Skip to main content
SpringerLink
Log in

Clinical Implications of Combined Lymphocyte and Neutrophil Count in Locally Advanced Rectal Cancer After Preoperative Chemoradiotherapy

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

There are controversies about the ability of neutrophil to lymphocyte ratio to predict the recurrence and survival in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiation. The objective of this study is to investigate the prognostic potential of combined lymphocyte count (LC) and neutrophil count (NC) in LARC patients treated with chemoradiotherapy (CRT) followed by curative surgery.

Methods

Patients with LARC who underwent surgical resection between January 2010 and December 2017 were reviewed retrospectively. We divided the patients into three groups: high LC and low NC, low LC and high NC, and the remaining patients. The cut-off values of LC and NC were determined by receiver operating characteristic curve analysis and log-rank test statistics. We compared the disease-free survival (DFS) rate between the groups.

Results

A total of 176 consecutive patients were included in this study. The 5 year DFS rate was significantly different among the three groups in pathologic node (pN)+ patients (73.2% vs. 61.9% vs. 14.2%; P = 0.025). Cox multivariate analysis for pN+ patients demonstrated that combination of low LC and high NC (hazard ratio, 3.630; 95% confidence interval [CI], 1.306–10.093; P = 0.013) was significantly correlated with decreased DFS.

Conclusions

This study showed that the combination of LC and NC is a powerful predictive factor for disease recurrence in pN+ LARC patients who underwent CRT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Maas M, Nelemans PJ, Valentini V et al (2010) Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol 11:835–844

    Article  Google Scholar 

  2. Karagkounis G, Kalady MF (2017) Molecular biology: are we getting any closer to providing clinically useful information? Clin Colon Rectal Surg 30:415–422

    Article  Google Scholar 

  3. Zhang Z, Wang S, Ji D et al (2018) Construction of a ceRNA network reveals potential lncRNA biomarkers in rectal adenocarcinoma. Oncol Rep 39:2101–2113

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Rampazzo E, Del Bianco P, Bertorelle R et al (2018) The predictive and prognostic potential of plasma telomerase reverse transcriptase (TERT) RNA in rectal cancer patients. Br J Cancer 118:878–886

    Article  CAS  Google Scholar 

  5. Conde-Muíño R, Cuadros M, Zambudio N, Segura-Jiménez I, Cano C, Palma P (2015) Predictive biomarkers to chemoradiation in locally advanced rectal cancer. Biomed Res Int 2015:921435

    Article  Google Scholar 

  6. Seicean R, Funariu G, Seicean A (2004) Molecular prognostic factors in rectal cancer. Rom J Gastroenterol 13:223–231

    PubMed  Google Scholar 

  7. Zeestraten EC, Kuppen PJ, van de Velde CJ, Marijnen CA (2012) Prediction in rectal cancer. Semin Radiat Oncol 22:175–183

    Article  Google Scholar 

  8. Sethi G, Shanmugam MK, Ramachandran L, Kumar AP, Tergaonkar V (2012) Multifaceted link between cancer and inflammation. Biosci Rep 32:1–15

    Article  CAS  Google Scholar 

  9. Ke TM, Lin LC, Huang CC, Chien YW, Ting WC, Yang CC (2020) High neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio predict poor survival in rectal cancer patients receiving neoadjuvant concurrent chemoradiotherapy. Medicine 99:e19877

    Article  CAS  Google Scholar 

  10. Carruthers R, Tho LM, Brown J, Kakumanu S, McCartney E, McDonald AC (2012) Systemic inflammatory response is a predictor of outcome in patients undergoing preoperative chemoradiation for locally advanced rectal cancer. Colorectal Dis 14:e701–e707

    Article  CAS  Google Scholar 

  11. Nagasaki T, Akiyoshi T, Fujimoto Y et al (2015) Prognostic impact of neutrophil-to-lymphocyte ratio in patients with advanced low rectal cancer treated with preoperative chemoradiotherapy. Dig Surg 32:496–503

