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Association of neutrophil-to-lymphocyte ratio, radiotherapy fractionation/technique, and risk of development of distant metastasis among patients with locally advanced rectal cancer

 Gowoon Yang  ;  Jee Suk Chang  ;  Jeong Eun Choi  ;  Eun Sil Baek  ;  Seung-Seob Kim  ;  Hwa Kyung Byun  ;  Yeona Cho  ;  Woong Sub Koom  ;  Seung Yoon Yang  ;  Byung Soh Min  ;  Sang Joon Shin 
 RADIATION ONCOLOGY, Vol.17(1) : 100, 2022-05 
Journal Title
Issue Date
Chemoradiotherapy / methods ; Humans ; Lymphocytes / pathology ; Neoadjuvant Therapy ; Neoplasm Staging ; Neutrophils* / pathology ; Rectal Neoplasms* / pathology ; Retrospective Studies
Distant metastasis-free survival ; Lymphocyte ; Neutrophil ; Poor outcome ; Rectal neoplasm
Background: We investigated the prognostic impact of the neutrophil-to-lymphocyte ratio (NLR) in patients with locally advanced rectal cancer (LARC) and whether modifiable factors in radiotherapy (RT) influenced the NLR.

Methods: Data of 1386 patients who were treated with neoadjuvant RT and concurrent or sequential chemotherapy for LARC between 2006 and 2019 were evaluated. Most patients (97.8%) were treated with long-course RT (LCRT; 50-50.4 Gy in 25-28 fractions) using three-dimensional conformal radiotherapy (3D-CRT) (n = 851) or helical tomotherapy (n = 504), and 30 patients underwent short-course RT (SCRT; 25 Gy in 5 fractions, followed by XELOX administration for 6 weeks). Absolute neutrophil and lymphocyte counts were obtained at initial diagnosis, before and during the preoperative RT course, and after preoperative concurrent chemoradiotherapy. The primary endpoint was distant metastasis-free survival (DMFS).

Results: The median follow-up time was 61.3 (4.1-173.7) months; the 5-year DMFS was 80.1% and was significantly associated with the NLR after RT but not before. A post-RT NLR ≥ 4 independently correlated with worse DMFS (hazard ratio, 1.42; 95% confidence interval, 1.12-1.80), along with higher ypT and ypN stages. Post-RT NLR (≥ 4) more frequently increased following LCRT (vs. SCRT, odds ratio [OR] 2.77, p = 0.012) or helical tomotherapy (vs. 3D-CRT, OR 1.29, p < 0.001).

Conclusions: Increased NLR after neoadjuvant RT is associated with increased distant metastasis risk and poor survival outcome in patients with LARC. Moreover, high NLR following RT is directly related to RT fractionation, delivery modality, and tumor characteristics. These results are hypothesis-generating only, and confirmatory studies are required.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Koom, Woong Sub(금웅섭) ORCID logo https://orcid.org/0000-0002-9435-7750
Kim, Seung-seob(김승섭) ORCID logo https://orcid.org/0000-0001-6071-306X
Min, Byung Soh(민병소) ORCID logo https://orcid.org/0000-0003-0180-8565
Byun, Hwa Kyung(변화경) ORCID logo https://orcid.org/0000-0002-8964-6275
Shin, Sang Joon(신상준) ORCID logo https://orcid.org/0000-0001-5350-7241
Yang, Gowoon(양고운)
Chang, Jee Suk(장지석) ORCID logo https://orcid.org/0000-0001-7685-3382
Cho, Yeona(조연아) ORCID logo https://orcid.org/0000-0002-1202-0880
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