Response Prediction to Neoadjuvant Chemoradiotherapy in Rectal Cancer Based on Systemic Inflammatory Markers (NLR, PLR, and LMR).

IF 1.6 Q4 ONCOLOGY

Journal of Gastrointestinal Cancer Pub Date : 2025-06-12 DOI:10.1007/s12029-025-01255-3

Roger Beltrati Coser, Caio Sergio R Nahas, Alex Jones Flores Cassenote, Omar S T Ghani, Rafaela B B Pinheiro, Sergio Carlos Nahas, Carlos Frederico S Marques

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引用次数: 0

Abstract

Purpose: This study aimed to evaluate whether systemic inflammatory markers-neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR)-can predict tumor response to neoadjuvant chemoradiotherapy (nCRT) in patients with rectal cancer.

Methods: A retrospective, single-center study included 396 patients with biopsy-proven rectal cancer (clinical stage T2-4NxM0 or any T N + M0) treated with curative intent. All patients underwent standardized nCRT, followed by either radical surgery with total mesorectal excision (TME) or non-operative management in cases of sustained complete clinical response (cCR). Pre-treatment NLR, PLR, and LMR were calculated from baseline blood counts. Tumor response was categorized using tumor regression grade (TRG): TRG 0 (complete response), TRG 1 (almost complete), TRG 2 (partial), and TRG 3 (no response).

Results: Incomplete responders (TRG 1-3) had higher NLR (p < 0.001), PLR (p = 0.002), and carcinoembryonic antigen (CEA, p < 0.001), and were more frequently male (p = 0.021). Complete responders (TRG 0) were more associated with higher LMR (p < 0.001), elevated hemoglobin levels (p = 0.049), more comorbidities (p = 0.001), and greater use of antihypertensives (p = 0.012) and antiplatelet/anticoagulant drugs (p = 0.045). Risk estimates of incomplete response were as follows: NLR > 2.08 (RR 2.30, 95% CI 1.60-3.31), PLR > 129.36 (RR 1.79, 95% CI 1.25-2.05), and LMR > 2.67 (RR 0.42, 95% CI 0.26-0.66).

Conclusion: Pre-treatment NLR, PLR, and LMR are predictors of response to nCRT in patients with rectal cancer. An NLR > 2.08 is an independent predictor of incomplete response to nCRT. These findings contribute a cost-effective and readily available tool to the rectal cancer management arsenal.

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基于全身炎症标志物（NLR， PLR和LMR）的直肠癌新辅助放化疗反应预测。

目的：本研究旨在评估全身炎症标志物——中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）和淋巴细胞与单核细胞比值（LMR）——是否可以预测直肠癌患者对新辅助放化疗（nCRT）的肿瘤反应。方法：一项回顾性的单中心研究纳入了396例活检证实的直肠癌（临床分期T2-4NxM0或任何T N + M0），并以治愈为目的进行治疗。所有患者都接受了标准化的nCRT，然后在持续完全临床缓解（cCR）的情况下进行根治性手术和全肠系膜切除术（TME）或非手术治疗。根据基线血液计数计算治疗前NLR、PLR和LMR。采用肿瘤消退等级（TRG）对肿瘤反应进行分类：TRG 0（完全缓解）、TRG 1（几乎完全缓解）、TRG 2（部分缓解）和TRG 3（无缓解）。结果：不完全应答者（TRG 1-3） NLR较高(p 2.08 (RR 2.30, 95% CI 1.60-3.31)， PLR为129.36 (RR 1.79, 95% CI 1.25-2.05)， LMR为2.67 （RR 0.42, 95% CI 0.26-0.66）。结论：治疗前NLR、PLR和LMR是直肠癌患者对nCRT反应的预测因子。NLR为2.08，是nCRT不完全反应的独立预测因子。这些发现为直肠癌的治疗提供了一种成本效益高且易于获得的工具。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Gastrointestinal Cancer ONCOLOGY-

CiteScore

3.80

自引率

0.00%

发文量

121

期刊介绍： The Journal of Gastrointestinal Cancer is a multidisciplinary medium for the publication of novel research pertaining to cancers arising from the gastrointestinal tract.The journal is dedicated to the most rapid publication possible.The journal publishes papers in all relevant fields, emphasizing those studies that are helpful in understanding and treating cancers affecting the esophagus, stomach, liver, gallbladder and biliary tree, pancreas, small bowel, large bowel, rectum, and anus. In addition, the Journal of Gastrointestinal Cancer publishes basic and translational scientific information from studies providing insight into the etiology and progression of cancers affecting these organs. New insights are provided from diverse areas of research such as studies exploring pre-neoplastic states, risk factors, epidemiology, genetics, preclinical therapeutics, surgery, radiation therapy, novel medical therapeutics, clinical trials, and outcome studies.In addition to reports of original clinical and experimental studies, the journal also publishes: case reports, state-of-the-art reviews on topics of immediate interest or importance; invited articles analyzing particular areas of pancreatic research and knowledge; perspectives in which critical evaluation and conflicting opinions about current topics may be expressed; meeting highlights that summarize important points presented at recent meetings; abstracts of symposia and conferences; book reviews; hypotheses; Letters to the Editors; and other items of special interest, including:Complex Cases in GI Oncology: This is a new initiative to provide a forum to review and discuss the history and management of complex and involved gastrointestinal oncology cases. The format will be similar to a teaching case conference where a case vignette is presented and is followed by a series of questions and discussion points. A brief reference list supporting the points made in discussion would be expected.