 79%（95%CI 77-82%）。多变量分析显示，基线 NLR 和 PLR 升高既不能预测 DFS 和 OS，也不能预测 pCR。
在接受 nCRT 治疗后行手术的 LARC 患者中，NLR 和 PLR 升高与 DFS 和 OS 无独立相关性，也不能预测 pCR。
