Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2020; 12(9): 390-396
Published online Sep 27, 2020. doi: 10.4240/wjgs.v12.i9.390
Predictive significance of cancer related-inflammatory markers in locally advanced rectal cancer
Kitinat Timudom, Thawatchai Akaraviputh, Vitoon Chinswangwatanakul, Ananya Pongpaibul, Pornpim Korpraphong, Janjira Petsuksiri, Suthinee Ithimakin, Atthaphorn Trakarnsanga
Kitinat Timudom, Thawatchai Akaraviputh, Vitoon Chinswangwatanakul, Atthaphorn Trakarnsanga, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Ananya Pongpaibul, Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Pornpim Korpraphong, Janjira Petsuksiri, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Suthinee Ithimakin, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Author contributions: Trakarnsanga A was involved in the conceptualization, project administration, writing review and editing; Timudom K was involved in data curation, and writing the original draft; Akaraviputh T, Pongpaibul A, Korpraphong P, Petsuksiri J, Ithimakin S and Chinswangwatanakul V were involved in writing review and editing; all authors read and approved the final manuscript.
Institutional review board statement: This study was approved by Siriraj’s institutional review board committee and the committee’s reference number is 335/2561(EC4).
Informed consent statement: All patient information is de-identified.
Conflict-of-interest statement: The authors declare that they have no competing interests
Data sharing statement: The dataset utilized during the current study is available within the institutional collected data system which was used under Siriraj’s institutional review board committee approval for this study. Data are available upon reasonable request with permission of Siriraj’s institutional review board committee.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Atthaphorn Trakarnsanga, MD, Associated Professor, Department of Surgery, Faculty of Medicine, Siriraj Hospital, 2 Prannok, Bangkoknoi, Bangkok 10700, Thailand. atthaphorn.tra@mahidol.ac.th
Received: February 27, 2020
Peer-review started: February 27, 2020
First decision: April 22, 2020
Revised: May 11, 2020
Accepted: August 16, 2020
Article in press: August 16, 2020
Published online: September 27, 2020
Abstract
BACKGROUND

Locally advanced rectal cancer is treated using neoadjuvant chemoradiation (nCRT), followed by total mesorectal excision (TME). Tumor regression and pathological post-treatment stage are prognostic for oncological outcomes. There is a significant correlation between markers representing cancer-related inflammation, including high neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) and unfavorable oncological outcomes. However, the predictive role of these markers on the effect of chemoradiation is unknown.

AIM

To evaluate the predictive roles of NLR, MLR, and PLR in patients with locally advanced rectal cancer receiving neoadjuvant chemoradiation.

METHODS

Patients (n = 111) with locally advanced rectal cancer who underwent nCRT followed by TME at the Minimally Invasive Surgery Unit, Siriraj Hospital between 2012 and 2018 were retrospectively analyzed. The associations between post-treatment pathological stages, neoadjuvant rectal (NAR) score and the pretreatment ratios of markers of inflammation (NLR, MLR, and PLR) were analyzed.

RESULTS

Clinical stages determined using computed tomography, magnetic resonance imaging, or both were T4 (n = 16), T3 (n = 94), and T2 (n = 1). The NAR scores were categorized as high (score > 16) in 23.4%, intermediate (score 8-16) in 41.4%, and low (score < 8) in 35.2%. The mean values of the NLR, PLR, and MLR correlated with pathological tumor staging (ypT) and the NAR score. The values of NLR, PLR and MLR were higher in patients with advanced pathological stage and high NAR scores, but not statistically significant.

CONCLUSION

In patients with locally advanced rectal cancer, pretreatment NLR, MLR and PLR are higher in those with advanced pathological stage but the differences are not significantly different.

Keywords: Locally advanced rectal cancer, Cancer-related inflammatory markers, Neoadjuvant chemoradiation, Neutrophil-to-lymphocyte ratio, Monocyte-to-lymphocyte ratio, Platelet-to-lymphocyte ratio

Core Tip: Previously, correlations between markers representing cancer-related inflammation, including high neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) and unfavorable oncological outcomes have been reported. The present study demonstrated the predictive role of these markers in patients with locally advanced rectal cancer. Pretreatment NLR, MLR, and PLR were higher in those with advanced pathological stage and high neoadjuvant rectal score, and represented a poor outcome.