Immunomarkers could predict overall survival and disease-free survival after neoadjuvant therapy and surgery due to locally advanced rectal cancer.

Background: In daily clinical practice, patients with similar risk profiles often show varied oncologic outcomes, including differing responses to neoadjuvant therapy and surgery. In this study, we seek to analyze the relationship of neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), and monocyte-to-lymphocyte (MLR) ratios with survival and recurrence in patients treated for locally advanced rectal cancer.

Material and methods: We have conducted a retrospective analysis of patients operated on due to rectal cancer with neoadjuvant long-course radiotherapy and sensitizing chemotherapy. After neoadjuvant therapy and before surgery, these immunomarker indices were analyzed. Each index was assigned a cut-off point to assess their association with overall survival (OS) and disease-free survival (DFS).

Results: A total of 156 patients were analyzed with a median follow-up of 71.5 months (51-89). The NLR index was identified as an independent predictor of 5-year OS and DFS. Values above the 6.3 cut-off point showed an OS of 58.9% (P = .019); in patients with values above 4.72, DFS was 57.4% (P = .034). Patients whose 3 indices (NLR, PLR, MLR) were elevated had a 5-year OS of 25% (HR 3.16, 95% CI [1.45-6.87], P = .004); and a 5-year DFS of 39.4% (HR 2.88, 95% CI [1.35-6.17], P = .006).

Conclusions: Elevated preoperative immunomarker values are related to worse outcomes in terms of OS and DFS in those patients with locally advanced rectal cancer after neoadjuvant therapy. The combination of the three indices is more accurate in predicting OS and DFS. These immunomarkers may be useful in choosing an individualized therapeutic strategy.