2Department of Medical Oncology, Istinye University, Istanbul-Turkey
3Department of General Surgery, Gazi State Hospital, Samsun-Turkey
4Department of Pathology, University of Health Sciences, Samsun Training and Research Hospital, Samsun-Turkey
5Department of Radiation Oncology, Memorial Hospital, Ankara-Turkey DOI : 10.5505/tjo.2022.3467 OBJECTIVE
The aim of this study is to investigate the relationship between baseline and post-treatment neutrophilto- lymphocyte ratio (NLR) levels and response to neoadjuvant chemoradiotherapy (CRT) in terms of good pathological response and survival.
METHODS
Fifty-six patients who underwent neoadjuvant CRT and curative surgery for locally advanced rectal
cancer (LARC) were analyzed retrospectively. Pre-CRT and post-CRT hematologic parameters were
recorded. The link between NLR and clinical outcomes was explored.
RESULTS
The receiver operating characteristic analysis revealed appropriate cut-off values of 2.87 for pre-CRT
NLR associated with good pathological response and 8.68 for post-CRT NLR predicting survival. The
low pre-CRT NLR group had better outcomes in terms of good pathological response compared to the
high pre-CRT NLR group (OR 4.15, 95% CI 1.23-13.76, p=0.021). However, the analysis failed to show
the correlation between NLR and pCR (OR 2.74, 95% CI 0.37-20.15, p=0.320). Patients with elevated
post-CRT NLR had significantly worse 5-year overall survival (OS), disease-free survival (DFS) and
local regional recurrence-free survival (LRRFS) rates compared to low post-CRT NLR in multivariate
analysis (46.6% vs. 74.4%, p=0.020; 35.3% vs. 71.9%, p=0.018; 40.8% vs. 78.1%, p=0.006).
CONCLUSION
High pre-CRT NLR might be used as a poor pathological tumor response predictor in LARC patients
treated with neoadjuvant CRT. In addition, low post-CRT NLR is associated with favorable OS, DFS,
and LRRFS. Therefore, easily accessible and cost-effective NLR can be considered as a potential predictive
marker to identify patients and establish personalized treatment strategies.