To explore the characteristics of cancer-associated systemic and local inflammation and its impact on overall survival (OS) in locally advanced rectal cancer (LARC) treated with neoadjuvant radiotherapy (RT).
A consecutive cohort of 76 LARC patients underwent neoadjuvant RT were retrospectively analyzed from February 2012 to September 2015. Peripheral neutrophil to lymphocyte ratio (NLR) was calculated at diagnosis, and tumor-infiltrating lymphocyte was examined in postoperative tumor tissue by immunohistochemistry. The association between clinicopathological features and inflammation was explored through chi-square test. The prognostic factors in terms of OS were investigated through uni- and multivariate Cox regression. SPSS 22.0 was used for statistical analyses.
The median follow-up time was 29.0 months (range, 2-59). The 1-, 3- and 5-year OS rates were 93.4% (95%CI 87.91-98.89), 80.0% (95%CI 69.81-90.19) and 68.6% (95%CI 46.06-91.14), respectively. High NLR (≥2.0) and low CD8+ T-cells (<9%) were more common in 76 patients (53.9% and 59.2%, respectively). For patients with high NLR and low CD8+ T-cells, 5-year OS was significantly worse than those with low NLR and high CD8+ T-cells (P = 0.005). Also, NLR ≥ 2.0 was associated with poor tumor regression after neoadjuvant RT (P = 0.039), while no significant association was found between CD8+ T-cells and tumor regression. In addition, NLR was related to lymphovascular invasion (P = 0.031). CD8+ T-cell was related to neural invasion (P = 0.048) and mucinous adenocarcinoma (P = 0.045). Furthermore, NLR (HR 7.71, 95%CI 1.30-45.71, P = 0.025), CD8+ T-cells (HR 0.09, 95%CI 0.01-0.67, P = 0.018) , age (HR 16.1, 95%CI 1.56-167.15, P = 0.020), lymphovascular invasion (HR 7.17, 95%CI 1.12-46.05, P = 0.038) and T stage (HR 0.03, 95%CI 0.00-0.45, P = 0.011) were independent risk factors for prognosis according to multivariate Cox regression.
High NLR and low CD8+ T-cells were significantly associated with dismal survival. Systemic combined with local inflammation might help to predict prognosis of LARC with neoadjuvant RT.
Clinical trial identification
Legal entity responsible for the study
National Clinical Key Specialty Construction Program.
All authors have declared no conflicts of interest.