Predictive and prognostic value of inflammatory markers in locally advanced rectal cancer (PILLAR) – A multicentric analysis by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Gastrointestinal Study Group
Background: Patients (pts) affected with locally advanced rectal cancer (LARC) may respond differently to neoadjuvant chemoradiotherapy (nCRT). The identification of reliable biomarkers able to predict oncological outcomes could help in the development of risk-adapted treatment strategies. It has be...
| Main Authors: | , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | Clinical and Translational Radiation Oncology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405630823000046 |
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| author | Giuditta Chiloiro Angela Romano Silvia Mariani Gabriella Macchia Diana Giannarelli Luciana Caravatta Pierfrancesco Franco Luca Boldrini Alessandra Arcelli Almalina Bacigalupo Liliana Belgioia Antonella Fontana Elisa Meldolesi Giampaolo Montesi Rita Marina Niespolo Elisa Palazzari Cristina Piva Vincenzo Valentini Maria Antonietta Gambacorta |
| author_facet | Giuditta Chiloiro Angela Romano Silvia Mariani Gabriella Macchia Diana Giannarelli Luciana Caravatta Pierfrancesco Franco Luca Boldrini Alessandra Arcelli Almalina Bacigalupo Liliana Belgioia Antonella Fontana Elisa Meldolesi Giampaolo Montesi Rita Marina Niespolo Elisa Palazzari Cristina Piva Vincenzo Valentini Maria Antonietta Gambacorta |
| author_sort | Giuditta Chiloiro |
| collection | DOAJ |
| description | Background: Patients (pts) affected with locally advanced rectal cancer (LARC) may respond differently to neoadjuvant chemoradiotherapy (nCRT). The identification of reliable biomarkers able to predict oncological outcomes could help in the development of risk-adapted treatment strategies. It has been suggested that inflammation parameters may have a role in predicting tumor response to nCRT and survival outcomes and in rectal cancer, but no definitive conclusion can be drawn at present. The aim of the current study is to evaluate the role of baseline inflammatory markers as prognostic and predictive factors in a large multicentric Italian cohort of LARC pts. Methods: Patients diagnosed with LARC from January 2002 to December 2019 in 9 Italian centers were retrospectively collected. Patients underwent long-course RT with chemotherapy based on fluoropyrimidine ± oxaliplatin followed by surgery. Inflammatory markers were retrieved based on a pre-treatment blood sample including HEI (hemo-eosinophils inflammation index), SII (systemic index of inflammation), NLR (neutrophil-to-lymphocyte ratio), PLR (platelet-to-lymphocyte ratio) and MLR (monocyte-to-lymphocyte ratio). Outcomes of interest were pathological complete response (pCR), disease-free survival (DFS), and overall survival (OS). Results: 808 pts were analyzed. pCR rate was 22 %, 5yOS and 5yDFS were 84.0% and 63.1% respectively. Multivariate analysis identified that a NLR cut-off value >1.2 and SII cut-off value >500 could predict pCR (p = 0.05 and 0.009 respectively). In addition to age, extramesorectal nodes and RT dose, MLR >0.18 (p = 0.03) and HEI = 3 (p = 0.05) were independent prognostic factors for DFS. Finally, age, RT dose, MLR with a cut-off >0.35 (p = 0.028) and HEI = 3 (p = 0.045) were independent predictors of OS. Conclusions: Higher values of baseline composite inflammatory markers can serve as predictors of lower pCR rates and worse survival outcomes in LARC patients undergoing nCRT. More reliable data from prospective studies could lead to the integration of these inexpensive and easy-to-derive tools into clinical practice. |
| first_indexed | 2024-04-10T06:33:50Z |
| format | Article |
| id | doaj.art-3458d5335f34428f8f771469654d6cd0 |
| institution | Directory Open Access Journal |
| issn | 2405-6308 |
| language | English |
| last_indexed | 2024-04-10T06:33:50Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical and Translational Radiation Oncology |
| spelling | doaj.art-3458d5335f34428f8f771469654d6cd02023-03-01T04:32:19ZengElsevierClinical and Translational Radiation Oncology2405-63082023-03-0139100579Predictive and prognostic value of inflammatory markers in locally advanced rectal cancer (PILLAR) – A multicentric analysis by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Gastrointestinal Study GroupGiuditta Chiloiro0Angela Romano1Silvia Mariani2Gabriella Macchia3Diana Giannarelli4Luciana Caravatta5Pierfrancesco Franco6Luca Boldrini7Alessandra Arcelli8Almalina Bacigalupo9Liliana Belgioia10Antonella Fontana11Elisa Meldolesi12Giampaolo Montesi13Rita Marina Niespolo14Elisa Palazzari15Cristina Piva16Vincenzo Valentini17Maria Antonietta Gambacorta18Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, ItalyDepartment of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, ItalyCatholic University of Sacred Heart, Rome, Italy; Corresponding author.Radiation Oncology Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, ItalyFacility of Epidemiology and Biostatistics, G-STEP Generator, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, ItalyRadiation Oncology Unit, “SS Annunziata” Hospital, “G. d'Annunzio” University, Chieti, ItalyDivision of Radiation Oncology, Department of Translational Medicine, University of Eastern Piedmont, and University Hospital “Maggiore della Carità”, Novara, ItalyDepartment of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, ItalyRadiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine – DIMES, University of Bologna S. Orsola-Malpighi Hospital, Bologna, ItalyDepartment of Health Science (DISSAL), University of Genoa, Genoa, ItalyDepartment of Health Science (DISSAL), University of Genoa, Genoa, ItalyRadiation Oncology Division, Santa Maria Goretti Hospital, Latina, ItalyDepartment of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, ItalyRadiation Oncology Unit, Santa Maria della Misericordia Hospital, Rovigo, ItalyRadiotherapy Unit, Azienda Ospedaliera San Gerardo, Monza, ItalyRadiation Oncology Department, Oncological Referral Center, Aviano, ItalyDepartment of Radiation Oncology, A.S.L. TO4, Ivrea Community Hospital, Ivrea, ItalyDepartment of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy; Catholic University of Sacred Heart, Rome, ItalyDepartment of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy; Catholic University of Sacred Heart, Rome, ItalyBackground: Patients (pts) affected with locally advanced rectal cancer (LARC) may respond differently to neoadjuvant chemoradiotherapy (nCRT). The identification of reliable biomarkers able to predict oncological outcomes could help in the development of risk-adapted treatment strategies. It has been suggested that inflammation parameters may have a role in predicting tumor response to nCRT and survival outcomes and in rectal cancer, but no definitive conclusion can be drawn at present. The aim of the current study is to evaluate the role of baseline inflammatory markers as prognostic and predictive factors in a large multicentric Italian cohort of LARC pts. Methods: Patients diagnosed with LARC from January 2002 to December 2019 in 9 Italian centers were retrospectively collected. Patients underwent long-course RT with chemotherapy based on fluoropyrimidine ± oxaliplatin followed by surgery. Inflammatory markers were retrieved based on a pre-treatment blood sample including HEI (hemo-eosinophils inflammation index), SII (systemic index of inflammation), NLR (neutrophil-to-lymphocyte ratio), PLR (platelet-to-lymphocyte ratio) and MLR (monocyte-to-lymphocyte ratio). Outcomes of interest were pathological complete response (pCR), disease-free survival (DFS), and overall survival (OS). Results: 808 pts were analyzed. pCR rate was 22 %, 5yOS and 5yDFS were 84.0% and 63.1% respectively. Multivariate analysis identified that a NLR cut-off value >1.2 and SII cut-off value >500 could predict pCR (p = 0.05 and 0.009 respectively). In addition to age, extramesorectal nodes and RT dose, MLR >0.18 (p = 0.03) and HEI = 3 (p = 0.05) were independent prognostic factors for DFS. Finally, age, RT dose, MLR with a cut-off >0.35 (p = 0.028) and HEI = 3 (p = 0.045) were independent predictors of OS. Conclusions: Higher values of baseline composite inflammatory markers can serve as predictors of lower pCR rates and worse survival outcomes in LARC patients undergoing nCRT. More reliable data from prospective studies could lead to the integration of these inexpensive and easy-to-derive tools into clinical practice.http://www.sciencedirect.com/science/article/pii/S2405630823000046Rectal cancerNeoadjuvant radiotherapyInflammatory markersPrognostic factorsPredictive factors |
| spellingShingle | Giuditta Chiloiro Angela Romano Silvia Mariani Gabriella Macchia Diana Giannarelli Luciana Caravatta Pierfrancesco Franco Luca Boldrini Alessandra Arcelli Almalina Bacigalupo Liliana Belgioia Antonella Fontana Elisa Meldolesi Giampaolo Montesi Rita Marina Niespolo Elisa Palazzari Cristina Piva Vincenzo Valentini Maria Antonietta Gambacorta Predictive and prognostic value of inflammatory markers in locally advanced rectal cancer (PILLAR) – A multicentric analysis by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Gastrointestinal Study Group Clinical and Translational Radiation Oncology Rectal cancer Neoadjuvant radiotherapy Inflammatory markers Prognostic factors Predictive factors |
| title | Predictive and prognostic value of inflammatory markers in locally advanced rectal cancer (PILLAR) – A multicentric analysis by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Gastrointestinal Study Group |
| title_full | Predictive and prognostic value of inflammatory markers in locally advanced rectal cancer (PILLAR) – A multicentric analysis by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Gastrointestinal Study Group |
| title_fullStr | Predictive and prognostic value of inflammatory markers in locally advanced rectal cancer (PILLAR) – A multicentric analysis by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Gastrointestinal Study Group |
| title_full_unstemmed | Predictive and prognostic value of inflammatory markers in locally advanced rectal cancer (PILLAR) – A multicentric analysis by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Gastrointestinal Study Group |
| title_short | Predictive and prognostic value of inflammatory markers in locally advanced rectal cancer (PILLAR) – A multicentric analysis by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Gastrointestinal Study Group |
| title_sort | predictive and prognostic value of inflammatory markers in locally advanced rectal cancer pillar a multicentric analysis by the italian association of radiotherapy and clinical oncology airo gastrointestinal study group |
| topic | Rectal cancer Neoadjuvant radiotherapy Inflammatory markers Prognostic factors Predictive factors |
| url | http://www.sciencedirect.com/science/article/pii/S2405630823000046 |
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