The Pretreatment Systemic Inflammatory Response is an Important Determinant of Poor Pathologic Response for Patients Undergoing Neoadjuvant Therapy for Rectal Cancer
| العنوان: | The Pretreatment Systemic Inflammatory Response is an Important Determinant of Poor Pathologic Response for Patients Undergoing Neoadjuvant Therapy for Rectal Cancer |
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| المؤلفون: | Ashita Waterston, Stephen T. McSorley, Stephan Dreyer, Donald C. McMillan, James J. Going, Joanne Edwards, Paul G. Horgan, Arfon Powell |
| المصدر: | Annals of Surgical Oncology |
| بيانات النشر: | Springer International Publishing, 2016. |
| سنة النشر: | 2016 |
| مصطلحات موضوعية: | Adult, Male, medicine.medical_specialty, Colorectal cancer, Neutrophils, medicine.medical_treatment, Adenocarcinoma, Gastroenterology, 03 medical and health sciences, Hemoglobins, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Humans, Lymphocyte Count, Lymphocytes, Survival rate, Neoadjuvant therapy, Serum Albumin, Aged, Neoplasm Staging, Colorectal Cancer, Aged, 80 and over, Inflammation, business.industry, Platelet Count, Rectal Neoplasms, Cancer, Odds ratio, Chemoradiotherapy, Adjuvant, Middle Aged, medicine.disease, Prognosis, R1, Total mesorectal excision, Neoadjuvant Therapy, Surgery, Radiation therapy, C-Reactive Protein, Oncology, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Female, business, Radiology, Chemoradiotherapy |
| الوصف: | Background\ud \ud Not all patients respond equally to neoadjuvant chemoradiotherapy (nCRT), with subsequent effects on survival. The systemic inflammatory response has been shown to predict long-term outcomes in colorectal cancer. The current study examined the association between systemic inflammation and nCRT in patients with rectal cancer.\ud \ud \ud Methods\ud \ud Between 1999 and 2010, patients who underwent nCRT were identified. Serum measurements of hemoglobin, C-reactive protein, albumin, modified Glasgow prognostic score (mGPS), and differential white cell counts were obtained before and after nCRT. The Rödel scoring system measured pathologic tumor regression, and magnetic resonance imaging and computed tomography determined radiologic staging.\ud \ud Results\ud \ud The study included 79 patients. Of these patients, 37% were radiologically downstaged, and 44% were categorized as showing a good pathologic response (Rödel scores 3 and 4). As a validated measure of the systemic inflammatory response, mGPS (P = 0.022) was associated with a poor pathologic response to nCRT. A radiologic response was associated with a good pathologic response to treatment (P = 0.003). A binary logistic regression model identified mGPS (odds ratio [OR] 0.27; 95% confidence interval [CI] 0.07–0.96; P = 0.043) and radiologic response (OR 0.43; 95% CI 0.18–0.99; P = 0.048) as strong independent predictors of a pathologic response to treatment.\ud \ud \ud \ud Conclusion\ud \ud The current study showed that a systemic inflammatory response before nCRT is associated with a poor pathologic response. Further study in a prospective controlled trial setting is warranted.\ud \ud \ud \ud Stephan B. Dreyer and Arfon G. M. T. Powell—contributed equally.\ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud \ud Colorectal cancer (CRC) is the third most common cancer and the second highest cause of cancer death in the United Kingdom.1 The 5-year survival rate for CRC still is less than 60% with surgery alone, offering the only chance of cure.\ud \ud Rectal cancers comprise about one third of surgical resections for colorectal cancer.2 The widely adapted surgical technique of total mesorectal excision (TME), increased centralization, specialization of rectal surgery, and earlier disease detection have led to improved survival in the last 30 years.3,4 Preoperative neoadjuvant radiotherapy with or without chemotherapy currently is accepted as a standard of care for patients with margin-threatening rectal cancer. This increases disease-free survival (DFS) and sphincter preservation rates and improves circumferential resection margins and local recurrence rates.5–8\ud \ud Current management of CRC in the United Kingdom involves evaluating patients using magnetic resonance imaging (MRI) and computed tomography (CT) before treatment to identify those with margin-threatening disease (T3 or T4).9 These patients are offered neoadjuvant chemoradiotherapy (nCRT) before surgical resection.10\ud \ud Not all patients respond to nCRT, and there is a need to identify biomarkers of response because treatment is associated with significant morbidity. Rödel et al.11 have shown that the presence of spontaneous apoptosis in the resected specimen is a good marker of tumor regression and improved prognosis.\ud \ud The prognostic value of the systemic inflammatory response (SIR) has been widely studied in gastrointestinal cancers, particularly in the operative setting, using measurements of circulating markers including C-reactive protein (CRP), albumin, the modified Glasgow prognostic score (mGPS), the neutrophil lympocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), and more recently, the neutrophil-platelet score (NPS) and the derived neutrophil-to-lymphocyte ratio (dNLR).12–16\ud \ud This study investigated the association between markers of the systemic inflammatory response and the pathologic response to nCRT in patients with rectal cancer. |
| وصف الملف: | application/pdf |
| اللغة: | English |
| تدمد: | 1534-4681 1068-9265 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::8ef0c4887c87ca9b4ec901222835aeabTest http://europepmc.org/articles/PMC5374176Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....8ef0c4887c87ca9b4ec901222835aeab |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15344681 10689265 |
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