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CC BY 4.0 · Journal of Coloproctology 2024; 44(S 01): S1-S138
DOI: 10.1055/s-0045-1808866
Câncer do Cólon/Reto/Ânus
Colon/Rectum/Anus Cancer
ID – 141702
Open Topics (oral presentation)

PREDICTION OF RESPONSE TO NEOADJUVANT THERAPY FOR RECTAL CANCER BASED ON INFLAMMATORY MARKERS IN PERIPHERAL BLOOD

Roger Beltrati Coser
1   Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
,
Caio Sergio Rizkallah Nahas
2   Instituto do Câncer do Estado de São Paulo, São Paulo, Brasil
,
Omar Sayed Taddeo Ghani
1   Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
,
Rafaela Brito Bezerra Pinheiro
2   Instituto do Câncer do Estado de São Paulo, São Paulo, Brasil
,
Artur de Souza Almeida
1   Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
,
Sergio Carlos Nahas
1   Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
,
Carlos Frederico Sparapan Marques
2   Instituto do Câncer do Estado de São Paulo, São Paulo, Brasil
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    Introduction Rectal cancer treatment is complex, multimodal, and associated with high morbidity. It is known that patients undergoing neoadjuvant chemoradiotherapy (nQRT) present varying degrees of tumor response, ranging from no response to complete response (CR). There is great interest in studying tools that can identify these patients (responders and non-responders). Among the numerous markers being studied, peripheral blood inflammatory markers stand out, such as the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), and the lymphocyte-to-monocyte ratio (LMR), based on the close relationship between inflammation and cancer.

    Objective To study the relationship between systemic inflammatory response markers (NLR, PLR, and LMR) and the degrees of response to neoadjuvant treatment in patients with rectal cancer, according to the TRG classification.

    Methods A retrospective evaluation was conducted on 396 patients from a single institution with rectal cancer who underwent nQRT. The evaluation involved clinical, laboratory, and pathological data. NLR, PLR, and LMR were calculated based on pre-nQRT hemogram data of the patients. Patients were stratified by tumor response (TRG) to nQRT based on the protocol of the American College of Pathologists.

    Results Patients with incomplete response (TRG 1-2-3) had higher levels of NLR (p<0.001), PLR (p=0.002), and CEA (p<0.001). Patients with complete response (TRG 0) had a higher number of comorbidities (p=0.001), higher hemoglobin levels (p=0.049), higher LMR (p<0.001), and more frequent use of antihypertensive medication (p=0.012) and antiplatelet/anticoagulant drugs (p=0.045). To estimate incomplete response: NLR > 2.08 - RR: 2.30 (95% CI: 1.60-3.31); PLR > 129.36 - RR: 1.79 (95% CI: 1.25-2.05) and LMR > 2.67 - RR: 0.42 (95% CI: 0.26-0.66). In the multifactorial linear model, NLR > 2.08 was independently associated with the absence of CR, RR: 1.19 (95% CI: 1.07-1.28), p=0.001, with an area under the curve (AUC) of 0.659 (95% CI: 0.599-0.718).

    Conclusion NLR, PLR, and LMR are predictors of response to nQRT in patients with rectal cancer. NLR greater than 2.08 is a predictive factor for incomplete pathological response to nQRT. These findings add a low-cost and widely available tool to the management of rectal cancer, with a focus on treatment individualization.


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    No conflict of interest has been declared by the author(s).

    Publication History

    Article published online:
    25 April 2025

    © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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