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Circulating Lymphocytes as Predictors of Sensitivity to Preoperative Chemoradiotherapy in Rectal Cancer Cases

  • Dou, Xue (Department of Radiation Oncology, Shandong Cancer Hospital and Institute, University of Jinan) ;
  • Wang, Ren-Ben (Department of Radiation Oncology, Shandong Cancer Hospital and Institute, University of Jinan) ;
  • Yan, Hong-Jiang (Department of Radiation Oncology, Shandong Cancer Hospital and Institute, University of Jinan) ;
  • Jiang, Shu-Mei (Department of Radiation Oncology, Shandong Cancer Hospital and Institute, University of Jinan) ;
  • Meng, Xiang-Jiao (Department of Radiation Oncology, Shandong Cancer Hospital and Institute, University of Jinan) ;
  • Zhu, Kun-Li (Department of Radiation Oncology, Shandong Cancer Hospital and Institute, University of Jinan) ;
  • Xu, Xiao-Qing (Department of Radiation Oncology, Shandong Cancer Hospital and Institute, University of Jinan) ;
  • Mu, Dian-Bin (Department of Pathology, Shandong Cancer Hospital and Institute, University of Jinan)
  • Published : 2013.06.30

Abstract

Objective: The objective of this study was to identify clinical predictive factors for tumor response after neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer (LARC). Methods: All factors were evaluated in 88 patients with LARC treated with nCRT. After a long period of 4-8 weeks of chemoradiotherapy, 3 patients achieved clinical complete response (cCR) and thus aggressive surgery was avoided, and the remaining 85 patients underwent a curative-intent operation. The response to nCRT was evaluated by tumor regression grade (TRG) system. Results: There were 32 patients (36.4%) with good tumor regression (TRG 3-4) and 56 (63.6%) with poor tumor regression (TRG 0-2). Lymphocyte counts and ratios were higher in good response cases (P=0.01, 0.03, respectively) while neutrophil ratios and N/L ratios were higher in poor response cases (P=0.04, 0.02, respectively). High lymphocyte ratios before nCRT and good tumor regression (TRG3-4) were significantly associated with improved 5-year disease-free survival (P<0.05). Pretreatment nodal status was also significantly associated with 5-year disease-free survival and 5-year overall survival (P<0.05). Multivariate analysis confirmed that the pretreatment lymphocyte ratio and lymph nodal status were independent prognostic factors. Conclusion: Our study suggested that LARC patients with high lymphocyte ratios before nCRT would have good tumor response and high 5-year DFS and OS.

Keywords

Rectal cancer;lymphocytes;neoadjuvant chemoradiotherapy;tumor regression grade

Acknowledgement

Supported by : Shandong province science and technology

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