Association of neutrophil-to-lymphocyte ratio, radiotherapy fractionation/technique, and risk of development of distant metastasis among patients with locally advanced rectal cancer
Abstract Background We investigated the prognostic impact of the neutrophil-to-lymphocyte ratio (NLR) in patients with locally advanced rectal cancer (LARC) and whether modifiable factors in radiotherapy (RT) influenced the NLR. Methods Data of 1386 patients who were treated with neoadjuvant RT and...
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| Format: | Article |
| Language: | English |
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BMC
2022-05-01
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| Series: | Radiation Oncology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13014-022-02065-8 |
| _version_ | 1811256763000815616 |
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| author | Gowoon Yang Jee Suk Chang Jeong Eun Choi Eun Sil Baek Seung-Seob Kim Hwa Kyung Byun Yeona Cho Woong Sub Koom Seung Yoon Yang Byung Soh Min Sang Joon Shin |
| author_facet | Gowoon Yang Jee Suk Chang Jeong Eun Choi Eun Sil Baek Seung-Seob Kim Hwa Kyung Byun Yeona Cho Woong Sub Koom Seung Yoon Yang Byung Soh Min Sang Joon Shin |
| author_sort | Gowoon Yang |
| collection | DOAJ |
| description | Abstract Background We investigated the prognostic impact of the neutrophil-to-lymphocyte ratio (NLR) in patients with locally advanced rectal cancer (LARC) and whether modifiable factors in radiotherapy (RT) influenced the NLR. Methods Data of 1386 patients who were treated with neoadjuvant RT and concurrent or sequential chemotherapy for LARC between 2006 and 2019 were evaluated. Most patients (97.8%) were treated with long-course RT (LCRT; 50–50.4 Gy in 25–28 fractions) using three-dimensional conformal radiotherapy (3D-CRT) (n = 851) or helical tomotherapy (n = 504), and 30 patients underwent short-course RT (SCRT; 25 Gy in 5 fractions, followed by XELOX administration for 6 weeks). Absolute neutrophil and lymphocyte counts were obtained at initial diagnosis, before and during the preoperative RT course, and after preoperative concurrent chemoradiotherapy. The primary endpoint was distant metastasis-free survival (DMFS). Results The median follow-up time was 61.3 (4.1–173.7) months; the 5-year DMFS was 80.1% and was significantly associated with the NLR after RT but not before. A post-RT NLR ≥ 4 independently correlated with worse DMFS (hazard ratio, 1.42; 95% confidence interval, 1.12–1.80), along with higher ypT and ypN stages. Post-RT NLR (≥ 4) more frequently increased following LCRT (vs. SCRT, odds ratio [OR] 2.77, p = 0.012) or helical tomotherapy (vs. 3D-CRT, OR 1.29, p < 0.001). Conclusions Increased NLR after neoadjuvant RT is associated with increased distant metastasis risk and poor survival outcome in patients with LARC. Moreover, high NLR following RT is directly related to RT fractionation, delivery modality, and tumor characteristics. These results are hypothesis-generating only, and confirmatory studies are required. |
| first_indexed | 2024-04-12T17:46:15Z |
| format | Article |
| id | doaj.art-6e8cc9d626b64e0c9e42e61496fde15b |
| institution | Directory Open Access Journal |
| issn | 1748-717X |
| language | English |
| last_indexed | 2024-04-12T17:46:15Z |
| publishDate | 2022-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj.art-6e8cc9d626b64e0c9e42e61496fde15b2022-12-22T03:22:40ZengBMCRadiation Oncology1748-717X2022-05-0117111110.1186/s13014-022-02065-8Association of neutrophil-to-lymphocyte ratio, radiotherapy fractionation/technique, and risk of development of distant metastasis among patients with locally advanced rectal cancerGowoon Yang0Jee Suk Chang1Jeong Eun Choi2Eun Sil Baek3Seung-Seob Kim4Hwa Kyung Byun5Yeona Cho6Woong Sub Koom7Seung Yoon Yang8Byung Soh Min9Sang Joon Shin10Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of MedicineDepartment of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of MedicineSongdang Institute for Cancer Research, Yonsei University College of MedicineSongdang Institute for Cancer Research, Yonsei University College of MedicineDepartment of Radiology, Severance Hospital, Yonsei University College of