Prognostic Potential of Lymphocyte–C-Reactive Protein Ratio in Patients with Rectal Cancer Receiving Preoperative Chemoradiotherapy

• Published in: Journal of gastrointestinal surgery 2021-02, Vol.25 (2), p.492-502
• Main Authors: Okugawa, Yoshinaga, Toiyama, Yuji, Fujikawa, Hiroyuki, Ide, Shozo, Yamamoto, Akira, Omura, Yusuke, Yin, Chengzeng, Kusunoki, Kurando, Kusunoki, Yukina, Yasuda, Hiromi, Yokoe, Takeshi, Hiro, Junichiro, Ohi, Masaki, Kusunoki, Masato
• Format: Article
• Language: English
• Subjects: C-Reactive Protein; Chemoradiotherapy; Chemotherapy; Colorectal cancer; Disease-Free Survival; Gastroenterology; Humans; Lymphatic system; Lymphocytes - pathology; Medical prognosis; Medicine; Medicine & Public Health; Metastasis; Neoadjuvant Therapy; Neoplasm Staging; Original Article; Prognosis; Radiation therapy; Rectal Neoplasms - pathology; Retrospective Studies; Surgery
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-019-04495-4

Purpose The systemic inflammatory response is attracting increasing attention as a predictive biomarker for oncological outcome in patients with colorectal cancer. This study is aimed at verifying if the lymphocyte–C-reactive protein (CRP) ratio (LCR) could be used as a predictor of oncological outcome in patients with rectal cancer (RC) receiving preoperative chemoradiotherapy (CRT). Methods We analyzed data for 86 patients with RC who received preoperative CRT followed by total mesorectal excision at our institution. A ratio of 6000 was used as the cut-off value for LCR for further analysis. Results The post-CRT LCR was significantly lower than the pre-CRT LCR in patients with RC. Although post-CRT LCR status was not significantly correlated with overall survival (OS), low pre-CRT LCR was significantly associated with shorter recurrence-free survival (RFS: p  = 0.02) and OS ( p  = 0.017) in this population and was an independent prognostic factor for both RFS and OS (hazard ratio (HR) 3.19, 95% confidence interval (CI) 1.33–7.66, p  = 0.009; HR 2.83, 95%CI 1.14–7.01, p  = 0.025, respectively). Furthermore, low pre-CRT LCR was a stronger indicator of early recurrence ( p  = 0.001) and poor prognosis ( p  = 0.025) in RC patients without pathological lymph node metastasis compared with patients with pathological lymph node metastasis, and prognostic potential of pre-CRT LCR was clearly revealed especially RC patients receiving long-course CRT. Conclusions Assessment of pretreatment LCR status might aid decision-making regarding postoperative treatment strategies in patients with RC receiving CRT followed by potentially curative resection.