Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian, People's Republic of China.
Int J Clin Oncol. 2020 Jul;25(7):1299-1307. doi: 10.1007/s10147-020-01670-5. Epub 2020 Apr 9.
This study aimed to evaluate the predictive value of hematological inflammation-based indexes in the treatment response to neoadjuvant chemoradiotherapy (NCRT) in rectal mucinous adenocarcinomas (MACs).
Patients with rectal MACs undergoing NCRT and curative resection were included. Inflammation-based indexes such as systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and prognostic nutritional index (PNI) were calculated. Receiver operator characteristics analysis was used to determine the optimal cutoff points. Multivariable logistic analysis identified predictors of good response to NCRT. A nomogram was developed and validated internally.
A total of 100 patients met the inclusion criteria, with 32 patients developing good response (tumor regression grade, TRG 0 + 1) to NCRT. Lower pre-treatment SII, NLR, and PLR levels were associated with a higher probability of good response to NCRT (P = 0.025, P < 0.001, P = 0.003, respectively), and a higher pre-treatment PNI level was associated with a higher probability of good response to NCRT (P = 0.005). Logistic regression analysis demonstrated that tumor size (< 3 cm, OR = 5.489, P = 0.025), pre-treatment NLR level (< 3.05, OR = 4.025, P = 0.028), pre-treatment PLR level (< 145.98, OR = 4.337, P = 0.038), and pre-treatment PNI level (≥ 41.32, OR = 3.477, P = 0.039) were independent predictors of good response to NCRT. A nomogram was developed with a C-index of 0.827.
Hematological inflammation-based indexes, in terms of pre-treatment NLR, PLR, and PNI levels, can help in predicting the treatment response to NCRT for rectal MACs.
本研究旨在评估血液学炎症指标在新辅助放化疗（NCRT）治疗直肠黏液腺癌（MAC）中的预测价值。
纳入接受 NCRT 和根治性切除术的直肠 MAC 患者。计算了炎症相关指标，如全身免疫炎症指数（SII）、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）和预后营养指数（PNI）。采用受试者工作特征曲线分析确定最佳截断值。多变量逻辑分析确定了对 NCRT 反应良好的预测因素。建立并内部验证了列线图。
共纳入 100 例符合条件的患者，其中 32 例对 NCRT 反应良好（肿瘤消退分级，TRG 0+1）。治疗前较低的 SII、NLR 和 PLR 水平与 NCRT 反应良好的概率更高相关（P=0.025、P<0.001、P=0.003），而较高的治疗前 PNI 水平与 NCRT 反应良好的概率更高相关（P=0.005）。逻辑回归分析表明肿瘤大小（<3cm，OR=5.489，P=0.025）、治疗前 NLR 水平（<3.05，OR=4.025，P=0.028）、治疗前 PLR 水平（<145.98，OR=4.337，P=0.038）和治疗前 PNI 水平（≥41.32，OR=3.477，P=0.039）是 NCRT 反应良好的独立预测因素。建立了一个 C 指数为 0.827 的列线图。
基于治疗前 NLR、PLR 和 PNI 水平的血液学炎症指标可有助于预测直肠 MAC 患者对 NCRT 的治疗反应。