MedicineDepartment of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of MedicineDepartment of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of MedicineDepartment of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of MedicineDepartment of Surgery, Yonsei Cancer Center, Yonsei University College of MedicineDepartment of Surgery, Yonsei Cancer Center, Yonsei University College of MedicineDepartment of Internal Medicine, Yonsei Cancer Center, Yonsei University College of MedicineAbstract Background We investigated the prognostic impact of the neutrophil-to-lymphocyte ratio (NLR) in patients with locally advanced rectal cancer (LARC) and whether modifiable factors in radiotherapy (RT) influenced the NLR. Methods Data of 1386 patients who were treated with neoadjuvant RT and concurrent or sequential chemotherapy for LARC between 2006 and 2019 were evaluated. Most patients (97.8%) were treated with long-course RT (LCRT; 50–50.4 Gy in 25–28 fractions) using three-dimensional conformal radiotherapy (3D-CRT) (n = 851) or helical tomotherapy (n = 504), and 30 patients underwent short-course RT (SCRT; 25 Gy in 5 fractions, followed by XELOX administration for 6 weeks). Absolute neutrophil and lymphocyte counts were obtained at initial diagnosis, before and during the preoperative RT course, and after preoperative concurrent chemoradiotherapy. The primary endpoint was distant metastasis-free survival (DMFS). Results The median follow-up time was 61.3 (4.1–173.7) months; the 5-year DMFS was 80.1% and was significantly associated with the NLR after RT but not before. A post-RT NLR ≥ 4 independently correlated with worse DMFS (hazard ratio, 1.42; 95% confidence interval, 1.12–1.80), along with higher ypT and ypN stages. Post-RT NLR (≥ 4) more frequently increased following LCRT (vs. SCRT, odds ratio [OR] 2.77, p = 0.012) or helical tomotherapy (vs. 3D-CRT, OR 1.29, p < 0.001). Conclusions Increased NLR after neoadjuvant RT is associated with increased distant metastasis risk and poor survival outcome in patients with LARC. Moreover, high NLR following RT is directly related to RT fractionation, delivery modality, and tumor characteristics. These results are hypothesis-generating only, and confirmatory studies are required.https://doi.org/10.1186/s13014-022-02065-8NeutrophilLymphocyteDistant metastasis-free survivalPoor outcomeRectal neoplasm |
| spellingShingle | Gowoon Yang Jee Suk Chang Jeong Eun Choi Eun Sil Baek Seung-Seob Kim Hwa Kyung Byun Yeona Cho Woong Sub Koom Seung Yoon Yang Byung Soh Min Sang Joon Shin Association of neutrophil-to-lymphocyte ratio, radiotherapy fractionation/technique, and risk of development of distant metastasis among patients with locally advanced rectal cancer Radiation Oncology Neutrophil Lymphocyte Distant metastasis-free survival Poor outcome Rectal neoplasm |
| title | Association of neutrophil-to-lymphocyte ratio, radiotherapy fractionation/technique, and risk of development of distant metastasis among patients with locally advanced rectal cancer |
| title_full | Association of neutrophil-to-lymphocyte ratio, radiotherapy fractionation/technique, and risk of development of distant metastasis among patients with locally advanced rectal cancer |
| title_fullStr | Association of neutrophil-to-lymphocyte ratio, radiotherapy fractionation/technique, and risk of development of distant metastasis among patients with locally advanced rectal cancer |
| title_full_unstemmed | Association of neutrophil-to-lymphocyte ratio, radiotherapy fractionation/technique, and risk of development of distant metastasis among patients with locally advanced rectal cancer |
| title_short | Association of neutrophil-to-lymphocyte ratio, radiotherapy fractionation/technique, and risk of development of distant metastasis among patients with locally advanced rectal cancer |
| title_sort | association of neutrophil to lymphocyte ratio radiotherapy fractionation technique and risk of development of distant metastasis among patients with locally advanced rectal cancer |
| topic | Neutrophil Lymphocyte Distant metastasis-free survival Poor outcome Rectal neoplasm |
| url | https://doi.org/10.1186/s13014-022-02065-8 |
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