The Prognostic Value Of Systemic Inflammatory Markers In Neoadjuvant Chemoradiotherapy For Locally Advanced Rectal Cancer

Objective:To investigate the prognostic value of systemic inflammatory markers in locally advanced rectal cancer(LARC)after neoadjuvant chemoradiotherapy(NCRT).Meth:From January 2011 to January 2016,LARC patients receiving NCRT and radical rectal surgery in the department of colorectal surgery,Fujian medical university union hospital were retrospectively collected.According to the inclusion and exclusion criteria,a total of 472 patients were included.According to the relevant literature,four representative inflammatory markers were selected,systemic immune-inflammation index(SII),neutrophil-to-lymphocyte(NLR),platelet-to-lymphocyte(PLR)and monocyte-to-lymphocyte(MLR),age,sex,ASA grade,distance from the anal verge,Pathological TNM stage,tumor size,AJCC tumor regression grading,interval time between NCRT,clinical T stage and clinical N stage,postoperative hospitalization days,pre-NCRT CEA and CA19-9 level,anemia,hypoalbuminemia,completion adjuvant chemotherapy or not,postoperative complications,nerve invasion,vascular invasion,tumor differentiation and the histopathology.As an indicator of relevant risk factors for disease-free survival(DFS)and overall survival(OS).The best interception points for SII,NLR,PLR and MLR were calculated using the x-tile software as 797.6,2.3,169.5 and 0.4,respectively.SPSS21.0 software was used for statistical analysis.The t-test,χ~2 test or Fisher’s exact probability method were used for single factor analysis comparison of each risk factor index.Kaplan-Meier method was used to draw the survival curve and calculate the survival rate.The R software was used to build the nomogram on the basis of multi-factor results,and the predictive power of the nomogram was internally verified.The predictive value of NLR was evaluated by TIME-ROC curve and KM analysis.Result:Cox univariate analysis showed that tumor size,postoperative pathological TNM staging,AJCC grading,pre-NCRT CEA and CA19-9 values,anemia or not,tumor differentiation,SII,NLR and PLR were strongly correlated with DFS and OS.Cox multivariate analysis showed that AJCC tumor regression grade(P=0.041),pre-NCRT CA19-9 value(P=0.036),postoperative pathological TNM stage(P<0.001)and NLR value(P=0.046)were independent risk factors for OS;AJCC tumor regression grade(P=0.027),pre-NCRT CA19-9 value(P=0.047),pre-NCRT clinical T stage(P=0.040),postoperative pathological TNM stage(P<0.001)and NLR value(P=0.044)were independent risk factors for DFS.Groups with higher NLR values(≥2.3)had higher pre-NCRT CA19-9 values(P=0.012),more anemia patients(P=0.024),larger tumor size(P<0.001),and more lymph nodes retrieved numbers(P<0.001).Conclusion:This study confirmed that NLR,SII,PLR and MLR,as markers of inflammation,are all related factors for prognosis and outcome of LARC patients after NCRT.As the best inflammatory marker,NLR is not only an independent risk factor for prognosis and outcome of LARC patients after NCRT,but also has important value in predicting survival.