Association Of Markers Of Systemic And Local Inflammation With Prognosis Of Rectal Cancer Patients With Neoadjuvant Radiotherapy

Background:The inflammatory status may play an important part on the short-term radiotherapy efficacy and long-term survival in cancer patients.We aimed to study the characteristics of systemic and local inflammation and its impact on the survival of patients with locally advanced rectal cancer(LARC)after neoadjuvant radiotherapy(n RT).Methods:A total of 76 consecutive LARC patients after n RT from February 2012 to September 2015 in our institute were analyzed retrospectively.The peripheral neutrophil-to-lymphocyte ratio(NLR)was determined by routine blood test,and the CD8+ T cell counts were determined by immunohistochemical analysis.The optimal cutoff was calculated through Cutoff Finder,and the statistical analyses were conducted by SPSS 22.0.Results:The median follow-up time was 23.0 months(range,2-59),and the overall5-year disease free survival(DFS)and overall survival(OS)were respectively28.4% and 68.6%.After n RT,NLR was significantly increased(P = 0.000).And there was no significant difference in CD8+ T cell count(P = 0.343).Moreover,NLR was also associated with lymphovascular invasion(OR 9.298,P = 0.014)and T stage(OR 3.324,P = 0.047),and CD8+ T cell count was associated with mucinous adenocarcinoma(OR 0.056,P = 0.005)and T stage(OR 0.279,P =0.049).Furthermore,compared with high NLR group(≥2.0),the low NLR group(<2.0)was related to better pathological complete regression(2.6% vs.17.1%,P =0.034).In the multivariate Cox regression model,CD8+ T cell count(HR 0.410,95% CI 0.192-0.873,P = 0.021)and lymphovascular invasion(HR 2.409,95% CI1.155-5.026,P = 0.019)were independent predictors of DFS.Moreover,NLR(HR7.707,95% CI 1.300-45.709,P = 0.025),CD8+ T cell count(HR 0.088,95% CI0.012-0.665,P = 0.018),age(HR 16.130,95% CI 1.557-167.151,P = 0.020),lymphovascular invasion(HR 7.166,95% CI 1.115-46.047,P = 0.038)and stage T(HR 0.029,95% CI 0.002-0.449,P = 0.011)were independent prognostic factors of OS.Conclusions:A high NLR was significantly associated with better tumor regression after n RT.Moreover,CD8+ T cell count was an independent prognostic factor of DFS,while NLR and CD8+ T cell count were independent risk factors of OS.Therefore,inflammation status was a potential predictor for treatment efficacy and survival in LARC patients who received nRT.