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Prognostic Role of Peripheral Neutrophil-Lymphocyte Ratio (NLR) and Platelet-Lymphocyte Ratio (PLR) in Patients with Rectal Cancer Undergoing Neoadjuvant Chemoradiotherapy

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Abstract

Purpose

To investigate the predictive and prognostic role of pretreatment hematological parameters for tumor response and outcomes in locally advanced rectal cancer (LARC) patients undergoing surgery after neoadjuvant chemoradiotherapy (nCRT).

Methods

From 2010 to 2016, 53 patients with LARC who underwent surgery following nCRT were analyzed. All hematological parameters were obtained from the initial blood tests performed before nCRT. The optimal cutoff values of significant hematological parameters for pathological tumor response (pTR), disease-free survival (DFS), and overall survival (OS) were determined using receiver operating characteristic (ROC) analysis. Patients have categorized into “good” and “poor” response groups according to their pathological results, and clinical-pathologic variables compared between the two groups. All survival analysis was calculated by the Kaplan-Meier method. Uni-multivariate analyses were performed using the Cox proportional hazard model.

Results

In the ROC analysis, neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) for OS and absolute platelet count and PLR for DFS were found as significant prognostic factors. In multivariate analysis, surgical margin, ypN stage, and elevated PLR were significantly associated with OS, and likewise, high PLR was found as an independent poor prognostic factor for DFS. The 5-year OS and DFS rates were worse in patients with high PLR group (82.3 vs. 47.3% for OS, p = 0.018 and 88.2 vs. 51.3% for DFS, p = 0.002).

Conclusion

Pretreatment high PLR is associated with worse OS and DFS in patients with rectal cancer. To use in daily practice, further studies are needed on its validation.

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Authors and Affiliations

  1. Cerrahpasa Medical Faculty Department of Radiation Oncology, Istanbul University-Cerrahpasa, 34098, Istanbul, Turkey

    Şefika Arzu Ergen, Ceren Barlas, Cumhur Yıldırım & Didem Çolpan Öksüz

Authors
  1. Şefika Arzu Ergen
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  2. Ceren Barlas
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  3. Cumhur Yıldırım
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  4. Didem Çolpan Öksüz
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Şefika Arzu Ergen, Ceren Barlas, and Cumhur Yıldırım. The first draft of the manuscript was written by Şefika Arzu Ergen and Ceren Barlas and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Şefika Arzu Ergen.

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The authors declare that they have no conflict of interest.

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The study protocol was approved by Ethics Committee of the Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty (number A-53).

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Ergen, Ş.A., Barlas, C., Yıldırım, C. et al. Prognostic Role of Peripheral Neutrophil-Lymphocyte Ratio (NLR) and Platelet-Lymphocyte Ratio (PLR) in Patients with Rectal Cancer Undergoing Neoadjuvant Chemoradiotherapy. J Gastrointest Canc 53, 151–160 (2022). https://doi.org/10.1007/s12029-020-00578-7

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