    Article  CAS  Google Scholar 

  12. Portale G, Cavallin F, Valdegamberi A, Frigo F, Fiscon V (2018) Platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio are not prognostic biomarkers in rectal cancer patients with curative resection. J Gastrointest Surg 22:1611–1618

    Article  Google Scholar 

  13. Shen J, Zhu Y, Wu W et al (2017) Prognostic role of neutrophil-to-lymphocyte ratio in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy. Med Sci Monit 23:315–324

    Article  Google Scholar 

  14. Dudani S, Marginean H, Tang PA et al (2019) Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as predictive and prognostic markers in patients with locally advanced rectal cancer treated with neoadjuvant chemoradiation. BMC Cancer 19:664

    Article  Google Scholar 

  15. Lino-Silva LS, Salcedo-Hernández RA, Ruiz-García EB, García-Pérez L, Herrera-Gómez Á (2016) Pre-operative neutrophils/lymphocyte ratio in rectal cancer patients with preoperative chemoradiotherapy. Med Arch 70:256–260

    PubMed  PubMed Central  Google Scholar 

  16. Oh SY, Heo J, Noh OK, Chun M, Cho O, Oh YT (2018) Absolute lymphocyte count in preoperative chemoradiotherapy for rectal cancer: changes over time and prognostic significance. Technol Cancer Res Treat 17:1533033818780065

    Article  Google Scholar 

  17. Liu H, Wang H, Wu J, Wang Y, Zhao L, Li G, Zhou M (2019) Lymphocyte nadir predicts tumor response and survival in locally advanced rectal cancer after neoadjuvant chemoradiotherapy: immunologic relevance. Radiother Oncol 131:52–59

    Article  Google Scholar 

  18. Diefenhardt M, Hofheinz RD, Martin D et al (2019) Leukocytosis and neutrophilia as independent prognostic immunological biomarkers for clinical outcome in the CAO/ARO/AIO-04 randomized phase 3 rectal cancer trial. Int J Cancer 145:2282–2291

    Article  CAS  Google Scholar 

  19. Meng X, Shi D, Zheng H, Xu Y, Li Q, Cai S, Cai G (2017) High preoperative peripheral blood neutrophil predicts poor outcome in rectal cancer treated with neoadjunctive chemoradiation therapy. Int J Clin Exp Pathol 10:7718–7725

    PubMed  PubMed Central  Google Scholar 

  20. Collins GS, Reitsma JB, Altman DG (2015) Moons KG (2015) Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement. Br J Cancer 112:251–259

    Article  CAS  Google Scholar 

  21. Dinaux AM, Leijssen L, Bordeianou LG, Kunitake H, Amri R, Berger DL (2018) Outcomes of persistent lymph node involvement after neoadjuvant therapy for stage III rectal cancer. Surgery 163:784–788

    Article  Google Scholar 

  22. Okugawa Y, Toiyama Y, Fujikawa H et al (2020) Prognostic potential of lymphocyte-C-reactive protein ratio in patients with rectal cancer receiving preoperative chemoradiotherapy. J Gastrointest Surg 25:492–502

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, 16499, Korea

    Sunseok Yoon, Yoon Oh & Seung Yeop Oh

Authors
  1. Sunseok Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoon Oh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seung Yeop Oh
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SYO contributed to design of this paper, analysis of data, revising this paper and final approval. SY contributed to design of this paper, analysis of data, revising this paper and final approval. YO contributed to design of this paper, analysis of data, revising this paper and final approval.

Corresponding author

Correspondence to Seung Yeop Oh.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yoon, S., Oh, Y. & Oh, S.Y. Clinical Implications of Combined Lymphocyte and Neutrophil Count in Locally Advanced Rectal Cancer After Preoperative Chemoradiotherapy. World J Surg 45, 2591–2600 (2021). https://doi.org/10.1007/s00268-021-06126-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-021-06126-z

Search

Navigation